[Question #7601] Information needed

1 months ago
Hello dear doctors ,
I am a male 42 from Romania , and back in November 5th  2020 in one nigh , i had an  protected vaginal contact, anprotected fellatio and an unprotected cunilingus ( 5 min or so)with a female sex worker - i don't know her STD status.
Since than i had some symptomps. After 3 weeks sore throat, fatigue,  nausea and bladder and urethral pain and frequent urination no fever no swollen lymph nodes. On 1st of December I was diagnosed by a urologist    ( ultrasound analysis) with chronic prostatitis ( under treatment since then)
On December 14 - PCR test; DNA for Chlamydia, Ureaplasma, Mycoplasma hominis, Mycoplasma genitalium, Trichomonas and Gonorrhoeae - negative; Gardnerella Vaginalis - positive ( 7 days - 2x500 mg of Metronidazole)
71 days after exposure;
Ab/Ag HIV Combo ( CMIA serum) - negative
hepatitis B - AgHBs ( CMIA serum) - negative
hepatitis C - HCV ( CMIA - serum) - negative
RPR - serum (syphilis) - negative.
1. Are these results  100% conclusive for HIV1 /2, hep B, Hep C, and syphilis. Do I need more tests or am i ok and how reliable is AB/AG Combo CMIA test for HIV?
2. What are the chances of contacting an oral HPV or an oral or genital HSV2 because I have oral HSV1 since childhood? since exposure i had 2 herpes in two different periods on the upper lip.
3. What are the chances of contacting oral Gonorrhoeae or Chlamydya - No symptomps untill now.
Dear doctors, I lived moments of terrible anxiety on sleepless nights and I lost 7 kilograms,Now I follow a psychological counseling. It was the only mistake in 20 years of marriage. Do you think it,safe to continue my normal unprotected sex life with my wife?
Thanks a lot and hope to hear from you soon.


Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
Welcome to our Forum and thanks for your questions.  I’ll be glad to comment.  Before I get to your specific questions let me state that the exposures you describe were quite low risk.  Most commercial sex workers do not have STIs and even when they do, most exposures do not result in infection.  Furthermore, different sex acts have different risks for acquisition of infection even if a partner is infected.  In your case, condom-protected genital contact, receipt of fellatio, and performance of cunnilingus very, very lead to infection.  Thus even before testing, it was unlikely that you would acquire an STI.  Your tests prove that you did not.  With regard to your specific questions 
:
1.  Your results from December 14, 71 days following the encounter are all conclusive and rule out each of the infections tests for including HIV 1/2, hepatitis B and C, and Syphilis.  The tests are highly reliable and do not need to be repeated related to the exposure you describe.
2.  Your risk for acquisition of herpes is virtually zero.  You prior HSV-1 means you will not acquire it at a different site and HSV-2 almost never causes oral infection.  As for HPV, the risk of any single exposure leading to infection is quite low.
3.  Believe your test results for Gonorrhea and chlamydia.  No additional testing is needed.

While I understand your concern and guilt over your misstep, I can say with great confidence that it did not result in acquisition of an STI.  I hope this assessment is helpful. EWH 
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1 months ago
Hello again dear Sir,
Thank you very much for your prompt and reliable response.
The only contact unprotected was the cunillingus. 
I forgot to mention that she also made a hand job  on my penis condomless. I presume this is rik free. Am I correct or do you think otherway?
Is there a risk that HSV 2 will exist in the oral cavity or pass it on to my wife or even spread to the genital area ,mine or hers?
The Gonorrhea and chlamydia was tested only on the secretions from the urethra and prostate, and the receipt of fellatio was condom protected. I was wondering about oral infection. Is there a risk becasue i understand there are no symptoms and i performed cunillingus? I also forgot to mention that after 1 week after exposure  I took 7 days Cefuroxime 2x 500 mg, then 1 g Azithromycin and 400 mg Cefixime single dose and after that from December 7 I took 14 days doxycycline 2x100 mg (doxycycline for prostatitis). That woul be  enough to treat orala gonorrhea or chlamidya?
Regarding HPV  i am very concerned about it . Are there specific oral symptoms or can it move to the genital area?Is there a specific test that needs to be done and when?
And for Gardnerella Vaginalis - 7 days - 2x500 mg of Metronidazole , Do you think that's enough?
And the last question. Is there any possibility of contacting cytomegalovirus from my exposure
Thank you very much and I look forward to your reply.
Best regards !!!

Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago

Thanks for the additional information.  Lots of follow-up questions.  None of which change my assessment or recommendations.

No risk from receipt of masturbation.

The combination of cefuroxime and azithromycin would have cured gonorrhea and chlamydial infection, if present.  The doxycycline would have cured chlamydia a well Even in the mouth.  Your tests prove there was no genital infection.

Oral HSV-2.  See reply 2 above. HSV-2 virtually never causes oral infection.  I would not worry about this.  There is nothing to suggest you acquired oral HSV-2.

There are no symptoms for oral HPV infection.  Your risk from cunnilingus is low.  By age 42, statistically you already have had HPV from distant partners.  There is no recommended test for HPV in men or at the oral site.  I would not worry about HPV.

Gardnerella is normal bacteria in men and typically does not required treatment.  Your Gardnerella did not need treatment.  If it were going to be treated, the metronidazole you took is the recommended therapy.

CMV infection is not a concern in your situation.

Once again, I urge you to set aside your fears of STI and move forward without concern.  You are overthinking your risk out of guilt.  Deal with your guilt.  STIs from your misstep are not a concern.  EWH

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1 months ago
Hello again dear Sir,
Thank you very much for your prompt and reliable response.
I do not want to be repetitive because I know that the site policy does not allow but to be able to conclude and be sure I would need an answer to the following:
1. Is Ab/Ag HIV Combo ( CMIA serum) - negative 100 % conclusive at 10 weeks because CDC and WHO recommend retest at 90 days to be 100% sure? Is there any possibility that a negative test at 10 weeks will become positive at 12 weeks, has there ever been a case?
2. Is hepatitis B - AgHBs ( CMIA serum) - negative 100 % conclusive at 10 weeks because some experts/doctors recommend retest at 6 month?
3. Is hepatitis C - HCV ( CMIA - serum) - negative 100 % conclusive at 10 weeks?
4. Although you said that the presence of gardnerella is normal in men, do you think that there was any possibility that it was contacted through cunillingus and transferred to the prostate?

In the end thank you for the answers, support and encouragement and it was an honor for me to talk to an international expert!
Best regards !!!

1 months ago
With the necessary apologies, I wanted to know if the test done for syphilis is 100% conclusive also??
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago

Straight to your questions:

1. Is Ab/Ag HIV Combo ( CMIA serum) - negative 100 % conclusive at 10 weeks because CDC and WHO recommend retest at 90 days to be 100% sure? Is there any possibility that a negative test at 10 weeks will become positive at 12 weeks, has there ever been a case?
Organizations such as CDC and WHO are traditionally conservative in their recommendations.  Current opinion by experts and even some of the most recent recommendations will state that the results of 4th generation HIV antigen/antibody tests, including CMIA assays) are conclusive 6 weeks after exposure in persons who are not taking PEP or PrEP and more than 99% conclusive at 4 weeks.  I have never seen or heard of a person who took more than 6 weeks to become positive or in whom at 6 week result went on to become positive later.  Believe your test results.

2. Is hepatitis B - AgHBs ( CMIA serum) - negative 100 % conclusive at 10 weeks because some experts/doctors recommend retest at 6 month?
The exerts who suggest testing for hepatitis after more than 6 moths are being overly conservative.  Believe your results.

3. Is hepatitis C - HCV ( CMIA - serum) - negative 100 % conclusive at 10 weeks?
Same answer as for 2 above.

4. Although you said that the presence of gardnerella is normal in men, do you think that there was any possibility that it was contacted through cunillingus and transferred to the prostate?
No, this is not a biologically plausible suggestion.  Infections in the throat do NOT migrate to other sites such as the prostate.

Your 10 week-71 day syphilis results are totally conclusive and prove that you did not acquire syphilis through the exposure you described either.

As you know, with this third reply, this thread is complete and will be closed shortly without further replies.  Take care. Please don't worry.  EWH
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1 months ago
Thank you very much !!!

So after all that said I think I can continue my life with my wife without worrying about any STI?!?