STD/HIV transmission risk from single protected encounter with CSW

[assg13]

About five days ago I had an encounter with a CSW in Singapore. She was from Ukraine or Russia. I'm a 32 year old caucasian male. We had protected oral sex (she put condom on with her mouth), then protected vaginal sex (same condom as oral), then another protected oral (new condom, again put on with her mouth). I came once, which was immediately upon inserting for protected vaginal, and stayed in for about 1 minute. No signs of condom failure, I pulled out with the condom still completely on and intact, and I checked condoms for leaks with "water balloon test" after (no leaks).

I have been freaking out. The morning after, I visited a doctor who specializes in STDs. He said nothing to worry about with HIV given the condom use. He said that other STDs transmitted by bodily fluids were also unlikely but to look out for urination pain and discharge. He took blood to test for HIV and syphillis anyway (came back both negative). He took urine for gonorrhea and chlamydia testing (no result yet). He also prescribed zithromax (1g, single dose) and a 10 day course of doxycycline just in case.

After reading a lot, I understand that, based on the epidemiology of these STDs, including HIV, and the various studies out there that I'm extremely low risk (or even no risk, because of condom). I'm still freaking out, however. I imagine this has something to do with feelings of regret, guilt, etc. I've been constantly checking my genitals and probably am too focused on that area.

I'd like to know what you think. The doc I saw in Singapore seemed knowledgeable but from reading your answers to others' questions, I have a strong belief in your credibility and expertise. What do you think my transmission risks are for the various STDs? HIV has particularly been freaking me out. Again, this was protected oral + vaginal + oral with a CSW. Thanks in advance.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Your question may be one of those in which the title alone has enough information for an accurate reply.  The large majority of sex workers don't have HIV, and condoms work.  The odds of catching HIV or other STDs from a single episode of condom-protected vaginal or anal sex is always very, very low -- usually zero for practical purposes, especially for HIV.

Now I have read the question itself.  The details do not change my assessment.  Moreover, the advice you had from your doctor is exactly what I would have said -- it suggests he is knowledgeable about STDs and his perspective can be trusted.  (I would not have prescribed any antibiotics at this point, but that's a judgment call and I don't fault him for doing so.)

So no worries.  Frankly, I wouldn't even have recommended any STD testing -- although it still has value if the negative results give you still more confidence about it.

I hope this has been helpful.  Best wishes--  HHH, MD

[assg13]

Thanks Dr. Handsfield. What you and Dr. Hook do on this forum is a wonderful service.

[H. Hunter Handsfield, M.D.]

I agree with your self-analysis.  I'm confident that your anxieties are just making you notice minor body sensations that otherwise you would not be aware of.  

That should end this thread.  Take care and stay safe.

[assg13]

Thank you again, Dr. Handsfield. One last follow up. I've noticed today that I've got a very slight burning sensation when I urinate. It isn't painful, but I do notice it. No discharge or pus of any kind. My logic tells me this shouldn't be a symptom of an STD like gonorrhea or chlamydia since I've been taking the antibiotics now for about 6 days. However, maybe my logic is off? Of course, I can't rule out that this is my mind playing tricks on me, either. This whole matter has driven my anxiety levels up (not to mention regret, guilt, etc). That said, your evaluation and advice on this forum for me (as well as others in similar predicaments) has certainly helped to assuage my worries! Thanks!

[H. Hunter Handsfield, M.D.]

From a medical or risk standpoint, I do not recommend testing for HIV or any other STD -- especially given the antbiotic therapy.  If I were in your circumstance, I would not have taken any antibiotics, would not be tested, and would continue unprotected sex with my wife.  You can safely do the same.

[assg13]

Thank you Dr. Handsfield. I very much appreciate your reply, advice, and confirmation of the other doctor's advice.

A quick follow up question (though I'm sure I have a sense of what you will say). Should I go and get std testing back home (in the US) including HIV? If this is completely unnecessary then please tell me. I am in an otherwise monogamous long term relationship, so would I also be safe to get back to having sex (unprotected) with her?

If there's a chance of having something and I infected her that would be awful so getting tested may make sense. What do you think?

Thanks again. I really appreciate your prompt and clear advice.

[H. Hunter Handsfield, M.D.]

Coated tongue occurs all the time from minor viral infections, diet changes, oral hygiene issues, etc.  And, as you suggest, as a side effect of several antibiotics, including doxycycline.

It's no problem to address HIV along with other STDs, or vice versa on the HIV prevention forum.

[assg13]

Just to briefly update... I've noticed that my tongue has a whiteish-yellowish coating. Nothing painful. No sores or anything like that. This emerged around 5-6 days after my stupid mistake. Could this just be a side effect of the doxycycline?

Thanks Doc in advance for answering my question. I know this is the STD forum (not HIV) so I apologize for mentioning HIV also. My concerns are obviously going to focus more on the more serious STDs that I'm worried about, but I'm concerned about all and any STDs. Thanks so much.