Two days after the first sexual encounter, I had symptoms of a UTI (increased urination frequency and urgency) and was prescribed Nitrofurantoin which has helped. On that same day, I also noticed some lower abdomen pain that is still here even though the urination issue has ceased (I have one more day of the antibiotic). I am very concerned about having contracted an STD from these two exposures.

I was tested for Chlamydia, Gonorrhea, HIV, and Syphilis today which is probably too soon for some of the results to be conclusive. What testing schedule would you recommend? Also, a telehealth doctor suggested that I take PEP -- do you agree with this suggestion?

Congratulations on your intent for using condoms with new partners, which I see was discussed with Terri in your previous question a little while ago. Too bad your partner didn't go along with you on that aspect. Still, it sounds like he probably is at low risk having a transmissible bacterial STD or HIV. Your UTI probably was just that, a UTI and not an STD. As you may know, sex is a common UTI trigger (it can massage genital area bacteria into the urethra), and nitrofurantoin is good treatment for most UTIs but ineffective against all STDs.

Most likely your abdominal discomfort also doesn't indicate an STD, both because gonorrhea and chlamydia are unlikely and not enough time has passed for onset of pelvic inflammatory disease (PID), the main cause of STD related abdominal pain. That said, if the pain continues and especially if it gets worse or you develop fever, you'll need to promptly get professional care.

It isn't too soon for urine or vaginal swab testing for gonorrhea, although chlamydia may take a bit longer. Assuming both are negative, you can rely on the gonorrhea result but another test might be a good idea for chlamydia. But indeed it is much too soon for positive results of HIV and syphilis blood tests. But in any case, the chance of either of these probably is near zero.

I do not agree with PEP to prevent HIV in this situation, unless you learn that your partner is at particular risk for HIV, e.g. sex with men, injection drug user, etc. Even in the most sexually active straight men in the US, under 1 in a thousand can be expected to have HIV; and if infected, the average chance of transmission to a female partner by vaginal sex is around one in a thousand. In any case, it's too late for effective PEP in relation to the first event (5 days ago) and nearly so for the second exposure:  72 hours is the maximum, and ideally PEP should be within 48 hours.

Are you still in touch with your partner? If he is willing to be tested, and if negative for all these (gonorrhea, chlamydia, HIV and syphiils), you'll both know neither of you was at risk. Assuming this isn't practical, you could have another chlamydia test any time 5+ days after the second vaginal sex event (which will include gonorrhea, since the two tests usually are done simultaneously); and HIV and syphilis blood tests after 6 weeks.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Do your best to move on without worry:  the chance you acquired any infection truly is extremely low! Thanks again for your confidence in our services and best wishes.