Worried and Advice Needed

[hitherandtither]

Hi,
I am 31. From July-11 to July-12 I visited CSWs ~ 20 times. Some were high-end working in Thailand (Soapy parlors) while some were street prostitutes working on GB Road in new delhi, India (you can be done by paying $3, the hygiene is very bad slum-like).  I never had any vaginal/anal/oral sex (neither given nor taken)/rimming (neither given nor taken). The activities were (1) mutual masturbation (w & w/o Condom), (2) fingering w/o  gloves, (3) rubbing/frottage, (4) body to body massage, (5) sucking  breasts, (6) kissing on cheeks, lip-to-lip lock once (7) bathing together . Penis may have touched the vagina.  She may have touched the tip of penis. I took below tests

1. HIV 1 & 2 antibodies screening , serum @ and HIV 1/2 & P24 Combo
    Index = 0.9  Non-Reactive

2. VDRL (RPR) Serum (Slide flocculation)    Non Reactive

3.  TPHA: Traponema Pallidum Haemagluttination Serum @ (Agglutination)    -ve

4. HSV(1+2) IgG, Serum @ (EIA)  Index 0.23 Non-Reactive

5. HSV(1+2) IgM, Serum @ (EIA)  
    Index 0.14 Non-Reactive

6. Fluroescent Treponemal Antibodies  @
    (Indirect Immunoflorescence)
     -ve

7. Chalmydia IgG Antobody panel, Serum @ (EIA)
    Chalmydia Trachomatis : -ve
    Chlamydia Pneumonia : +ve

I see 2 small red non-itchy  around 3 mm dia  on my stomach. no other symptoms

A) I saw on web that C. Pneumonia is not a STD. Can you confirm? What are its consequences?

B) Are the tests totally reliable?  Can I be sure that I dont have hiv/hsv/syphillis/chlamydia.  I was reading in chlamydia forum that blood test for chlam. is not absolutely reliable. One sud do urine and swab test.

C) I would also like to get tested for hepatitis, gonorhea and hpv for my peace of mind. For Hep-B I see HBsAg  and for Hep-C I  HCV IgM. For Gonorreha I see - Gonococcus Culture. which test should  I take for HPV (male)

D) I hope that 2 red non-itchy regions do not mean much, seeing them for > 3 weeks. The redness has reduced .

Thanks

[H. Hunter Handsfield, M.D.]

1) No, this information does not change my opinion or advice.

2) It means exactly what is says, for example if the skin of the penis were to touch the skin of a woman's labia.  It does not include non-genital skin touching.

3) See my original reply.  I see no need to repeat myself.

4) The test type is called nucleic acid amplification test, or NAAT.  There are 3 or 4 different brands of NAAT for chlamydia and gonorrhea.  They all are equally reliable.

5) Your reasoning is irrational and I will not endorse or support it.  But do whatever you like. It's your money.

The purpose of the 2,000 character limit is to require the entire question to appear in the initial space provided.  You have provided all the information needed for reliable responses, and there is no information you can provide that would change my opinion or advice.  Therefore, I will delete any additional follow-up comments.  And you may not start a new thread with the same questions.  Repetative, anxiety driven questions are against MedHelp policy and are deleted without reply (and without refund of the posting fee).

[hitherandtither]

Thanks a lot, Dr Handsfield for your answer. I wanted to write in more in my first  post but shortened it due to 2000 character limit. Here is a bit more followup and some questions.

In addition to the above activities, I recall that (1) only once  I had kissed the vagina (1 or 2 seconds), (2) only once I had  tried to have sex with condom but just inserted may be half an inch, at max for 5-10 seconds and (3) only once a CSW had licked the balls and base of the shaft (not the tip) again may be for few seconds. Each time I quickly stopped these activities. Each of these was absolutely only once.

Regarding the exposure to urethera, as mutual masturbation was done almost each time, would it not have exposed urethera as the CSW would be playing with it?  Also the body to body massage involves a quite lot skin-to-skin contact.

I also feel a bit of burning sensation while urinating once in a while say 7-10 days which lasts for few seconds. Also some skin in my hands is coming out. But I have been feeling these two many years before my first encounter with a CSW.

So my questions are:

1. Does this change anything you recommended?

2. what exactly is "skin-to-skin" contact? I read this term quite a lot but seem to get conflicting answers.

3. Are the blood tests I took for HIV, Syphillis and HSV are absolutely reliable? I also read a post by you that HSV IgG results are not reliable but Igm once are. I think both in HSV IgG and C. Trachomatis blood test, false positives are not reliable but false negatives are. Can you please confirm?

4. What is the urine test for chlamydia called?

5. Logically I understand I dont need to get tested more. But I want to do the tests for my peace of mind. I will save money by taking a lesser vacation and stop eating out. Hep-B, Hep-C,Gonorrhea and HPV are other common stds so I would like to test for these. Can you please confirm that HBsAg, HCV IgM and Gonococcus culture are the reliable tests for these?

I have couple of more questions which I will ask in the next post due to 2000 words constraint. Thanks a lot again.

[H. Hunter Handsfield, M.D.]

Noted, makes no difference.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

Congratulations for following safe sex practices during your CSW encounters last summer.  There was no measurable risk of any STD from the events you have described.

So you really didn't need testing at all on the basis of these events.  That said, all your test results are valid and show you were not infected with any of them (except see comments about chlmydia below).  To your specific questions:

A) Chlamydophila (formerly Chlamydia) pneumoniae is never sexually transmitted.  It is a respiratory organism that can cause bronchitis or pneumonia.

B) You already undestand that the chlamydia blood tests are unreliable.  The only valid way to test for chlamydia is by a urethral swab or urine test.  But since your urethra was not exposued, there is no chance of infection and I would recommend you not spend any more money on unnecessary testing for chlamydia or anything else.

C) I recommend against these tests.  Based on the expousre describe, it would be a waste of money.  There is no valid HPV test for males.

D) These symptoms are not typical for any STD and undoubtedly have nothing to do with your past CSW exposures.  See a doctor or clinic if they continue or you otherwise remain concerned.

Regards--  HHH, MD

[hitherandtither]

Sorry for HIV index is 0.09