STDs Expert Forum
Non-penetrative experience - still worried
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Non-penetrative experience - still worried

Hi Doctors:

I'm sitting here a bit nervous about a brief encounter with a stripper approximately 10 days ago.  After reading your other advice here, I'm fairly certain I know what your response will be, but I'd like to hear you address my specific case anyway.  Here it goes:

On Thursday, April 18, I rubbed the head of my unprotected penis against a stripper's bare vagina for approximately 4-8 seconds.  There was no actual penetration, but the head was certainly enveloped by vaginal folds.  The stripper was quite wet at the time, and her fluids definitely got on my penis.  Whether they got inside, I can't know.  They certainly got on, and around, the tip.

I am not the least bit concerned about HIV, and recognize that HPV is always a possibility. I saw no lesions, so I'm also not particularly concerned about Syphilis and Herpes.  I AM concerned about chlamydia, gonorrhea, and trich, however.  I understand that those bacteria tend to live near the cervix, and would typically not be present outside the vagina, but as I said above, she was quite wet, so perhaps those fluids came from all the way inside?  

On Monday, April 22, despite not showing any symptoms, I took three single dose antibiotics to combat those three (forgive my spelling: erythromycin, metrodonizol and suprax).  I felt somewhat ill all week, but felt normal by Friday.

On Sunday, April 28, I had unprotected vaginal sex.  

Should I be concerned that I transmitted anything to that partner?  

I understand the likelihood of my having anything is quite low (???), but lets say I did. Would the antibiotics have worked in that time frame? The internet tells me that I should wait 7 days after taking single dose antibiotics.  I waited 6. I assume the 7 day period is just to be safe, and that they most likely work after a few days, but am I off base about that?

Thank you for sharing your expertise.
Welcome to the forum.  Thanks for an articulate question and congratulations for a sober perspective on this sexual exposure -- not always the case on this forum!

Minor point, not your main question:  absence of lesions is poor security against syphilis and herpes.  Most such infections are transmitted by infected persons who don't have any visible signs of infection.  Of course this doesn't mean you were at serious risk for either one -- but for the future, I don't want you and other forum users to kid yourselves that you can protect against these infections by visually inspecting partners for genital lesions.

As for gonorrhea and chlamydia, we generally advise that non-penetrating sexual contact is risk free.  However, given the detail you have provided, with clear exposure of the head of your penis to vaginal secretions, in theory you could have been at risk for these STDs.  But I stress "in theory"; the actual risk was very low.

Given the low risk, I would not have recommended any antibiotics.  The cefixime (Suprax) and metronidazole were effective protection (or early treatment) for gonorrhea and trichomonas, respectively -- assuming of course you took the right doses, i.e. at least 400 mg cefixime and at least 1 gram of metronidazole.  The erythromycin is questionable however.  Are you sure it wasn't azithromycin?  Single dose azithromycin (1 gram or higher) would have effectively aborted an early chlamydial infection.  (And by the way, azithro and/or cefixime would have also aborted syphilis.)  However, single dose erythromycin is inadequate to prevent or cure chlamydia or any other STD.

You are correct about the time frame for effective antibiotic therapy.  Six days is plenty of time.

Most likely your more recent partner is not at risk on account of the sexual exposure 10 days ago.  But please clarify the ery/azithro issue and I may have further comments about it.

Best regards--  HHH, MD
Doctor Handsfield:

Thanks for your prompt response.

The third antibiotic was, in fact, azithromycin rather than erythromycin.  I hadn't realized that it, and the cefixime, combated syphilis as well.

I appreciate the reassurance.  Despite being outwardly calm, I am actually just as concerned and nervous as most of your standard forum users!  Less so, now.

Thanks again.

My only final advice is that you do your best to stop obsessing about a sexual decision you obviously regret.  Deal with that aspect as you need to, but at this point you can move on with no worry about any STD as a consequence.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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