[Question #7670] STD Testing Guidance

1 months ago
Hi Doctors,

thanks so much for you help here... I am glad to finally get some feedback/advice.

Here it is:

A few weeks ago, I had two incidents:
22nd Jan vaginal sex with a CSW I know quite well (csw1)
23rd Jan vaginal sex with CSW I do now know. (csw2)
both times with a condom.

on the 3rd Fed I had sex again with CSW1 - again with a condom.
I became a little concerned about these incidents (I have a long-term partner) and tested on the 4th Feb along with CSW1 who I convinced to come with me. We both tested negative for everything.

On the 11th Feb (8 days after my last encounter with CSW1) I did another test for bacterial infections which was negative.

A few days after, I started to feel some discomfort which tends to follow any urination. It's not a burning per se (I had this with a UTI recently, and this is certainly not as painful) It is a lighter feeling, very hard to describe but not based around the urethra from what i can tell.

My questions are:

- Do I have anything to worry about?
- Was my last test (8 days post) sufficient time to get a good and reliable result? Here in the UK, they often talk about 14 days and I tested quite a bit earlier. I know there is some talk of 4-5 days, but does that apply to tests in the UK too?
- Do my 'symptoms' sound realistic/reasonable?
- Should I re-test?

I have since had unprotected sex with my partner, so I am quite worried now..

Many Thanks

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
Welcome to the forum. Thanks for your confidence in our services.

You descbie a pretty risky lifestyle from an STD standpoint -- even with consistent condom use. You are right to be concerned about your regular partner and her STD risk.

I suspect you've already had an STD:  non-STD UTIs are rare in men under 40 (you don't say your age, I'm just guessing) -- in younger men, a high proportion of apparent UTIs in fact are urethritis, i.e. gonorrhea, chlamydia, or nongonococcal urethritis (NGU). Whatever the cause, what does "recently"mean in terms of timing? How was it diagnosed, and was it manged by your GP or a GUM clinic? How was it treated? What was the timing of that infection in relation to your various sexual exposures, condom use (including your regular partner), and so on?

Did our sexual exposures include oral or anal sex in addition to vaginal? Protected or unprotected? Are you confident the condoms were used correctly and properly?

What sort of testing was done 11 February for "bacterial infections"? Urine culture for bacterial UTI? Gonorrhea? Chlamydia? Other, including Mycoplasma genitalium and/or trichomonas?

Another factor that's worth considering is that when one member of a couple finds a need for other sexual experiences, often the other has done so as well. Are you confident your partner has had no othe rpartners recently.

All these are issues that would come up routinely if you had been in my STD clinic. There's a lot here and the overall istuation is potentially omplex. I may be able to answer your specific questions better if you'll fill in some of the missing details I've asked about. But most likely the next best step would be a visit to an NHS GUM clinic (or a private sexual health service, such as London's Freedom Health Clinic), holding off on all sex until that has been done.

Looking forward to hearing more and perhaps being able to help.

1 months ago
Hi Doctor,

Thanks for coming back to me so soon. I really appreciate it.

Apologies - the UTI I describe was never diagnosed. without being too crass, I believe it was related to my having used a really harsh soap when cleaning my penis after sex one day. It was really uncomfortable for a few days and I even tested for gon/chlam but received a negative.

I have never otherwise had an STI.

With respect to the exposures in my below question. Both were fully protected, no oral/anal. Simply condom protected vaginal sex.

In both instances, the condom appeared to remain intact. I am already a little sensitive to this so usually check the condom after to ensure it is ok (on properly, no slippage, no leaks, no breaks etc. As a result, I do not rush them off, but take my time to do it myself and inspect a little bit.

The test on the 11th was a urine test for gon/chlam at an NHS testing facility in London at 8 days after the latest exposure, but 18/19 from the first two.

I appreciate what you say about my partner. You are right, I cannot know for sure.

I thought I would be safe to resume as the CSW1 tested negative 11 days after my first and 1 day after my last encounter with her, as well my negative an additional 8 days after that.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
Thanks for the clarifications. It's good to hear how careful you are to limit STD/HIV risk with your non-regular partners.

Soap is highly irritating to the urethra; by itself it can cause significant pain, as you found. Probably you had no infection at all, just chemical irritation from the soap. If you feel a need to wash afrer sex, superficial liight washing with a mild soap, taking care not to get soap inside the urethra, is suffcient. (Washing after sex probably doesn't reduce infecion risk -- and in fact one study many years ago suggested that vigororous or harsh washing after sex actually increased HIV irsk.)

The urine gonorrhea/chlamydia tests were conclusive; the second test was superfluous (but of course not harmful).

With these additional details, I agree there is little chance you are putting your regular partner at risk for HIV or other STDs. But that risk is not zero, especilly for those infections transmitted primarily by skin contact, rather than fluids -- i.e. syphilis, HPV, and herpes. But as long as you have occasional syphilis blood tests that remain negative and have no symptoms to suggest genital herpes or HPV, these risks also will remain low.
1 months ago
Thank you very much and apologies for my lack of accuracy originally.

Apologies for being pedantic,  just want to put this to bed so want to be clear:

1. Are you saying my first test, which was only 24 hours after protected sex with her was conclusive? If so, is this because of her test? Do you think that I could safely rely on her negative test as - although a day after our encounter - is highly probative of her not having an infection? D=Are there any concerns about the fact that there is still a small window which her test would not cover - again, given her profession?

In my mind, the first two encounters are largely irrelevant as I tested 19 days after, so have nothing to worry about. It is really the latest that I am concerned about. Another possible point of clarification: CSW1, with whom I had two encounters. I have known her for almost 4 years now (I have even met her son). We are really good friends in fact and so whilst I generally have reason to trust when she says she is clean and careful, I also didn't want to downplay the risks associated with her profession.

2. I note you usually tell people 4-5 days, does this guidance apply for tests used here in the UK? and if so, irrespective of whether it is a private or a public healthcare center? Also, why is there such a difference in the timelines given by the NHS? Are they being safe? Are they behind the times?

Is it the case that, irrespective of the risk - for example, if we had engaged in protected anal sex, unprotected oral, unprotected anal, at 5 days I could still rule out these STDs? or is this approach risk-weighted?

3. I am trying to contextualize this (and suspect that others will do as I did, read a ton of these threads) - how risky is this encounter? If we use a condom and are reasonable careful about them having not broken (assuming they are so blindingly obvious when they break), could we be comfortable about not having been at risk for the main STDs?

Thanks again so much, conscious this might be my last interaction. I just want to say just how much the work you do is appreciated. Years ago I went through a really dark spell related to HIV and I honestly cannot emphasize how much your words meant to me - eben though they were to for me. I read older threads on MH by yourself and Dr Hook and to say it might have saved my mental health is not an exaggeration. God bless you both. Truly.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
1 months ago
1,2) You say above that your first test was 8 days after a sexual exposure, not one day. One day would be too soon. There has never been careful research on the time required to reach maximum detection of gonorrhea or chlamydia, but almost certainly 4-5 days is sufficient -- maybe only 2 days for gonorrhea, but chlamydia is slower growing. The tests are the same technology world wide; no reason to assume any difference between London and anywhere else.

3) You should assume that every encounter with a sex worker (or any other partner other than your main relationship) carries a certain amount of risk. I have no way of judging any one of them versus others, and you probably should not assume there is any difference. Rather than testing after every encounter other than your main relationship, a smarter strategy would be to plan on regular testing at say 3 or 6 month intervals. Assuming of course you have no symptoms; in the event of symptoms that suggest STD, of course get tested at that time.

Thanks for the thanks and your kind words about our services; I'm glad we have helped. However, please note that repeated questions on the same topic are discouraged. Your two discussions probably have all the information you will need to self-assesss your risks and interpret your test results in the event of additional similar sexual encounters and test results.

Best wishes and stay safe.