[Question #9582] Risk assessment?
 |
31 months ago
|
Hi There - I had an encounter with someone I've met twice in the past (male CSW). I was the insertive partner, condom was used. For oral (both ways) condom was not used. He says he is regular tested, on prep, mpox vaccinated, etc. There was no apparent lessions or any sores. Of course my anxiety is getting the best of me. I took doxypep (200mg 18 hours after). Would that protect against gonorrhea at all? I am itching a bit from the doxy which happens when I take it. What about HSV1/2? I know it can be transmitted orally, but if no sores what are the odds? I have not been able to get the MPOX vaccine yet, as he is my only outside partner. If he is vaxxed would I be somewhat protected? Thank you. Really appreciate your work.
 |
Edward W. Hook M.D.
31 months ago
|
Welcome to the Forum. Thanks for your questions. I'll be glad to comment:
Congratulations for discussing your partner's history of testing and vaccination- this will do much to reduce your risk. Most people do tell the truth and he said all the right things.
---The encounter you describe was low risk and taking doxy-PEP will virtually eliminate your already very low risk for syphilis and chlamydia as well as reduce your risk for gonorrhea somewhat (estimates are 30-50%- not all gonorrhea is prevented by doxycycline).
Your risk for monkeypox is quite low given that the disease is now sporadic and your partner reduced his risk for acquiring the infection (and therefore transmitting it to you) by getting vaccinated. It sounds like you plan to do the same and I completely endorse that plan
Your risk for herpes is likewise low. Condoms reduce the risk for herpes by about 50% and HSV-2 is only very rarely transmitted through oral sex. Your odds of getting HSV of any sort from the exposure you describe given your condom use for insertion and his lack of lesions is substantially less than 1%- probably far less.
I hope this information is helpful. EWH
|
31 months ago
|
Thank you Dr. Hook. What about HSV1? (I know 50% of the population has it, I believe). When you say less than 1%, is that IF the partner had it? I believe Dr. Handsfield often cites "pissing razeblades" if one has gonorrhea - After how many days if I have no symptoms, do you think I am "okay"? Thank you.
|
Edward W. Hook M.D.
31 months ago
|
You are correct that over 50% of the population has HSV-1 and most (~80%) of those persons do not know it, having had it as a child and then not experiencing cold sores. Even if your partner had HSV-1, most exposures do not result in infection-probably substantially less than 15 as long as obvious cold sores are not present.
The discomfort on urination which is characteristic of gonorrhea (present in about 90% of infected persons) is moderate discomfort, is typically accompanied by an obvious, discharge (pus), and occurs 3-5 days after exposure. I think the "pissing razorblades" reference that Dr. Handsfield mentioned was for urethral herpes. If you are out a week from your last encounter without symptoms, the likelihood of infection being present, which is already very low, approaches zero.
I urge you not to worry. EWH
--- |
30 months ago
|
Hi There - So, 3'ish weeks after the CSW and I were chatting. Last week he had pain in his anal area.. He had several encounters after me. He went to the doctor and was tested and tested positive for chlamydia. We used protection (he did not with the other encounters). I was the top. There was oral. I took doxypep the day after our encounter. Should I be tested? I have had no symptoms.
|
Edward W. Hook M.D.
30 months ago
|
Between the fact that three weeks and other partners occurred in the interval since your exposure, as well as your doxy PEP, your risk for infection is vanishingly low and not something I would worry about although I might seek testing just to relieve any lingering anxiety.
As you know, we provide up to three responses to each client's questions. This completes this thread which will be closed shortly without further responses. Take care. EWH
---