[Question #753] STD Testing Results

53 months ago
Hello, I had unprotected vaginal and oral sex with somebody I met at a bar one evening in a very stupid decision. At 6 weeks post exposure I got tested for HIV, Syphillis, HSV 1/2, Hepatitis B and C. Three weeks post exposure I was tested for Chlamydia and Gonnorhea. All tests came back negative. The tests administered are below. My question is how accurate are these tests at those time frames? The only symptoms I have had are my penis head seems slightly red, and I'm getting a lot of dribble after I urinate or atleast more than I usually would. Also very very mild discomfort on the right side of my upper groin/lower abdomen area and my tongue has stayed white with bright red dots. I've lost about 6-7 lbs which has me worrying as well. I should also mention that at the 3 week mark following exposure I went to the doctor and they found a small amount of bacteria in my urine and put me on ciprofloxacin for 10 days. Any help or insight would be greatly appreciated as I'm pretty anxious and worried. Thanks. 
HIV 1/2 antigen/antibody 4th generation with reflexes 
HSV 1/2 IGG Herpselect AB 
HB S AG with reflex conf 
RPR with Titer and Conf RFX-RPR screen 
Hepatitis C antibody with reflex to HCV, RNA, Quant,RT-PCR 
Chlamydia Trachomatis RNA, TMA 
Neisseria Gonorrhea RNA, TMA

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome to the forum. Thanks for your question.

In general, such exposures are indeed high risk, because the STD frequency in people inclined to hook up with others on short notice in bars etc. That said, most such persons are not actively infected; and when they are, STDs are generally not transmitted with high efficiency. That is, most exposures to infected partners don't result in transmission -- although this varies a lot from one STD to the next.

In any case, you were smart to be tested -- although some of your tests were unnecessary in my opinion. The times to reliable results are 3-4 days for chlamydia and gonorrhea RNA testing; 4 weeks for HIV 4th generation tests; and 6 weeks for syphilis and hepatitis B. Hep C is not an STD in heterosexuals, despite what you have read and I wouldn't have recommended it -- but the negative result at 6 weeks is conclusive. However, the HSV test was too early; it takes 12-16 weeks for conclusively negative results. OTOH, the chance of herpes from any single exposure was under 1 in 1,000 and I would not have recommended that one either.  But if you feel you must have a conclusive test result, you'll need to repeat it at 4 months after the event.

Finding "a few bacteria" in the urine is not abnormal and I would not have recommended ciprofloxacin -- which in any case is ineffective against some STDs and unreliable for others. It's never used for STD management. But it probably did no harm. As for your symptoms, no STD causes any of the symptoms you mention (altered color of penile skin, urinary dribbling, groin discomfort, altered appearince of the tongue, etc). Many if not all these almost certainly are related to anxiety, not infection. Same for the weight loss. In any case, the test results are definitive and for sure you have none of the infections for which you were tested.

If any symptoms continue to concern you, see a physician. But I'm confident none are related to any infection from your adventurous night in the bar; any link to that event almost certainly is psychological.

I hope this has helped. Best wishes--  HHH, MD

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53 months ago
Thanks so much Dr. for your quick response. I was very nervous and was tested for all of the tests I mentioned at 1 week, 3 weeks, and 6 weeks (except chlamydia and  gonorhea which I only tested at 1 and 3 weeks). I received negative results for each every time. I did want to ask your opinion on other less known stds,  such as Trichomaniasis and Mycoplasma Genitalium. Do you recommend getting tested for those? I have a regular partner who I would like to become sexually active with again but have held off over concerns from my egregious decision 2 months ago. The last thing I would want to do is pass anything on.  Any thoughts on some of the lesser known std s I could have got would be greatly appreciated.  Lastly, I know men cannot be tested for HPV, but how long is the average time it would take for any genital warts or lesions to appear due to HPV infection?  Once again, thanks for the timeliness of your response. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Trichomonas is a trivial infeciton that rarely if ever does harm; rarely causes symptoms at all in men; and clears up on its own (in men). M. genitalium is a bit controversial, with unclear knowledge about whether it ever causes serious health problems. (There is good reason that there are no commercial tests in the US and CDC and other experts don't recommend testing asymptomatic people for it.) In any case, the chance of catching probably is very low from any single exposure.

HPV generally remains asymptomatic; is equally common in people with few or many sex partners; and when it appears (e.g. an abnormal pap smear) it can never be traced to a particular partner or exposure. And there's nothing to be done for it at this point anyway. Genital warts are rare after any single exposure and if they develop, typically show up 3-12 months after catching HPV. 

If I were somehow in your situation, I would have resumed unprotected sex with my wife as soon as I had the negative gonorreha and chlamydia results, which I would have done at about 1 week, as you did. And certainly I recommend you resume sex at home now.
 
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53 months ago
Thanks Dr. I appreciate your insight. My last question for you is if any of your advice changes if my usual partner is pregnant. It has added on to obvious anxiety as we did have sex briefly one time in the shower yesterday and she later she informed me she was 11 weeks pregnant. Also, because this unprotected sexual encounter I had back in March with an unknown person was only my second partner ever are my chances lower? Your reassurance on my previous tests and extremely unlikely chance of HSV or HPV was helpful. Thanks again for answering my questions and for providing this service. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Of course the risk of any particular exposure depends on that exposure alone, not whether it is someones second, twelfth, or two thousandth exposure, so that part makes no difference one way or the other.  Your wife's pregnancy doesn't change the low chance you were infected during the exposure described. And your test results remain valid, and included the main STDs that might be particular concerns for pregnant women. 

I'm glad to have helped and hope these final comments give you some final reassurance. Best wishes for you and your growing family.

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