[Question #837] std's

51 months ago

On May 28 I had an unexpected, unprotected encounter with another man; he initiated it, I didn’t stop it.  Beyond guilt I fear passing something on to my spouse.  The details: maybe a minute of kissing, tongue on tongue.  I sucked his penis briefly (don’t think there was any precum) and inserted my penis in his rectum briefly and went in and out a little.  I saw no sores of any type on his lips, penis, anus.  He performed oral sex and rimmed me for quite some time.  At no time did I see blood. I’m concerned about Hepatitis A, B, C, syphillis, chlamydia, gonnorhea, hiv, oral and genital herpies (I find the herpes info confusing, it seems that much of the population has some form of it). I feel I should get tested for them all now, and then repeat some at later dates.  My partner and I (in our 50’s) haven’t had sexual contact for months; however a new closeness is occurring.  She kissed my lips briefly a couple times since the encounter -I keep it minimal and pull away quickly because I fear her catching herpes.  If I test for all of these now, I would learn what doesn’t register at the moment; it seems I could have a positive herpes result because it seems much of the population has it.  I’ve read that hepatitis shots could help prevent catching it, but I need to do so within 2 weeks of the encounter; it seems later I could test positive for hepatitis A or B because of the shots.  Telling my spouse would likely end our marriage, but that would be better than passing something on.  It seems some diseases can linger unknown for long periods of time. The person says I have no worries, but that means nothing.  He drinks a lot -not sure how that impacts Hepatitis matters.  I have no symptoms that I can tell. Thank you for your insights and compassion.

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago
Welcome to the Forum. I'll be pleased to comment.  The exposure you describe, sex with another man of unknown status including unprotected insertive rectal sex, was relatively risky and testing is warranted.  I recommend that you be tested for gonorrhea and chlamydia, the most likely infections, of the throat and penis.  Testing for these organisms at this time will be accurate.  If you were going to develop herpes you would have most likely have developed lesions by this time.  You risk for HIV, syphilis, and hepatitis is low but I would suggest testing for these diseases about 4 weeks after exposure.  The HIV testing should be done using a 4th generation, combination HIV antigen/antibody test.

I hope these comments are helpful.  EWH
---
51 months ago
Thank you for your response Dr. Hook.  Sorry for all the questions to follow.  The person in question says he was tested for everything, -don't know how believable that is. He is a person I know to a degree, not sure if I should talk more with him or whether that matters now.  I was planning on taking a urine test for gonnorhea and chlamydia.  Are you saying I also need to have swabs of my throat and penis taken?  It seems you aren't suggesting any testing of herpes of any kind, I may follow up on this in a future reply.  Should I allow my wife to kiss my lips?  Have I already put her at risk of anything by letting her kiss me a couple times?  We will not have sex of any type, is she at risk for anything.  Are the tests for HIV, syphilis, and hepatitis blood tests only?   Is there any point in being tested now for them and then at the 4 week time frame?  Do I need a swab of my general anus area done for anything as he did rim it. I wash my hands thoroughly, even excessively, should I wear gloves when cooking for my family?   Like many posts on this site, extreme guilt, shame, and anxiety are overwhelming and always there.  I guess you can't comment on the following options:  telling my spouse which would be so hurtful to her and my children or hopefully getting through the testing with no positives, living with my shame and regret, but with a zest of wanting to make every second of my wife's life  incredibly special  Again, thank you.         
Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

I appreciate that your partner indicated that he had been tested and assured you that he was not infected.  Indeed, most people tell the truth and that he said this is good but there is still the possibility that he may have asymptomatically acquired infection in the interval since he was last tested and, of equally importance, my sense is that as you deal with your guilt and anxiety over this exposure, negative tests would provide helpful reassurance.  I see little reason to talk with him further about this, it might just offend him and it does not change my recommendation for testing.

You do not need a swab specimen from your penis- the urine specimen will provide accurate results. In that you performed oral sex on him however, a throat swab specimen is appropriate. 

In the absence of an outbreak we typically do not recommend herpes testing.  The odds are that you, like over 60% of American adults, already have HSV-1.  HSV blood tests in situations such as yours most often detect pre-existing infections and are typically not very useful to detection of recently acquired infection in the absence of an outbreak.  False positive tests are relatively common.

There is no reason not to kiss your wife.  Even if you have gonorrhea of the throat, kissing does not transmit the infection.  If you do not have sex until you know where you stand infection-wise, she is not at risk.

The tests for HIV, syphilis and hepatitis are blood tests.  Testing at this time will provide little useful information about recent infection.

Receipt of rimming does not put you at risk for acquisition of STI.  You do not need a rectal swab.

You do not need to worry about casual, non-sexual contact with your family.  You do not need to wear gloves to cook. 

As for working through your shame and guilt, you have to sort this out.   EWH

---