Antibiotics and STDs

Hi Doc...my exposure was unprotected oral sex with a woman (both giving and receiving, no ejaculation - I am a man) as well as some genital to genital rubbing.

At the time of my exposure, I was on the antibiotic Levaquin (a 500mg dose daily for 14 days) to treat a prostate infection. Three months after exposure, I was put on Cipro, 500mg twice daily because the infection re-occurred. I was on the Cipro for 2 sessions of 10 days each. The two sessions were separated by about 5 days.

My questions are 1. Would being on the Levaquin at the time of my exposure block me from getting bacterial STDs such as chlamydia and gonorrhea? Or is this drug not effective against those? 2. If by chance (and, please correct me if I am wrong, but the chances of being infected with the exposure I have described is extremely low??) I was to have picked up one of these STDs, would the Cipro treatment a few months later be enough to rid me of the bacteria if I had become infected unknowingly? and 3. If a man does not experience the classical symptoms of these STDs, and did not get tested, is there a way to tell if he might be infected? Do these always progress to have complications which will then cause symptoms later, or do they tend to clear on their own with no real consequences? (For men, I understand that complications for women can be dangerous). Thank you for your time.

[H. Hunter Handsfield, M.D.]

Levofloxacin (trade name Levaquin) would have prevented chlamydia if exposed, but chlamydia almost never infects the mouth or throat and has never been documented to be transmitted to a partner's genitals by oral sex, so chlamydia isn't an issue.  Levo is 100% protective against gonorrhea if the gonorrhea strain is susceptible to it.  Resistance of gonorrhea to the quinolone antibiotics (including levo) is increasing in the US but still is rare in most geographic areas, and so far most resistant strains have been found in gay men with gonorrhea.  But anyway, if you got gonorrhea, you would know it; asymptomatic infection of the urethra is very rare.  As you undoubtedly know, the genital rubbing without penetration cannot transmit gonorrhea or chlamydia.  Cipro is identical to levo in its activity against gonorrhea, but is slightly less active against chlamydia.

Gonorrhea and chlamydia rarely lead to serious complications in males, only females.  The natural course of untreated infection with either of these STDs is complete resolution; the immune system eventually clears it up.  In the pre-antibiotic era, most gonorrhea in men resolved within 6-12 weeks.  The duration of untreated chlamydia is less certain, but in men it usually clears up within a few months, and probably always within a year.  There is no way to test for past chlamydia or gonorrhea once the infection has resolved.  All gonorrhea or chlamydia complications are clinically obvious; that is, your lack of symptoms means you cannot have developed epididymitis, infertility, urethral stricture, or other serious outcomes.

A bottom line is that these infections rarely are serious health problems for men, only women.  The importance of male infections is that they signify a risk for the men's partner, not for infected men themselves.  There are exceptions to this, but they are rare.

Another bottom line:  The sexual exposures you describe were extremely low risk for these or any other STDs.

Good luck--  HHH, MD

Good luck--  HHH, MD

[DR79]

Doc...with this type of exposure, should herpes be a big concern? The girl I was with did not have any visable cold sores present on her mouth or any visable lesions or sores down below, and I have not seen any symptoms of herpes on myself. This exposure occurred back at the start of June, so it's been about 4 months. Should we conclude I'm probably in the clear at this point?? Thank you.

[H. Hunter Handsfield, M.D.]

Although in theory HSV-1 could have been transmitted from your partner's mouth to your penis, the odds are very small.  You can safely assume you didn't acquire herpes during the exposure you describe.  (However, half the population has HSV-1 and a quarter has HSV-2.  With those statistics, I certainly cannot assure you with certainty you do not have one or both of those infections.)

HHH, MD

[jayar08]

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