Assess symptoms and advise for tests

[Gunta0011]

Hello doctor,
I had a incident of condom burst for 4-5min with CSW on 30-July-2010 and I kissed her and unprotected oral sex for 5min. I didnt find any sore or blood in her mouth. I am from India

After that on 22-Sep-2010(23th day from exposure), I had gone for following tests
1) Uretheral swap for Gonorrhoea
2) Herpes simplex(1+2) IGM ELISHA
3) TPHA test
4) Chlamydia IGM antibodies

all turned negative.

I had following symptoms
1) 4 red rashes(Sharp pointed, very small and not in same place) of 1-2mm size is there in my back(mostly upper and middle) near spinal cord. I had burning sensation on it.
2) I reduced by 2.5-3kgs. I feel really hungry like normal but due to heavy anxiety, depression and stress I couldnt able to eat properly.
3) Slight burning sensation on tip of my penis but no pain. I dont know this happens because I dont drink enough water.No other symptoms on penis.
4) No other symptoms like fever but sore throat yes.. Recently maximum temperature I had is 99-99.5
5) Because of stress I feel like body pain, tiredness and everything.

My questions are
1) What are the risks of getting STD from exposure?
2) Does my test results conclusive?
3) How early I can get 100 conclusive result from result of exposure for the following STDs?What are those tests for these STD's?
            a) Herpes(1+2)
            b) Warts
            c) Syphilis
            d) Hepatitis(A, B, C and others)
            e) Gonorrhoea
            f) Chlamydia
            g) NSU
            h) TPHA
4) How early I can get 100% conclusive test using blood tests for the above said STD's?
5) During my childhood I had immunity injection for Jaundice and triple antigen - Is this good for Hepatitis immunisation?
6) What other STD's i need to go for tests?
7) Is there any of these STD's doesn't have permanent cure?

Apologies for so many questions doctor. I am really concerned even small changes in my body I started noticing as a symptoms.  

[Edward W Hook, MD]

Further questions will be deleted without comment.

1.  No tesing needed
2.  By examination by a knowlegable clinican.

Thread is over.  EWH

[Gunta0011]

Thanks for your answers again..

I dont know how to appreciate for your prompt and good and fine answers..  Just not fine its excellent answers

I have already told you that I had hepatits B immunity injection 10 years back..

1) But if I need to go for Hepatits A/C/others tests what is the best time to for it after exposure? Is it blood test is enough or any other test available?

2) I have gone through all other threads and in that yourself and Dr.Hunter have advised that Warts testing is not recommendable as it is not standardised but then how it is diagnosed, treated and when? Coz there are pep smears tests are available? This question I have asked generally as many can benefit by reading your answer from this thread.

I have asked too many questions, I am sorry about it.. I promise this will be my last question in this thread..

[Edward W Hook, MD]

1.  Blood tests for chlamydia are not recommended.  the way to prove or disprove the presence of chlamydia is with a urine or swab test.
2.  You do not have herpes and I recommend against further tests.  

EWH

[Gunta0011]

Thanks for your comments..

The information provided on American Social Health Association is very helpful..

Few questions to verify
1) Is Chlamydia IGM antibody test after 2-3 weeks of exposure is confirmatory?
2) For Herpes, they say mostly symptoms occur in first 2-20 days after exposure.. If I didnt get any symptoms within first 3 weeks and my antibody tests @ 3weeks negative, does this suggest the results are conclusive? Or should I need to go for tests @ 12th week after exposure for confirmation?. If I go for antibody test 6th week is it conclusive?

Please advise..

[Edward W Hook, MD]

You are anxious and it is your anxiety that is a problem more than anythng else.  I will not continue to feed your anxiety with answers to anxiety driven questions. These will be your last answers. After this further questions will be delted without comment.

1.  Tests for herpes in the absence of an putbreak are more likely to lead to false positve results than infection.  HPV tests are not recommended- they are not standardized and do not help to guide therapy for men.  You said you were vaccinated for hepatitis.

2.  See comments above about testing for HPV and hepatitis.  Gonorrhea and chlamydial testing will be accurate at any time more than 2 days after your exposure.

3.  the TPHA is a blood test for syphilis, not NSU.  NSU is diagnosed with a swab or urine test as I have already said.

4. Given you history, the rash on your back is not herpes or warts.

5.  That is the ASHA web site.

End of thread. EWH

[Gunta0011]

One more thing.. The website you have mentioned is http://www.ashastd.org.. Isnt it?

[Gunta0011]

Thanks doctor for your comments.. You can see how much worried I am. I am getting up in the middle of the night and replying to your thread answers...

Actually my worries are mostly about HSV(Herpes), HPV(Warts) and hepatitis).

I am looking at each new rashes on my body and thinking this might be HPV or HSV.

1) You have mentioned that no tests needed for HSV or HPV. Please advise why?
2) what is the best time to go for these tests(HPV, HSV, Hepatitis, Gonorrhoea and chlamydia) after the risk of exposure?
3) My doctor said TPHA test is good for NSU. Please confirm this or advise if there is separate tests?

The problem is there is no good gum or sex clinics in India(Bangalore). Even if they are there, mostly treat only HIV and not others..

Just to double confirm the red rashes I specified in my back which is burning and itching. Can this be releated to symptom of Herpes or warts?

[Edward W Hook, MD]

Welcome to our Forum.  I am sorry to hear of your recent experience with condom failure. this happens about 1% of the time.  Despite the condom failure however it is unlikely that you got an STD from the exposure you describe.  Most people, even commercial sex workers, do not have STDs, including HIV and even when they do, it is unusual for an STD to be transmitted following a single sex act. Your negative initial tests are further evidence that you do not need to worry.  As for your symptoms, none of them are highly suggestive of STD and all are seen regularly in persons who are anxious and/or guilty over such an exposure.  With regard to your specific questions:

1.  See above. the risk is low.
2.  Your tests for syphilis (urethral swab) and TPHA test for syphilis are conclusive. The other tests are suggestive but not conclusive.
3.  You have made a long list of infections you are worried about.  I will not comment on the best test for each infection.  I will tell you that there should be blood tests performed for syphilis (which you have done), hepatitis, and HIV.  Swab or urine tests should be done for gonorrhea (done) chlamydia and NSU.  No testing is needed for HSV or HPV.  
4. this varies and depends on which disease. Discuss this with your doctor.
5. If this was a hepatitis vaccine it should protect you from hepatitis B.
6.  None
7,  This is not an important question unless you have that infection. I doubt that you will.

To summarize.  You appear quite anxious and probably overly so about your risk for STDs from the exposure you describe. In actuality your risk is low.  Try not to worry.  You can learn much about STDs by reading other posts on this site.  Alternatively, there is excellent, highly informative information available at the web site run by the American Social Health Association.  (Disclosure. Dr. Handsfield and I are both members of the American Social Health Association Board of Directors.)  

Take care. EWH