On January 16 at the peak of my alcoholism I went to 4 asian massage parlors in san diego California and had 4 instances of protected vaginal sex and 4 instances of protected oral sex besides one parlor which was unprotected oral. After that day ive been feeling horrible to myself and my partner and alert on any symptoms while trying to sober up. in that anxiety i got a full panel std test 2 days after on the 18th without realizing its too early for any conclusive blood and urine work, everything came back negative. On janurary  26th i went to my urgent care after feeling discomfort in peeing and my bladder all day, that urine test and analysis came back normal and negative for chlymydia and gonorrhea. The doc gave me 1g Azithromycin as a treatment however after the test. 

my questions are 

do my urine tests on the 18th and the 26th prove im negative for chlamydia and gonorrhea?

if my test on feb 16th comes back negative for syphilis and all full panel, would that be conclusive or would i need to abstain from sex and retest again?

and finally is there any other risks besides chlamydia syphilis and gonorhea?

thanks for your help, you guys are doing a great service for the world, its a shame how lackluster std education can be in this country 

You were at no significant risk for any STD from the exposures described. The only one with any measurable risk at all was the single episode of unprotected oral sex. But oral sex is very safe, with low risk for all STDs and zero risk for some. No STD causes the urinary symptoms you describe; they are typical for genitally focused anxiety, which is common after sexual events that seem shameful or otherwise are regretted. To your specific questions:

"do my urine tests...?" The test results are proof you did not have gonorrhea or chlamydia. (Chlamydia is zero risk from oral sex anyway.)

Azithromycin etc:  You were at little or no risk for syphilis. If somehow you were exposed, the azithromycin might to might not have prevented or aborted the infection; some syphilis bacteria are resistant to azithro. With or without azithromycin, a negative syphilis blood test a month later proves you did not have it at the time you were tested and could not pass it to a partner.

Alcohol does not reduce the effectiveness of any antibiotic.

I would not recommend any further STD testing at all. But if done, the results will be conclusive.

Unprotected oral sex also risks herpes due to HSV1 and nongonococcal urethritis (NGU), often caused by normal oral bacteria. Absence of symptoms is strong evidence you acquired neither of these. No testing is needed.

I agree about the poor state of STD education in the US -- not everywhere, some schools and communities have excellent programs. The biggest problems are in politically conservative communities and states (which, not coincidentally, also have the highest rates of unwanted pregnancy).

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

HHH, MD

if i may ask as a follow up, what makes syphilis high or low risk, does it matter if its with sex workers? and why do some say results are conclusive after 8-12 weeks, would it make a difference if i tested on feb 15th vs feb 16th?

I can put my mind to rest on chlamydia and gono, and i assume hepatitis and hiv isnt a worry here, im just confused by syphilis and conflicting information.

When we evaluate risk, it always considers the chance a partner was infected, if infected how likely to be in a stage that is more or less transmissible, details of the exposure (vaginal, anal, oral, none of these, etc and condom use), and perhaps other factors. Sometimes one factor overrules everything else. In this case, having no unprotected penetrative sex except one episode of oral makes the events describe little or no risk even if your partner(s) were infected. Also, syphilis is rare in female sex workers; the large majority of cases in the US are in men who have sex with other men.

There has never been high quality research on the time to conclusive syphilis testing, and biological factors can be variably interpreted by various experts -- hence inconsistent advice. Certainly a negative syphilis blood test at 6 weeks is very close to 100% conclusive, but some experts believe 3 months. (But the combination of sex with a partner unlikely to have infectious syphilis, condom protection for vaginal, absence of a syphilitic chancre (sore) at an exposed site within 2-3 weeks, plus a negative blood test at 6 weeks probably leaves under one chance in a billion that someone acquired syphilis. So even when the test itself isn't quite conclusive, it is often possible to reassure the patient in conclusive terms.

One day makes little or no difference in test reliability.

Based on your input im feeling this is more a anxiety mental thing, and that if i test negative February 15th i should put this bed. 

That completes the two follow-up exchanges included with each question and so ends this thread. Best wishes and stay safe.