[Question #7697] Asymptomatic transmission before testing

53 months ago

Hello. First I want to assure the good doctors of this forum that I believe my results and prior advice I received here. I hope this new question is acceptable, as I believe it is entirely new and deserves an entirely new response, despite it covering an old event.

To summarize, roughly 1.5 years ago I had a one-time unprotected vaginal encounter with a female outside of my monogamous relationship (foolish and wicked, I know, and I should have disclosed to you in my earlier posts). A week later I was diagnosed with mono, but since mono symptoms are exactly like HIV synonyms, I feared the worst.

Luckily, I tested for HIV several times and received a negative 4th gen test at 8 and 12 weeks respectively. Thus my worries were alleviated (thanks to you guys!) I also did a 10-test panel at 12 weeks (chlamydia, gonnorhea, hep, hsv, etc.) and was negative on all fronts. I believe these results!

However, before I fully understood my STI risks, I had resumed sexual activity with my girlfriend before I took this panel at 12 weeks. Now, my fear is that I passed chlamydia or some other asymptotic STI to her, but was unaware of it because my immune system hypothetically was able to clear it from me before my 10-panel test.

Neither I, nor her, have had symptoms resembling STIs, but again I now understand the common asymptomatic nature of many infections.

All of this is to say, however unlikely this perfect storm is, I feel obligated to confess to my girlfriend my encounter and have her tested just to ensure this nightmare scenario didn’t go down: that I passed an asymptomatic STI to her which wasn’t caught by my tests thanks to my immune system clearing it. I may confess either way, but don’t want her to freak out about infection if she doesn’t have to.

Please share your insights as to the likelihood of this scenario happening and any advice you may have for me..

Thank you.

53 months ago

Again, I am really sorry for overreacting to what you, in your expert opinion, believed to be a low risk situation.

However, if the above is at all possible, I feel a strong moral obligation to rectify. That is primarily the purpose of my question and need for clarification.

53 months ago

Only commenting again because my question says it has been updated 10 minutes ago but I am not seeing a response here.. Just want to make sure I didn't miss the doctor's response!

Edward W. Hook M.D.

53 months ago

Welcome back to the forum. I’m sorry the extraordinarily low possibility that you may have had an STI, irrespective of how small the chance, continues to cause you anxiety. My response will have two answers. One will relate to the science and the fax which make it extraordinarily unlikely that you have an STI that could be transmitted to your partner. The other will the other response will consider You are now long-standing and obviously very troublesome anxiety.

Is both Dr. Handsfield and I have indicated in the past. Your negative tests are very strong evidence that you do not have an STI. Please remember the following facts:

1. Most people do not have STI ‘s. It is statistically unlikely that your partner for your single out of relationship encounter had an STI.

2. Even when a person has unprotected sex with an infected partner, it is uncommon for that infection to be transmitted. Admittedly you appear to have acquired a mononucleosis like illness from the encounter you mentioned. For you have acquired another STI at the same time remains very unlikely.

3. You raise the possibility that you may have been asymptomatically infected and that that asymptomatic infection would have resolved in the interval between your encounter and being tested approximately 12 weeks later. Both of these scenarios are also unlikely. Current tests for STIs, even asymptomatic ones are among the most reliable tests in all of medicine.

4. Your partner has remained asymptomatic and you do not mention whether or not she has been tested in the interval or not. If she is following recommended sexual health screening, she may well have been tested

When you put each of these considerations together the likelihood that you became infected and infected your partner is extra ordinarily low. Chances are more than 99.99% that you were not infected and she has not been infected. You have been told this before yet you continue to worry. Thus, were not for your strong sense of guilt and continuing anxiety I would suggest that it would be fine for you to move on without concern. My sense however is that now over a year and a half since your misstep, this continues to occupy your thoughts and make your you concerned. That being the case, my sense is that your mental health may well benefit from acknowledging your misstep to your partner OR seek the help of a mental health professional in dealing with your guilt and anxiety.

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Edward W. Hook M.D.

53 months ago

Oh please. Be patient and allow me the time to write and proof read my response. EWH ---

53 months ago

Oh I by no means meant to signal impatience on my part! I just wanted to make sure there wasn't a glitch in the system and that I caught your response. Apologies if I came across the wrong way. I am very, very thankful for the service and respect your time. I appreciate you getting back to me so quickly, honestly.

So overall...the likelihood of 1. acquiring chl/gon from the situation described, 2. asymptomatically transmitting it to my partner, and 3. my immune system clearing it before testing negative at 12 weeks, altogether is in the realm of getting struck by lighting, and all of this coupled with my partner's absence of symptoms leads you to see zero medical reason for disclosure or cessation of sexual activity, correct?

I have been free from the anxiety for a majority of this time. I hope you will forgive my mild OCD/intrusive thoughts which cropped up after randomly hearing about some of the dangers of undiagnosed chlamydia in women today. I am largely uneducated in the realm of STIs (as you probably have garnered from my posts) and I just wanted to make sure that medically speaking, this should not be a concern for me or my partner, and that life can go on without fear from this particular incident.

Edward W. Hook M.D.

53 months ago

Your summary is correct. Having said that your occasional “intrusive thoughts” more than a year and a half following the encounter is problematic. I again suggest (Recommend and urge) that you seek professional counseling to address this persisting concern. EWH ---

53 months ago

Thanks for the affirmation, doc. I know you guys are the best there are. I have no doubt in my mind now that I’m in the clear from a medical standpoint and I’ll do my best to accept it.

Will probably take you up on that advice too. The human brain is amazing, and daunting, and I’m sure it is subconscious guilt that has kept me fixated on my physical health, as if expect illness as a cosmic punishment for my crime.

Sorry for rambling. I hope everything is going well for you and Dr. H during these strange times. And with that you may now close the thread, and I’ll be sure to never come back (in a good way!)