Testing advice needed please

[alan74]

Hello Dr's

I (Male) recently had a 5 min exposure with a CSW.  Condom protected insertive oral and protected vaginal with same condom. I couldn't perform due to alcohol. I lost my erection and took the condom off myself.  It seemed intact and had covered the top of the penis.  The CSW used her hand to keep the condom in place.
When i woke up I was consumed with guilt and anxiety.  I have not had any symptoms and had planned to test at 28 days.  At 21 days due to emergency appendix removal I was given a weeks course or Amoxicilin. I later read that chlamydia can cause appendicitis which added to my STI worry. I have managed to avoid sex with my wife for her protection until I am sure I am no STI risk to her.
I was concerned with HIV, Syphilis and gonorrhea (accept HPV could be possible also) What do you think of my risk?  I am  concerned that the weeks course of Amoxicilin will effect the results.  I have no idea when to test now  and how reliable they will be.  When can I get reliable test results and be sure I am not putting my wife at risk?
I am currently day 26 and just finished Amoxicilin.. Dr Hook has said in other posts that Amoxicilin could cure syphilis but other ports contradict this. I just need you expert advice please and some idea when testing would be conclusive.  

Thanks very much for being here providing the service you do.

[alan74]

Hi Dr Hook

Just for completness of this thread I wanted to let you kow  I tested negative for hiv, syphilis,gonorreah and clamydia at 39 days.  Not quite 6 weeks but its good enough for my peace of mind.  

From me personally - i just wanted to send you a sincere tbig hank you.
All the very best DR. Thanks for being here and supporting us.  

[Edward W Hook, MD]

Final answer.this does not sound like herpes and occurred far after herpe would have been expected to occur.  I would not worry about it.  If you feel you need testing for your pece of mind, the only meaingful test you could have would be a a culture or PCR test for HSV

EWH

[alan74]

Hello again doctor

Thank you for your time and patience in hopefully dealing with another worried well panicker. I am so appreciative of your time.

Your advice was very comforting but as there is an innocent person at risk I decided I owe it to myself and her to be tested for peace of mind.  Tests are booked for 18th March and include hiv,syphilis, gonorreah and chlamydia'

There is no routine test for HSV2 and I was happy based on your feedback not to pursue this for a fee at a private clinic.  Today (day 34) after my shower i noticed what appears to be a small cut/crack on the foreskin.  Its as the base of the penis just above the scrotum.  Its a single cut/crack and  is not blistered at all and has no pain.  I have cold sores/herpes every so often on my lips and it looks nothing like a cold sore.  Does this sound worrisome to you given the single occurence and timing?  I have inspected myself daily and this definitely arrived today.  How will this manifest if it is a herpes sore, will there likely be more than 1 and would it blister?  If it disappears without blister shall i just assumed i nicked myself somehow?

I still havent had any sex woth my wife until I have test results back but this has me concerned now about herpes.  Sorry to be a pain doctor.  Really appreciate any response you can give.  I'll share my results next week for the benefit of others.  Thanks again.

[Edward W Hook, MD]

No.  EWH

[alan74]

Dr - sorry to trouble u again. I was drawing comfort from your response. One final question having considered my last months sexual history - after my exposure my wife gave oral sex 3 days later. Just 1 exposure. My amoxicilin might have cleared my infection so ill never know if this was a risk to her.  In the absence of any sores did I put her at risk. Final question I promise. Thank you.

[alan74]

Thank you very much.  You professional opinion as been my best purchase of the year.   All the best.

[Edward W Hook, MD]

If you feel the need to test, testing for STIs such as gonorrhea and chlamydia will be reliable about 3-4 days after you complete your amoxicillin.  Syphilis testing would be reliabe at this time.  Given the nature of your expsoure, as well as the antibiotics however, I see no medical need for STI testing.  EWH
'

[alan74]

Sorry Dr. for this additional question. You made reference to mis-directed antibiotics in the post below.  Does this alter you opinion of use of Amoxociln and the possibly if my give false negative results?


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Edward W Hook, MDBlank

Jun 27, 2008
I'm pleased to hear that you will not have to take antibiotics without knowing what you have.  That is EXACTLY the right thing to do since mis-directed antibiotics can cause problems and make diagnosis more dificult.

Indeed NGU and chlamydia are treated with the same medicine but gonorrhea requires a different one.

Good luck.  EWH

[alan74]

Thank you Dr EWH,

Your expert opinion is very assuring and comforting. Guilt and anxiety have consumed me since this encounter.  I will try and put this behind me now. Should I need assurances of medical  tests when can I consider them accurate following the completed  course of Amoxicilin? I finished Amoxicilin today.

I assume HIV test results would not be affected by the Amoxicilin, which tests would likely be affected?  Should I treat today as the exposure day and follow standard  testing advice from the exposure time?
Im hoping you wont suggest another 6 weeks for accurate syphilis testing.

Thank so much for you considered response.

[Edward W Hook, MD]

Welcome to the Forum. I'll be pleased to comment.  It sound to me as though you've been sending some time on the internet investigating the potential consequences of your exposure.  I'd advise you to stop.  While there is much useful information to be found here there is also a lot of misinformation and distinguishing which is which can be difficult.  Further, internet based misinformation can fuel anxiety and apprehension, something that you just do not need.

The exposure you describe was virtually no risk for STI.  It appears that you have read some of our earlier posts to others in the site but they bear repeating- Most people, even most CSWs do not have STIs. Most unprotected single exposures do not lead to infection.  Condoms effectively prevent virtually all STIs transmitted through penetrative sex (i.e. gonorrhea, chlamydia, NGU, trichomoniasis, HIV) and substantially further reduce risk for all other STIs (herpes, syphilis, etc.).  There is little medical reason for you to worry about the exposure that you describe and your recent course of amoxicillin reduces your risk for STIs still further.

At this time, I see no medical reason for you to test for STIs and no reason to worry.  Not that you needed it for any STI, your amoxicillin has further reduced any risk for STI you might have as it would likely cure much gonorrhea, chlamydia and all syphilis, were it present.  There is also no reason for you to abstain from unprotected sex with you wife related to the exposure you describe  

I hope these comments are helpful. EWH