[Question #9275] Over treated? Nothing to worry about?

34 months ago

Thank you for the service. I have reviewed many previous questions and think i know my answers, but I have come this far so wanted some reassurance. The situation is I am in a committed relationship and had a brief oral sex encounter with a stripper. I am male, she preformed oral on me, unprotected for about 1 min. before I stopped it. Same day I thought it was a good idea to chat with an online doctor that said I was at high risk for bacterial infection. Gave me doxy 100mg, 2x daily for 7 days. Told me to take 2 immediately then 1 every 12 hours subsequent days. Gave me one gram of zpak (2 big pills) and told me to take all at once. I did exactly that 10 hours after the event. I am now on my second day of doxy. i do feel some internal urethra discomfort but I think that is psychsomatic. My questions.

1. I assume there are no STI symptoms that can happen in less than 24 hours?

2. After reading the information here, I think i have been over treated. Will taking what I have taken so far harm me? I normally do not take antibotics. This did upset my stomach.

3. It appears trich was not treated but after reading here, it appears its not an issue for oral sex. I also already have HSV 1 so that appears to be moot too. Correct?

4. It appears syphillis, gono and NGU were my biggest risks. Correct? If so, I assume my risk was low?

5. Assuming I did catch an STI, I also assume what I have taken so far would abort it? If not, how long might I be contagious? I plan on avoiding intimacy for 7 days. Is that necessary?

6. After reading here, I am not sure if I should finish the medication given my risk. I cannot contact the exact online doctor back for questions. It would seem reasonable to finish since I started but wanted to make sure taking them both at the same time will not harm me.

7. I assume these treatments will also work on NGU that is more normal mouth bacteria too?

Thank you for this service and posting all the past questions. They are helpful in an indep

H. Hunter Handsfield, MD

34 months ago

Welcome to the forum. Thanks for your confidence in our services, and for reading other threads with questions similar to your own.

I disagree with the online doctor. This was a low risk exposure. The main potential risks are for gonorrhea, nongonococcal urethritis (NGU) which often is probably due to normal oral bacteria, and herpes, but probably under one chance in a few thousand for any of them. Chlamydia is near zero risk from oral sex, and the chance of syphilis zero or close to it. I would not have recommended preventive treatment. That said, the treatments you received would have cured incident gonorrhea, chlamydia, NGU or syphilis if exposed, and there was little risk of harm. To your specific questions:

1. Correct, no symptoms possible in under ~36 hours.

2. Correct, see above.

3. Trichomonas does not infect the oral cavity, hence never a risk from oral sex. And true that HSV1 is moot: people are immune to new infections with the HSV type(s) they already have. You'll never catch HSV1 or HSV2 again.

4,5. All true, see above; no risk to your regular partner. I don't think you need to avoid sex at all; even a 7 day wait is unnecessary.

6. Once started, it is best to continue and finish the doxycycline. Although I wouldn't have recommended treatment, a full course is always better than incomplete treatment.

7. Also correct -- see above.

I think that covers things. Let me know if anything isn't clear.

HHH, MD

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34 months ago

Thank you. This is helpful. However, I do have questions and a lesson for others for I feel I have taken a lot of wrong steps just not waiting and then testing if symptoms.

I finished the medication as directed. Mentally I know IF I caught anything it should have aborted. However, on Friday of last week, and now, I have had some pains, stinging at the tip of penis. Like soreness. I did an online gonna/clymidia test and waiting for results. I was able to do a follow up with the online doctor that gave me meds. He said the test will not be reliable, it's possible the gonna is resistant or just did not abort. Said no risk of ngu or clymidia. Said go to a clinic to be evaluated and likely get a shot of rocephrine. I made an appointment at the end of the day with my pcp. My questions.....

1. Is it possible I have an still that did not abort?, especially gonna.

2. I assume if I get negative results from Friday's test (4 days), it can't be relied on due to suppressing sti but not curing? Or does negative mean negative and its something else.

3. Given the meds I have taken, i assume adding this shot would not harm me and kill any sti that might be present?

4. I have not had sex with my partner. I assume they aren't likely at risk now? If I am positive by chance and get the shot, how fast does it work. I assume in a day or 2 but still plan on waiting.

5. Knowing my doc, I will get a lecture on treating prior to testing because this could be behind us now with a negative test. He may or may not treat me given my significant other situation. I am sure he will test regardless. If he does, this will be day 7 post exposure and meds. That said, if he does test, can I rely on those results?

6. Any advice on what questions to ask if I see my paper? Other the obvious I should have waited.

Thank you

H. Hunter Handsfield, MD

34 months ago

You have made another mistake in testing for chlamydia this soon after treatment. The online doctor is right about testing too soon, but for the wrong reasons (further evidence s/he isn't up to speed on STDs). There has never been a case in which doxycycline for 7 days failed to cure chlamydia. However, if you WERE infected (which is very unlikely), a test at this point could still be positive. The standards tests detect chlamydia RNA, which can persist for up to 3 weeks after the organism is killed by antibiotics. When post-treatment testing is done, it should always be delayed until 3 weeks after single dose azithromycin or 2 weeks after the last dose of doxycycline. Probably it will be negative, but should it be positive, don't panic: there is no possibility you still are infected and almost certainly never were. As I said previously, if you acquired chlamydia from oral sex, you would be the very first proved such case among millions who have been tested following oral exposure!)

1. There also is no realistic chance of gonorrhea that would resist both azithro and doxy.

2. See above. A negative result will be reliable evidence you are not infected (and probably never were). If the result is positive, it will be unreliable.

3. Yes and yes.

4. They never were at risk, and now even more certainly.

5. I see no need for you to be seen at a clinic or by any other doctor at this point. You should not be tested again for anything, unless (strictly for reassurance) you decide to do so, not sooner than 2 weeks after your last dose of doxy. But it really would be overkill.

6. I don't understand what "paper" you refer to.

We do not like to brag, but you get truly world class expertise on this forum. Trust me on this: there probably are no more than 10 other people worldwide who have the level of general STD expertise, and especially in gonorrhea and chlamydia, than Dr. Hook and I do. (We both are recipients of the American STD Association's Distinguished Career Award, formerly called the Thomas Parran Award. It is the world's highest accolade for STD expertise. Google it for more information, or explore www.astda.org.) Do your best to accept the advice you have had and stop overreacting to a truly near-zero risk event and move on with your life without worry.

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34 months ago

Dr. Handsfield,

You should brag. I appreciate the service, have learned a great deal and it should be required reading medical school, especially PCPs (primary care physicians that for some reason I typed "paper" in my last response). I do want to write and follow up to end the threat officially, even though you are right, it ended after the first post.

I kept my appointment with PCP and had not gotten my Gonorrhea test from 4 days after the exposure back yet. I assumed he would give me a shot since I had symptoms, even though I had 7 days a doxy and 1gram of zithromax.....He is much more knowledgeable than the online MD. He is actually a nurse practitioner and not an MD. He said...

1. It is not likley I could be infected given the risk and if so it would be gonorrhea or chlamydia,

2. The medications I took would have stopped or cured any infection I might have gotten from the event and I am definately not infectious now, despite recommendations to wait a full week after finishing treatment,

3. Like you, he said if my test comes back positive I took at 4 days, I am still not contgious given the medications I have taken.

4. He said he would not give me a shot without a positive test or overt symptoms, which he did not see. But for peace of mind he would do a urine Gonnorrhea, chlamydia and trich test. he said the trich test was not for the event that I had but only because I reported some symptoms he would test to see if it was from my current partner, which he doubted. He also did a urine dipstick and saw nothing remarkable, whatever that means. He would call with the results of the STI tests today.

5. Last night my gonorrhea test came back negative from 4 days post exposure.

6. I got a call from the PCP office today that stated all test (gono/chlym/trich) at 7 days post exposure are negative. Looked in the online patient portal and saw the same three test negative. Also got an electronic message in the patient portal from the NP stating all STI test negative, no STI infection. Urine dipstick taken in office shows no abnormal findings. Recommend if symptoms continue call for an appointment. No treatment recommended at this time.

Again, just wanted to follow up for his recommendation was very, very close to yours and I think he tested me again for peace of mind and he was curious about the trich from previous, non-oral, exposure. He did seem to rely heavily on the results of trich being accurate, even though the DNA urine trich is not approved in men.

I appreciate this service, your expertise. If you have any comments to add or disagree, please do share. Otherwise, thank you for helping me get through this and believing in the results of my normal provider for I had only previously gone to him with COVID and routine metabolic labs.

H. Hunter Handsfield, MD

34 months ago

Thanks for the follow-up information. I don't see any further questions, but I'm glad things have all worked out.

That concludes this thread. Thanks again for your kind words about our services. Perhaps you would like to consider supporting ASHA, the forum sponsor -- the nation's premier sexual health support agency that emphasizes STI prevention. There's a donation line on the website https://www.ashasexualhealth.org/

Best wishes and stay safe.

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