Worried STD

[DanielFreeman]

Dear Doctor,

I am 38 years male, married and with kids. Trying my best to keep myself away from risk but this time I failed. Five days ago I’ve ended up with the casual sex worker (Kenyan origin). She came to Abu Dhabi 3 months ago as a hair dresser and for this reason I am sure that she had passed her pre employment medical test which is inclusive of all SDTs including HIV. Anyway we spent together for approximately 1 hour. Firstly she gave me unprotected oral sex for 15 minutes. After that we had protected sex (vaginal) using a condom and then I removed the condom and masturbated myself while she was occasionally giving me oral sex. I am extremely worried because I used my hand to masturbate myself which I also used to finger her and to remove the condom. After examination of the condom, I’ve noticed a vaginal secret and traces of blood as well.

Questions:

1. As I don’t have time to wait for 6-8 weeks for the various STDs tests would you please list all STDs I’ve been potentially exposed (have to travel to see my family)
2. As it is my 5th days since the exposure I still didn’t develop any symptoms, so I rather not wait so would it be OK if I start with the therapy (e.g. antibiotics) regardless the test results and what you would recommend as the successful therapy (anything common for majority of STDs e.g. Gonorrhoea, Syphilis, NGU, Chlamydia, etc.)  
3. Although I know that HIV is not part of this form I’d really appreciate your advise on what are the odds for contracting HIV.

Thank you.

[Edward W Hook, MD]

Welcome to the Forum.  Your risk of having acquired an STD of any sort, including HIV from the activities you describe is very small because it is unlikely that your partner had an STD (assuming that your comments about her being tested on arrival are correct), because most STDs are not spread in the majority of encounters with infected partners and, most importantly, because of the nature of the activities you took part in.    STDs are not spread during condom protected sex or by masturbation, even though it is typical for persons engaged in mutual masturbation to touch themselves with hands that have each other's genital secretions on them or to otherwise get genital secretions on each other.  Thus your risk primarily relates to oral sex.  

Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.   You can be tested at any time now for gonorrhea and NGU with a specimen taken from your penis or tests done on a urine specimen collected just as you begin to urinate.  

As for HIV, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.

Thus, with these facts in mind, the responses to your questions are:

1.  See above.
2.  The problem with starting antibiotics is that not all antibiotics work against all STDs and they tend to both have their own side effects and to just confuse things if symptoms do occur.  I would not recommend it. If you feel you must, the only antibiotic I would recommend at this time is doxycycline 100 mg twice daily for 14 days.
3.  See above. HIV is not really a concern.

Take care. EWH

[DanielFreeman]

Dear Doctor,

Thank you for your prompt response. I forgot to mention deep kissing over the whole course but I assume it would not be relevant either . If I may summarise your answers:

1. No risk of touching genitals with hands even if vaginal secrets and blood are present (any sort of STDs).
2. Minimal risk exposure is present due to oral sex performed on me.

As a follow up, can you please just clarify following:

1. Do I require tests on HIV and Syphilis and how would you assess a negative test results at 27th day after the exposure (that is a time I have before my trip)?
2. Can you please list the STDs which would be healed/ prevented with the Doxycycline 100 mg twice daily for 14 days? Any trouble with the effects of the Doxycycline on STDs if I was treated for helicobacter pylori 45 days ago using combination of the two antibiotics for 14 days?

Thank you.

[Edward W Hook, MD]

Your summary is correct

1.  I see no need for testing related to the activites you describe.  You negative tests are further stong evidence that you did not get syphilis or HIV.
2. Having taken antibiotics for helicobacter would have also reduced your risk for getting some STDs (syphilis, perhaps gonorrhea).  The doxycycline regimen I mentioned would be treatment/prevention for chlamydia, NGU, syphilis and some gonorrhea (not all gonorrhea is cured by doxy)

EWH

[DanielFreeman]

Dear Doctor,

Sorry to trouble you again but as a follow up on my previous post, I’d appreciate your opinion and advise on the antibiotics regiment. Local GP over here has prescribed Zithromax 250mg (twice a daily for 3 days). Is the dosage prescribed OK and how it would affect (heal/prevent) NGU, Chlamydia, Syphilis and Gonorrhoea. If the dosage is not OK, what would you recommend as a regiment for STDs with Zithromax. I have found several posts suggesting single or double dose which makes me confused.

Thank you.

[Edward W Hook, MD]

I will not engage in a prolonged discussion of treatment for STDs that you are not at risk for.  I do not agree with "just in case" treatment- it causes more trouble than it prevents.  The dose of azithromycin you were provided has not been studied for STD treatment and is less than what is recommeded for STD treatment. For treatment of chlamydial infection or NGU the recommeded treatment is 1.0 grams, once.  For gonorrhea it is 2.0 grams, again given once, as a single dose.  EWH