Exposure with potential CSW in Thailand

[JackWolfskin]

Dear Dr.

3 days ago - unprot oral (both ways) with Chinese girl. Not CSW. No obvious lesions on mouth, too dark to see down below.

2 days ago-Thai girl at a bar. 10-20 secs of an unprotect ** before i told her to stop then protected vaginal sex. I was drunk but she had no obvious mouth lesions, i am not sure vaginally. After the event i checked the condom, no breakage, however now my anxiety is making me doubt that i actually used a condom (even though i am 97% sure i did - i checked it for breakage afterwards using water - i remember doing this). After,the girl told me that she does have sex with men for money, however that it was always with a condom and that she was clean. She didnt have any condoms with her, which makes me doubt that sentence a little. She didn't speak english well enough when i tried to drill down into the specifics on HSV but i am advised that it is prevalent out there among CSW's

Have taken 2g of azithromycin as i will be meeting my regular partner and didnt want to take any chances.

I will only be able to get back to be tested 10 days after the encounter. Please could you advise me position on:

1. HIV-i know i am no risk/low risk, but to ease my mind i want to take a PCR RNA which i have been told is 99.5% accurate on a negative result after 10 days. I know that it is not meant to be used as a real diagnostic tool in these encounters, but can i consider it definitive on a negative on the above?
2. HSV-my second great worry. I am HSV 1 and 2 negative prior to this encounter. If i have caught it, i would expect a big primary outbreak - correct? If i have a full genital and rectal exam on day 10 and they find nothing worrying, what are my chances that i have not caught anything? What about day 14 which is when i see my partner?
3. other stds e.g bacterial and molluscum?

Any medical excuses why i would start to use condoms again.It is going to be a bit suspicious if i just pull them out. How long can thrush last for?

[Edward W Hook, MD]

1.  No.

2.  In theory, having taken antibiotics might interfer with symptom development but if you were infected the PCR type test should still be positive.  If you choose to test, I urge you to believe the results although if I were you I would not even test.  EWH

[JackWolfskin]

Dr - two last follow up questions before i put this to bed.

1. Imagining that there was a bacterial infection that passed during the episode Is it possible to take antibiotics too early after the encounter for them to be effective e.g during incubation?

Common sense tells me no, but i just want to make sure.

2. Considering that antibiotics had been taken, does this have any effect on the reliability of taking a PCR or swab test on 6/7 days after the encounter. From reading, this should be reliable but i am not sure if the AB's effect in any way. If i test neg at 6/7 days for NGU, gonorrhea and chlamydia post encounter can i consider this reliable even if AB's are taken.

[Edward W Hook, MD]

While not all persons who acquire herpes develop severe outbreaks, most do.  you would likely see such an outbreak if you are checking.

Sorry, I have no good "excuses" for starting condom use with a partner who you have not used condoms with before.

Even with HPV 6 there are benefits to the HPV vaccine as it can be expected to protect against the other types of HPV. EWH

[JackWolfskin]

Thanks Doc,

Can i expect a big primary outbreak if i have caught HSV and i have no prior HSV 1 or 2 infection for antibody production? As in i would likely see something if i am checking most days in my anal/genital region.

I don't know if you missed my question on the medical reasons to wear condoms again (i know i am looking for an excuse) because you did not want to answer it, or because you just missed it.

one last one - I do have HPV type 6. Any data on whether it is worth me getting Gardasil anyway?

Thanks Anyway

[Edward W Hook, MD]

Welcome to our Forum.  The encounters you describe were low risk.  It is apparent that your genital exposures were condom protected and oral sex (giving or receiving is low risk for all STDs, including HIV (more on this below).  You want complete assurance that there is no risk of any STD from these encounters and, of course, that cannot be provided however the risk that you acquired any STD from the encounters you describe is very, very low.

1. HIV-i know i am no risk/low risk, but to ease my mind i want to take a PCR RNA which i have been told is 99.5% accurate on a negative result after 10 days. I know that it is not meant to be used as a real diagnostic tool in these encounters, but can i consider it definitive on a negative on the above?
There are no data. The people who sell these tests and thus have a vested interest in having you purchase them of course are enthusiastic about their performance but, as you mention these tests are neither approved, nor well studied for ruling out HIV.  On the other hand, there are no reported cases of HIV transmitted by receiving oral sex or performing cunnilingus.  With or without testing you can presume you are not at risk for HIV.

2. HSV-my second great worry. I am HSV 1 and 2 negative prior to this encounter. If i have caught it, i would expect a big primary outbreak - correct? If i have a full genital and rectal exam on day 10 and they find nothing worrying, what are my chances that i have not caught anything? What about day 14 which is when i see my partner?

With a normal exam at 10 days there is little chance of HSV.  If you do not experience an outbreak within 14 days of exposure, you can be confident that you did not get HSV.  

3. other stds e.g bacterial and molluscum?
The azithromycin you took is effective therapy had you acquired gonorrhea, chlamydia, NGU and probably syphilis.  There are no data on molluscusm

My advice- you have little to worry about here.  I hope these responses are helpful.  EWH