STD exposure

[englishmanabroad]

Dear Dr,

18 days ago I had protected oral and vaginal with CSW in Chinese bath house. During the vaginal sex the condom came completely off, exposing me for around 1-3 minutes. I did not ejaculate.
After 4 days I began to experience urethral awareness and increased frequency of urination. Also slight fever. No discharge, blemish, swelling or other discomfort. At 6 days I went to hospital and was tested for Chlamydia & Gonorrhea. Also prescribed Azithromycin (1000mg) & Ceftriaxone (125mg) as precaution.
Chlamydia test - positive, Gonorrhea - negative.

As I had had unprotected sex with my wife before any symptoms, she was tested for Chlamydia and got negative result. Before test result we were both prescribed Azithromycin (1000mg) as precaution aganst possible mutual re-infection.

I have had no other exposures as have been in solid relationship for 23 years. I believe my wife has also been completely faithful, so this is the only exposure.

My question now - What other STDs should I be tested for to ensure total peace of mind - HIV, HBV, HPV, Syphilis, others ? Also, at what inetrval after exposure should I insist on the tests (earliest possible for confident result please)

Can you advise on the statistical likelihood of catching other bacterial or viral infections, both in terms of unknown status of partner, and assuming she was positive in each case.

I see my risk as being statistically very low, but having contracted one STD from this mistake, I want to be sure I have nothing else and get my life back on track.

It goes without saying that this was the worst event of my life, emotionally and physically, and I have managed to wreck a good relationship by getting drunk and losing my judgement.

Thanks for your advice.

[Edward W Hook, MD]

Ti sis far, far more likely to be the sort of community acquired viral illness that most people get from time to time than any STD, including hepatitis.  There is no need for testing sooner. EWH

[englishmanabroad]

Dear Dr,

Thankyou for your support so far.

It is now 10 weeks since my exposure and in the last few days I have had what I would describe as flu like symptoms. Muscle aches, mild fever, sore throat, headache, cough, runny nose. My wife also has come down with the same symptoms.

I wonder if this could be early symptoms of Hep B. I don't have any of the other symptoms - dark urine, light stools, abdominal pain, appetite loss, itching...

Would you think it is most likely just a common cold ?

I return to UK in 2 months, and am planning Hepatitis and HIV testing then. Do you think I should arrange testing sooner ?

Thanks for your valuable advice.

[Edward W Hook, MD]

There are few good data on the risk for sexual transmission of hepatitis B. Sorry.,  Low will have to suffice.  

HIV.  If your partner had HIV, and is is unlikely that she did, the risk for sexual transmission, on average is less than 1 transmission for every 1000 acts of intercourse.  

There are data that suggest that if you already have an STD, it may increase your risk for getting HIV slightly, if exposed but no data to suggest that risk changes if you are exposred to both at the same time.  EWH

[englishmanabroad]

Dear Dr,

Thankyou for your replies, but I now have additional questions which are causing me great concern;

Could you advise what is the rate of transmission of Hep B ? You say low, but can you quantify ? Obviously the disease is endemic in China and I was, unfortunately, not immunised, so now I am very concerned of contracting this disease.

Same question for HIV.

Is there any evidence that having contracting Chlamydia will increase the likelihood of Hep B or HIV in the same encounter ?

I will get tested, but cannot do so until return to england in 3 months time.

Thankyou

[Edward W Hook, MD]

It certainly would be reasonable for your wife to also be screened for trich.

Your risk for HIV is low but testing for this is also reasonable.  A combined HIV antibody/p24 antigen test will be positive at 4 weeks post exposure or a standard HIV antibody test will give definitive results at 8 weeks.,EWH

[englishmanabroad]

Dear Dr Hook,

Thankyou for your response.

You don't mention HIV - would you advise testing for this  ? When ?

Secondly I had unprotected sex with my wife, one time, 4 days after exposure. Would you advise she is screened for Trichamonas. I have experienced no symptoms other than described in original post. It is now 19 days after the incident.

Thanks again.

[Edward W Hook, MD]

Welcome to our Forum. Sorry to hear of your condom mishap and the subsequent infection. that said, the treatment you have had would cure not only gonorrhea and chlamydial infections but would also be preventative for syphilis. thus those STDs should not be a concern.  As for other STDs:

HPV. there are no tests available to evaluate men for this virus.  Most (>80%) of people will be infected with HPV at some point in their life and you may have already been.  When people get HPV, the infection typically resolves over a period of 18-24 months without consequence.  As long as your wife gets her regularly scheduled PAP smears, HOV should not be a problem.

Herpes. We do not recommend blood tests for this infection.  If you do not develop lesion in the 14 days following your exposure, there is no reason for concern.

Trichamonas.  Occasional infection in men but difficult to detect.  In most men when they get trich the infection appears to be transient. Condom use for the 2-3 weeks following your encounter will prevent transmission.

Hepatitis B.  If you are vaccinated no risk.  If not, you risk is low.  Blood tests can rule out the possibility at 2-3 months following exposure.

Hepatitis C- not an STD

Hope this helps.  Overall, the risk that you have any other STD from this encounter is low. EWH