Evaluation of Risk

[daniel4444]

Hi Docs,

I already (accidentally) posted about this issue in the international STD forum, but given that I took the decision to post on this website reading the answers given by Mr. Handsfield and Mr. Hook (and with all due respect to the others), I wanted to hear their opinions.

I engaged in sexual activities with 2 female sex workers simultaneously in a Belgian brothel 2 weeks ago.

. Mutual kisses on the lips and a couple french kisses.

. I received short and not overly penetrative unprotected oral from both.

. I gave "surface" (not penetrative) unprotected cunnilingus to both.

. I gave short "surface" unprotected anulingus to one.

. I received protected oral from both.

. Had protected vaginal sex with both.

The acts were preceded by a shower and mouth antiseptic wash for all.

A different condom was used each times.

The girls said they were spanish. They both looked healthy and I didnt notice anything wrong with them.


I do not have any symptoms. Bit of a rash on the following days but I drove a lot and it was very hot and it's nothing uncommon with me. No symptoms in the mouth or genitals. I felt healthy for the last 2 weeks since then.

My partner is currently on a 3 weeks vacation and is coming back in a week.

This is where my anguish comes from as I am terrified to transmit something to her.

I made the mistake to check what my risks were on the internet and have been spending the last 10 days thinking almost exclusively of it.

Syphilis especially is my main fear. Partly because I know I won't have time to get properly tested before my partner's return.

I intend to get tested for gonorrhea on monday eventhough I don't have symptoms because I've read it can be asymptomatic. Maybe oral gonorrhea too ?

Would a test for syphilis at 2 weeks be any use ?

[Edward W Hook, MD]

Welcome to the Forum.   I'll be pleased to comment.  the exposures that you describe were low risk for any STI, including syphilis.  Sex workers is=n well maintained, legal brothels are, in general lower risk sexual partners than a casual partner than you might meet at a bar or party.  This is the case because, as pointed out to you, they are checked regularly for all STIs and because they take appropriate precautions to reduce their risk for acquiring or transmitting STIs.  The exposures you describe are very, very low risk for any STI.  Condom protected sex is safe sex, STIs are not transmitted by kissing (even French kissing), and licking a partner's genitals or anus are close to no risk events.  The fact that you have not developed symptoms in the interval since your exposure is further strong evidence that you were not infected.

Regarding syphilis, syphilis is a rare STI and at the present time in the U.S. and in Western Europe, over 2/3 of infections occur in men who have sex with men, not among heterosexuals.  As Dr. Sean has already mentioned, your risk is low. Syphilis is transmitted sexually only through DIRECT contact with an infectious lesion. Thus, is your partners had syphilitic lesions at sites of exposure, you would have known it.  

I urge you not to worry.  If you wish to test, please understand the you are doing this for your own peace of mind, not because your risk is high.  Thus if you choose to test, your throat should be tested for gonorrhea and you could have a penile swab or urine test for gonorrhea and chlamydial infections.  As syphilis blood test at this time would provide partial but not absolute confirmation that you have not gotten syphilis as well.

Most importantly, if I were you, I would not be worried and see no reason, with or without testing, for you to abstain from unprotected sex with your regular partner.

I hope these comments are helpful. EWH

[daniel4444]

Thanks doctor. This is reassuring, especially since I still have slight discomfort and sore at the head of my penis.

Guess I can blame it on the antibiotics and anxiety.

[Edward W Hook, MD]

The antibiotics you took would have cured/prevented gonorrhea, chlamydia, NGU and syphilis.  If you took them Wednesday, you would not longer be infectious to others the next day.

Att his point, testing is a waste of time after the antibiotics you took.  EWH

[daniel4444]

I shamefully report that I gave in to panic and took 400mg of cefixime and 1g of azythromycine on wednesday ...

The deep fear of "possibly" infecting my partner when she comes back made me ignore all rationality ... She's coming back soon and I am positively terrified at the idea of a "possibility" that I may put her to risk ...

I perfectly realize how irrational I am being, but yet here I am for a few extra questions, hoping you'll have the patience to deal with my craziness ...

Before I took the antibiotics, I started focusing so much on my genitals I started "vaguely" feeling something wasnt right. I have no symptoms to report, except the fact I was urinating a lot more often than usual. Since then after 24 hours, I have started feeling discomfort at the head of my penis and the urethra looks a little sore.

I understand that it could very well be a yeast infection due to the antibiotics. No discharge for now but I feel like if it happens I'll just think it's gonorrhea/chlamydia/ngu and will simply lose it.

What are the chances it could be anything else but yeast (if even that) after the antibiotics I took ?

My partner will be home roughly 72 hours after I took the antibiotics. "If" I had something to start with, would I still be contagious at that time ?

Like I said we are very sexually active and she will be suspicious if I decline sex after that long ...

What STDs would the antibiotics I took effectively clear ? gono/clam/ngu ? syphilis too ?

Lastly, when to do a test ? My "risk" exposure was 3 weeks ago already, and I took the antibiotics ~3 days ago.

I am very sorry and perfectly conscious to appear silly, but panic has been getting the best of me these last few days ...

Thanks in advance.

[Edward W Hook, MD]

Glad to help. EWH

[daniel4444]

Thanks a lot for your fast answer Dr. Hook.

I think like many I fell in the trap of reading too much general online litterature on the subject. Websites who insist diseases like syphilis can be transmitted trough any kind of sexual contact including through saliva and secretions without making the distinctions gained through experience that you doctors at medhelp do on the actual occurances of such transmissions.

When you only know about the possibilities and the fact that there can be no symptoms, anything becomes possible and that's when the fear and anxiety kicks in for people like me.

Add this to (deserved) culpability for people involved with someone and it can become unbearable at times.

Thank you again for your honest, experienced opinion. I feel like I'm breathing a bit better already.

Sincerely.

[daniel4444]

(cont...)

Should I avoid any sexual contact with my partner when she comes back and find an excuse for it ? (we are very sexual and she will find it very suspicious after 3 weeks of not seeing each others)

Any other diseases I should look out for ?

Any study about recurring transmitted diseases in Belgian brothels ? The girls said they were checked monthly.


Finally, about syphilis, and in the case I would have it indeed, would I be contagious already ? Even without chancres on the penis or in the mouth ?

Thanks in advance.