STD Symptoms

[Macker1225]

Thank you for all of the valuable info posted on this site.  If possible, I request Dr. HHH to reply to this post since I read similar posts from past.
I'm middle aged M and othwerwise healthy.  40 days ago I made huge mistake.  I had contact with an F asian sex wrker.  She rubbed my penis with her hands for 10-15 min., then performed oral sex on me for 1-2 min.  I ejaculated into her mouth.  Approximately 12 hrs after the incident, I had an irritation sensation on the outside of my penis which lasted for approximately 1 1/2 to 2 days.  I've had no blisters, no lesions, no sores, no warts, no discharges, no burning sensations while uriniating, etc.  Only potential sign would be the skin irritation feeling.  

34 days after incident, I consulted my dr, as I was (and am) feeling high anxiety.  Based upon my description, he believed the initial irritation feeling to be psychological or as a result of the amount of time my penis was rubbed by hand.  He believed the STD risk to be quite low.

We ran some blood antibody and urine tests, which came back as follows:
HIV: negative
Herpes HSV-2 (IgG): negative
Syphilis: negative
Chlamydia: negative
Ghonorrea:  "weak" positive

We didn't test HSV-1.  He thought I would have shown symptoms by then if newly infected.

dr prescribed injection of Ceftriaxone (1G Rocephin) and 100MG of Doxycycline caps twice daily for 10 days.  I did the injection and am in midst of caps.

Just under 6 wks have now passed since incident.

1  Should I still worry about any of the STD's that I have tested neg (perhaps some of the tests require longer windows)?  Or, are the chances too slim to suggest addt'l testing.
2  Should I be concerned about other STD?
3  Should I feel sure that I am clear of additional STD reactions from this contact?  
4  Do I need to be retested for Ghonorrea after the Ceftriaxone 7 day period has passed?  I read there are no reports of resistant strains to Ceftriaxone.

more ?'s in next post...

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.

You had a low risk exposre from an STD/HIV standpoint.  No STDs can be transmitted by hand contact with genitals or elsewhere on the body, and oral to penis STD transmission is relatively uncommon and is only possible for a few STDs.  Second, the penile "sensation" did not reflect any STD, becuase no STD (or any other infection) can start to cause symptoms 12 hours after exposure.  2-3 days is the minimum.

In any case, the negative tests are valid.  Syphilis was tested a little early, since it can take 6 weeks.  But that's such a rare outcome in cases like yours that it isn't worth repeating that test.

I don't know how to react to a "weak positive" gonorrhea test, which is a rare outcome with modern gonorrhea tests.  Catching gonorrhea by oral sex is possible, but urethral gonorrhea is rarely without obvious symptoms, with pus dripping from the penis and usually painful urination as well.  Probably you didn't have gonorrhea.   But in case you did, you were adequately treated for it.  (In fact, over-treated.  You received 8 times the normal dose of ceftriaxone [125 mg], and the doxycycline also would be effective against most gonorrhea cases.)  To the specific questions:

1-3) You should have no further STD worries of any kind after this event.  For sure you are clear.

4) Retesting for gonorrhea is sometimes recommended several weeks later, but the reason is not that treatment fails; it almost never does.  But many people with gonorrhea or chlamydia are at high risk for catching it again.  However, you probably never had it, and if there are no more sexual indiscretions, you obviously will not be at risk for reinfection.  So don't worry about retesting.

5) Discussed above.

6) Testing for HSV-1 isn't necessary.  (Neither was HSV-2. which is virtually impossible from oral sex, since infected people rarely have HSV-2 in their mouths.)  Your doctor is correct that if you had caught herpes, you would probably have known it; and in any case, over half of all adults in the US (more in many other countries) have HSV-1 from childhood, so your result probably would have been positive -- with no relationship to the sexual exposure you are worried about.

You should look at this episode as over and done.  You didn't catch anything and all is well.

I hope this helps.  Best wishes--  HHH, MD

[Macker1225]

a few more questions continued...

5  what does a "weak positive" result for gonorrhea mean?
6  Should I have been tested for or be tested for HSV-1?  Or, would that have shown itself by now if new?

Thank you.

[Macker1225]

Thank you for your response.  I certainly can't ask for anymore positive of a response than what you provided.

For my own education, can you explain a bit on test accuracy and timelines for my tests mentioned above?  I am just trying to understand why CDC provides such longer time references as compared to the 34 day tests for me that you are so sure about. I suppose your answer takes into account all of the factors: tests, lack of symptoms, type of contact, etc.  I appreciate and accept your original answer.  I am just trying to understand it.

Lastly, my longterm F monagomous partner has had a history of yeast infections.  Could this have contributed to the "weak positive" gonorrhea test?

Thank you

[H. Hunter Handsfield, M.D.]

I'm not sure what differences between CDC and my advice you are referring to.  I already commented on syphilis, for which 6 weeks is pretty much standard advice by all authorities.  And there is no argument that gonorrhea and chlamydia testing is reliable within a few days exposure.  My comments really weren't pertinent to HSV-2, since there was zero risk of that infection and most experts would not have recommended herpes testing at all in this situation.  But most of the commercial tests turn positive within 5-6 weeks in around 80% of infected people, although it takes 3 months to approach 90-95%.  (Some infected persons never develop postive results.)  For HIV, almost 100% of new infections show up on modern blood tests within 5-6 weeks, but many authorities continue to adhere to the somewhat outdated advice about 3 months for definitive testing.

Your partner's yeast infections have no bearing on the gonorrhea or any other test results.

[Macker1225]

Thank you again for your very helpful information.  I had not seen some of these stats b4, so thank you for clearing it up.

So, not to be repetitive, but in the end are you saying that I am at no risk based upon the previous details provided?  

Or, should I still go back and have HIV restested since that test was made at less than 6 weeks (34 days)?  

Would you have recommended HIV testing in the first place?

I read different things on the risks from receiving oral and am unsure if the potential acquisition of gonorreha in the "weak positive" result would create a reason for more concern on the HIV retesting.

I guess looking back at your initial response, you seemed quite certain that all is clear.

In any case, thank you for all of the help.  I look forward to your answers.  This will be my last post.

[H. Hunter Handsfield, M.D.]

"I guess looking back at your initial response, you seemed quite certain that all is clear."

Yup, you got it.

That's all for this thread.  Take care.