[Question #8812] Possibly STD exposure
39 months ago
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Hello,
Last week I had protected oral and vaginal sex with a sex worker. Is it possible that I could contract Chlamydia or gonorrhea even if a condom was used during the encounter?
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H. Hunter Handsfield, MD
39 months ago
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Welcome and thanks for your confidence in the forum.
At any point in time, the large majority of sex workers do not have gonorrhea or chlamydia, so any single exposure generally is low risk, even without condom protection. Perhaps more important, condoms are highly effective in preventing transmission of these STIs. Assuming the condom was properly used (no exposure before it was in place) and didn't obviously break open, you can assume protection was complete and there is no risk you acquired either gonorrhea or chlamydia, either genital or oral. I see no need for testing, and if you have a regular partner you are concerned about, you can continue your usual relationship without putting her (or him) at risk.
Please let me know if I have misunderstood anything, or if these comments aren't clear.
HHH, MD
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39 months ago
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There was no exposure before the condom was in place. Three days after having protected sex with the SW I had unprotected sex with my partner. Two days later she mentions she is experiencing dry skin on her genitals, itching and burning and just overall general discomfort.
Her gyno did an examination and diagnosed a yeast infection. She has finished a course of anti-fungal medication however there’s still discomfort after one week.
I know you mentioned I can resume activities with my partner but is there any possibility I contracted am STI even when using a condom and passed it to them?
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H. Hunter Handsfield, MD
39 months ago
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Thanks for the additional information. Happily, it does not change my evaluation or advice. There remains little or no chance you acquired an STI and infected your regular partner.
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Yeast infections are common in women, are not sexually transmitted, and usually are accurately diagnosed and easily distinguished from STIs. Your partner should contact her doctor about her continuing symptoms; up to 10% of vaginal yeast infections are caused by strains of yeast resistant to the usual treatments. In addition, the only STI likely to cause symptoms that might be confused with yeast is herpes. However, three days is too soon: it is very unlikely you acquired genital (or oral) herpes, then transmitted it to your partner, and she started to have symptoms all in three days, especially in absence of herpes symptoms yourself.
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39 months ago
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Thank you doctor. I have just one more question.
I’ve tested positive for hsv-1 and have had cold sores in the past. I have never had any sores in my genital region besides an ingrown hair. Is it possible I could pass hsv-1 to my partner when performing oral sex even if I didn’t have a cold sore at the time?
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H. Hunter Handsfield, MD
39 months ago
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Yes, this is possible. It is unlikely for any particular oral sex event, but the chance of course becomes higher the more frequently such exposures occur. Did you perform oral on your partner in the week or so before her symptoms began? If so, you should discuss this with her; if her genital irritation includes blisters or open sores, herpes is more likely. With her apparent yeast infection not clearing up as expected, she should also discuss with her doctor right away: herpes diagnosis is more accurate, and treatment more effective, the sooner they are done.
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Threads normally are closed after two follow-up exchanges, but I'll leave this one open for now, in case this raises more questions or if you would like to tell me the outcome if or when your partner is evaluated for possible herpes.
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39 months ago
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Oral was performed 2-2 1/2 weeks before symptoms started. They will be discussing this with their doctor tomorrow. My partners symptoms include sensitive dry raw skin, vulva irritation that is sensitive to the touch, discharge with no odor, and burning if urine touches the vulva. Test results will take a few days but in the meantime along with a possible yeast or herpes diagnosis could this be a uti or trich? Can trich be contracted if using a condom?
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H. Hunter Handsfield, MD
39 months ago
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Your description of your partner's symptoms are most consistent with her original diagnosis, a vaginal yeast infection, and perhaps all she needs is a different treatment. However, herpes remains possible. Trichomonas and UTI both are unlikely based on this information, and condoms are highly protective against trich. It should be possible for her doctor to have a pretty good idea of what's going on just by examination, before lab test results are available. For example, if she has visible open sores that suggest herpes, she should be treated for herpes (e.g. with valacyclovir or acyclovir) without waiting for test results.---
I'll leave this open for one more report, but only to report the outcome of her reevaluation tomorrow. I won't have anything more to say until then.---
I'll leave this open for one more report, but only to report the outcome of her reevaluation tomorrow. I won't have anything more to say until then.---
39 months ago
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Their doctor performed an examination and said it could possibly be herpes and prescribed an anti viral. They took a swab and blood test and results will be back soon.
I have ocd and am having a lot of anxiety that this also could be chlamydia or gonorrhea. My partners symptoms have gotten a little better however they’re still experiencing some pain and discomfort.
The timeline of events is really getting to my head knowing that my partner started having these symptoms 2 days after we had unprotected sex and 4 days after having protected sex with a csw. Is this just my anxiety and a bad coincidence or is there any chance this could be chlamydia or gonorrhea as well?
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H. Hunter Handsfield, MD
39 months ago
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If it's herpes, there probably are no implications about your sexual fidelity, having other partners, etc; it would more likely be from your own oral HSV1 infection, as we discussed above. Whether herpes or yeast, it's probably just a coincidence of timing, not from the CSW event. And as I said above, the timeline you describe doesn't fit well with new herpes from your CSW event: it is exceedingly unlikely you could have acquired new herpes (HSV2), transmitted it to your wife only 2 days later (with no symptoms yourself), and your wife then to start having symptoms only 2 days after that. I can't say it is impossible, but the chance is extremely low.
Neither gonorrhea nor chlamydia causes symptoms like this, i.e. external genital inflammation or sores.
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I'll continue to leave this open. I'll be interested to hear how your wife does after ~3 days of the anti-herpes treatment (presumably either valacyclovir or acyclovir by mouth, right?); and the results of herpes testing. If she has a positive swab test (i.e. PCR for HSV), make sure they determine the virus type, i.e. HSV1 versus HSV2. As discussed above, HSV1 is much more likely, but it's always good to have confirmation; it makes quite a difference in what to expect in the future, treatment needed, etc.
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