[Question #7374] Chlamidya confusion

57 months ago

Hi Doc. I had a massage from a reasonably high risk prostitute. She proceeded to sit on top of me and perform heavy frottage with her vagina/labia. I DID NOT penetrate her but she actually made me orgasm with rubbing my exposed penis up and down with a very wet vagina. There was definitely lots of vaginal fluids on my penis shaft and head(my penis was definitely exposed to lots of vaginal fluids). This mixed with massage oil. About 2 to 3 days later I took Zithromax but I took 500mg a day for 4 days just in case. I never had any symptoms but out of paranoia 5 weeks later I ordered a home test kit for chlamidya from a company that is produced in Singapore. The control line changed color and eventually after about 3 to 5 mins the test line appeared extremely faintly. I was surprised because most home tests for stds turn positive quite quickly, almost at the same time the control line turns positive. I was quite shocked because I read frottage even with fluid is relatively low risk and taking antibiotics a few days later might have helped. After the home test I then took 1gram Azithromyzin but stupidly had sex with my wife 3 and half days later. I know you should wait 7 days. Questions.

1. Do you think I could have contracted chlamidya with that type of exposure or maybe the home test failed.

2. Would the 4 x 500mg zithromax pills have helped to abort any infection even if i took it about 3 days later? Do u think the pills should have worked?

3. Is it possible the home test was wrong and the faint line was an evaporation line? Combined with the fact I didn't penetrate and I took precautionary zithromax.

4. If I was in fact positive what are the chances that the other 1 gram azithromyzin could clear the infection in 3 and a half days before having sex with my wife?

The test i bought did look cheap and along with is was a gonnarea test that failed and didn't show any lines at all.

https://www.jalmedical.com/products/std-rapid-screen-test/

Thanks for you help

H. Hunter Handsfield, MD

57 months ago

Welcome to the forum. Thanks for your confidence in our services.

You had a very low risk exposure in regard to STDs. With substantial vaginal fluid exposure on your ujnprotected penis, there could have been very slight risk for chlamydia, but too low to be treated: I would have recommended against the azithromycin. (And your "just in case" comment is nonsense. The recommended single 1 g dose is plenty; there is no increased effectiveness of the higher dose you took. And then you went ahead and took another 1 gram dose?

The rapid chlamydia tests are useless. STD experts never use or recommend them. Your weakly positive result almost certainly was false. Even a strongly positive result would not have been reliable, however. Medical science has yet to devise an accurate rapid test for chlamydia. Same for gonorrhea -- that negative result was unreliable. However, absence of symptoms (painful urethral discharge) is almost 100% proof against gonorrhea.

1. All things considered, there is no possibility you have chlamydia at this point and probably never did. Stop testing, stop worrying, and continue sex withour regualr partner without worry.

2. See above. This dose of azithromycin has never been studied, but probably would work.

3. See above about the rapid test.

4. If you had been infected, azithro would have aborted infectivity within 4 days.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

---

57 months ago

Thank you Doc. I really did believe those tests were rubbish.

Just to clear things up. I didn't know what the correct dosage was so I organized a pack of 4 zithromax pills and took 1 a day for 4 days. This was about 60 hours after the exposure.

The only reason I took another 1gram dose 5 weeks later was because of that stupid positive rapid test. I panicked thinking the test was correct and by this time I had done my research and found out that the correct dosage is 1 gram once off.

1. I slept with my wife 3.5 days after the 1gram single dose I took 5 weeks after exposure after doing the rapid test. Do u still reckon all is good and neither of us were infected?

And last question.

2. I also did a biosure blood antibody home test for hiv 33 days after the exposure. Can I rule out HIV or must I test again at 42days(6 weeks?)

Thanks again. You have really put my mind at ease.

57 months ago

Sorry doc I might as well ask what was my risk of contracting HPV ?

H. Hunter Handsfield, MD

57 months ago

Thanks for the clarifications.

1) It is unlikely you ever had chlamydia. If you did, the first round of azithro probably would have cured it. (One other possibility for the borderline test is that you had been infected and cured. It can take up to 3 weeks for chlamydia tests to become negative after effective treatment. I don't think this is likely, given the low risk of the exposure and having had no symptoms. But theoretically it is possible.)

2) There's never been a report of sexually acquired HIV without penetration. In addition, in the US or western Europe, the chance any particular female sex worker has HIV is low, usually under one chance in a thousand. I would not have recommended HIV testing at all. But let's assume there was actually some very low risk, say one chance in a million. A third generation (antibody) test would pick up 95% of new HIV infection by 33 days. That 95% odds reduction means your current chance of having HIV is 1 in 20 million. I hope you would agree that is zero for all practical purposes.

3) First, who cares if you get HPV? Everybody gets it, you and your wife probably have been infected before and could be carrying HPV now. Getting and having genital HPV is a normal, expected, unavoidable consequence of having sex. That said, the chance of HPV infertion during any single exposure without penetration is very low, but I can't put a percentage number to it. If you or your wfe ever has an HPV issue, like an abnormal pap smear, there will be no basis to attribute it to the commercial sex event described above.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been useful.

---