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Need for Urine Test and HIV Concerns
Had unprotected sex with woman of unknown status 6 days ago. She is over 40 and I would guess she gets around a little. I did get some blood on my penis from apparent menstruation while I was inside.
I took 1.5g Z-Pack that I had over 24 hour period beginning about 14 hours after exposure (5pm, 7am, 5pm).
Questions:
1) Was the 1.5g Z-Pak (in 500mg doses) over 24 hours enough to kill bacteria? Should I have a urine test if I have no symptoms after 7 days?
2) Do I have increased HIV/Herpes risk due to her bleeding? Does ejaculation outside of vagina do anything to flush any substances that could have entered my body? Would you recommend HIV/Herpes testing in this case? If so, at what point?
How do you assess my overall risk profile here?
I took 1.5g Z-Pack that I had over 24 hour period beginning about 14 hours after exposure (5pm, 7am, 5pm).
Questions:
1) Was the 1.5g Z-Pak (in 500mg doses) over 24 hours enough to kill bacteria? Should I have a urine test if I have no symptoms after 7 days?
2) Do I have increased HIV/Herpes risk due to her bleeding? Does ejaculation outside of vagina do anything to flush any substances that could have entered my body? Would you recommend HIV/Herpes testing in this case? If so, at what point?
How do you assess my overall risk profile here?
MEDICAL PROFESSIONAL
1) I see no reason for further STD testing.
2) If you are truly in a state of equanimity with respect to this particular exposure, you may as well have your routine HIV test the next time you see your doctor. But many people in your situation are more nervous about the specific exposure than they realize themselves. If that applies for you, maybe you will sleep better by waiting until 6-8 weeks after that exposure. You can discuss the pros and cons of both approaches with your doctor.
That should end this thread. Take care.
2) If you are truly in a state of equanimity with respect to this particular exposure, you may as well have your routine HIV test the next time you see your doctor. But many people in your situation are more nervous about the specific exposure than they realize themselves. If that applies for you, maybe you will sleep better by waiting until 6-8 weeks after that exposure. You can discuss the pros and cons of both approaches with your doctor.
That should end this thread. Take care.
Ok - I broke my promise. I hope you will indulge me for one final follow up on this subject.
I'm preparing for my doctor visit tomorrow. I don't think at 15 days post-exposure it would make much sense to get an HIV test (I know you didn't recommend a test anyway given my circumstances but it is a regular doctors visit).
My final two questions:
1) Does it make sense to get tested for anything else while I am there tomorrow? HSV, HBV or even the bacterial infections? I haven't had any symptoms (lesions,etc) and am 14 days post-event and as I mentioned before I took 1.5g of Z-Pak which you felt would cover me. I don't want to create a bunch of unneccessary costs and work, but I will be in a Doctor's office so thought I would check.
2) If I don't get tested for HIV tomorrow then should I just wait until next year when I go back or try to do something at 4 -6 weeks? I'm honestly convinced with the improbability of the risks so it wouldn't really be for peace of mind but rather to comply withe recommendations for periodic testing.
Again - thanks for your patience with me. You input had been invaluable in controlling my anxiety - I just want to make sure I am approaching this in the right way.
I'm preparing for my doctor visit tomorrow. I don't think at 15 days post-exposure it would make much sense to get an HIV test (I know you didn't recommend a test anyway given my circumstances but it is a regular doctors visit).
My final two questions:
1) Does it make sense to get tested for anything else while I am there tomorrow? HSV, HBV or even the bacterial infections? I haven't had any symptoms (lesions,etc) and am 14 days post-event and as I mentioned before I took 1.5g of Z-Pak which you felt would cover me. I don't want to create a bunch of unneccessary costs and work, but I will be in a Doctor's office so thought I would check.
2) If I don't get tested for HIV tomorrow then should I just wait until next year when I go back or try to do something at 4 -6 weeks? I'm honestly convinced with the improbability of the risks so it wouldn't really be for peace of mind but rather to comply withe recommendations for periodic testing.
Again - thanks for your patience with me. You input had been invaluable in controlling my anxiety - I just want to make sure I am approaching this in the right way.
MEDICAL PROFESSIONAL
"In all your years working in this field, have you worked directly with a male who was infected by a female (confirmed not to be by some other exposure)?"
Nope, never saw such a patient or heard one described by my colleagues. All the heterosexually acquired cases I have seen occurred in the ongoing partners of known HIV infected persons, who had been repeatedly exposed. You are correct that in the 5+ years of this and the HIV prevention and safe sex forum, there has not been a single case of anyone who reported a confirmed HIV infection after a single sexual exposure, despite an average (as a guess) around 3-4 such questions per day year in and year out. (In fact, there have been no documented new HIV infections reported at all. The most recent possible positive (I'm waiting to hear about definitive test results) involved unprotected anal sex in men.
This doesn't mean that HIV transmission cannot occur after any single vaginal exposure. But it isn't common.
I cannot list all the circumstances that would raise my concern to higher levels. Probably the most important would be a partner known to have HIV, especially if the history suggested that person had a high HIV viral load, e.g. brand new infection, very advanced infection (overt AIDS), or not being on antiviral therapy.
Nope, never saw such a patient or heard one described by my colleagues. All the heterosexually acquired cases I have seen occurred in the ongoing partners of known HIV infected persons, who had been repeatedly exposed. You are correct that in the 5+ years of this and the HIV prevention and safe sex forum, there has not been a single case of anyone who reported a confirmed HIV infection after a single sexual exposure, despite an average (as a guess) around 3-4 such questions per day year in and year out. (In fact, there have been no documented new HIV infections reported at all. The most recent possible positive (I'm waiting to hear about definitive test results) involved unprotected anal sex in men.
This doesn't mean that HIV transmission cannot occur after any single vaginal exposure. But it isn't common.
I cannot list all the circumstances that would raise my concern to higher levels. Probably the most important would be a partner known to have HIV, especially if the history suggested that person had a high HIV viral load, e.g. brand new infection, very advanced infection (overt AIDS), or not being on antiviral therapy.
Just one final follow up and I promise this will be the last....
After reading a lot of the posts on this forum (which have been very educational and helpful by the way), it seems that you and your partner are pretty consistent when it comes to the risk of female to male HIV transmission with unprotected vaginal sex. You usually don't even recommend testing after a single exposure even when it may have been with a sketchy character.
In all your years working in this field, have you worked directly with a male who was infected by a female (confirmed not to be by some other exposure)? If so, what were the circumstances? Multiple contacts over time? Exposed sores? In your mind, what takes you from "mellow out" to "get checked out" when it comes to female to male risk of HIV? I know we don't want to give people false confidence that leads to risky behavior but you mention no positive cases in 5 years on this board, how many have you been associated with?
Thanks for taking the time to respond. I truly appreciate the work you do here.
After reading a lot of the posts on this forum (which have been very educational and helpful by the way), it seems that you and your partner are pretty consistent when it comes to the risk of female to male HIV transmission with unprotected vaginal sex. You usually don't even recommend testing after a single exposure even when it may have been with a sketchy character.
In all your years working in this field, have you worked directly with a male who was infected by a female (confirmed not to be by some other exposure)? If so, what were the circumstances? Multiple contacts over time? Exposed sores? In your mind, what takes you from "mellow out" to "get checked out" when it comes to female to male risk of HIV? I know we don't want to give people false confidence that leads to risky behavior but you mention no positive cases in 5 years on this board, how many have you been associated with?
Thanks for taking the time to respond. I truly appreciate the work you do here.
MEDICAL PROFESSIONAL
It has been speculated that urinating after sex might reduce STD risk by flushing the urethra, but there are no data on either that or ejaculation. I would not assume any reduced risk by either of these.
Thank you for the quick and concise answer.
My question about ejaculation was whether or not the semen discharge would have "expelled" any dangerous fluids in my urethra that could have settled during intercourse.
Does ejaculation help to flush the pipe? Especially if its happened after I pulled out?.
My question about ejaculation was whether or not the semen discharge would have "expelled" any dangerous fluids in my urethra that could have settled during intercourse.
Does ejaculation help to flush the pipe? Especially if its happened after I pulled out?.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help with your straightforward questions.
In general, STDs are uncommon when women get to their forties, including women who "get around a little". For example, chlamydia is especially uncommon after age 25-30, gonorrhea is uncommon after 30-35, and although herpes and HPV remain potential issue at any age, most infected people probably are quite unlikely to have transmissible infections as they pass age 40. As for HIV, it remains rare in women and heterosexual men who are not injection drug users, commercial sex workers, or otherwise at especially high risk. Of course, it would have been wise to use a condom and I recommend that you do so for future casual sexual encounters. To the specific questions:
1) Normally antibiotics are not recommended after sexual exposures in this fashion, even though there is a certain logic to it. But if it is done, azithromycin is a good choice, and you took more than was necessary. (A single dose of 1 gram would have been sufficient.) You are 100% protected against chlamydia and syphilis, 90+% protected against gonorrhea, and probably 90-100% against nonchlamydial nongonococcal urethritis (NGU). There is no need for testing of any kind unless you develop symptoms of infection, which would be very surprising.
2) Sex during mestruation does not significantly increase the risk of STD/HIV transmission. Maybe a little for HIV, but that's so unlikely anyway that it makes no real difference here. Definitely no known increased risk for herpes. Whether or not there is ejaculation in the vagina affects the risk of STD transmission to women, for obvious reasons, but has no known effect on men's risk for female to male transmission. I don't recommend testing for HSV or HIV. However, every person who is sexually active outside mutually committed relationships should be tested for HIV from time to time, like once every 1-2 years. If you haven't been tested recently, this would be a good time, since it's on your mind. But not because of this particular exposure.
I hope this helps. Stay safe-- HHH, MD
In general, STDs are uncommon when women get to their forties, including women who "get around a little". For example, chlamydia is especially uncommon after age 25-30, gonorrhea is uncommon after 30-35, and although herpes and HPV remain potential issue at any age, most infected people probably are quite unlikely to have transmissible infections as they pass age 40. As for HIV, it remains rare in women and heterosexual men who are not injection drug users, commercial sex workers, or otherwise at especially high risk. Of course, it would have been wise to use a condom and I recommend that you do so for future casual sexual encounters. To the specific questions:
1) Normally antibiotics are not recommended after sexual exposures in this fashion, even though there is a certain logic to it. But if it is done, azithromycin is a good choice, and you took more than was necessary. (A single dose of 1 gram would have been sufficient.) You are 100% protected against chlamydia and syphilis, 90+% protected against gonorrhea, and probably 90-100% against nonchlamydial nongonococcal urethritis (NGU). There is no need for testing of any kind unless you develop symptoms of infection, which would be very surprising.
2) Sex during mestruation does not significantly increase the risk of STD/HIV transmission. Maybe a little for HIV, but that's so unlikely anyway that it makes no real difference here. Definitely no known increased risk for herpes. Whether or not there is ejaculation in the vagina affects the risk of STD transmission to women, for obvious reasons, but has no known effect on men's risk for female to male transmission. I don't recommend testing for HSV or HIV. However, every person who is sexually active outside mutually committed relationships should be tested for HIV from time to time, like once every 1-2 years. If you haven't been tested recently, this would be a good time, since it's on your mind. But not because of this particular exposure.
I hope this helps. Stay safe-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
