STD incubation periods and source of infection

[quite_concerned]

I’m female. As of 10/2008, I was HIV, HPV & STD free. On 11/15/08, I had an unprotected oral & vaginal encounter with a male of unknown status, Person A. My test results are as follows: 12/21/08: NEG for Gonorrhea, Chlamydia & HIV. 12/22/08: NEG for Syphilis. 3/15/09: NEG for HIV. March 16th - 21st, 2009: I had several unprotected encounters (oral, anal & vaginal) with another male of unknown status, Person B.
More test results: 3/17/09: Person B tested NEG for HIV, 3/29/09: I tested NEG for Gonorrhea & POS for Chlamydia. 4/5/09: Person B tested POS & was treated for Chlamydia & tested NEG for Gonorrhea, Syphilis & HIV (Venous Blood Draw). 4/11/09: I was treated for Chlamydia w/one dose Zythromax & tested NEG for HIV.
4/20/09: I was tested for Bacterial Vaginosis, Trich, Yeast, Chlamydia Gonorrhea, HIV (Venous Blood Draw), Syphilis, Hepatitis B, Hepatitis C,  HSV1, HSV2 & *all* test results, with the exception of BV & HSV1 were NEG. I was treated for the BV with 500mg of Flagyl daily for 10 days. I understand the pathology around HSV1 & do not have any concern. 5/3/09: I tested NEG for BV, Trich, Yeast & HPV. Note: All HIV tests unless otherwise indicated were via the Unigold Fingerstick method.
Questions: What are the incubation periods for the following STD’s: Chlamydia, Gonorrhea, Trich, HIV, Syphilis, Hepatitis B, Hepatitis C & HSV2? What is the likelihood that I contracted Chlamydia from Person A? Understanding incubation periods as well as my results from the December test for Chlamydia (NEG), would it not stand to reason that I contracted Chlamydia from Person B & *not* Person A, especially since Person B tested positive for Chlamydia? It is important to note that I never did discover if Person A had been tested for anything, however they did *claim* to be STD free. As I have not had *any* sexual contact since 3/21/09, what would be the absolute best, most definitive date to test to ensure that I am completely free of any & all STDs, but especially HIV?

[Edward W Hook, MD]

Dense but very helpful.  When we diagnose STDs of any sort in clients they typically ask 3 questions - "who gave this to me, How long have I had it?  and What can you do about it".  Usually we can answer only the last question.  In your case, while we never say never in this business (or science in general), given the dates and times of encounters and testing it is far more likely you got infected by person B and, as shown be subsequent testing, are cured.  

The incubation periods for different STDs are quire variable.  Based on your 4/20 and, to some degree, 5/3 tests you can be confident that you do not have gonorrhea, chlamydia, trichomonas, or syphilis.  As for hepatitis C, it is not an STD for heterosexuals unless you had receptive rectal intercourse and even then it would be most unusual for you to have acquired this.  it really is not worth worrying about.  For HIV, a negative test 8 weeks following your last encounter is definitive so while your 4/20  result strongly suggests you did not get HIV, "definitive" testing would be any testing after 5/16.  For hepatitis B and HSV-2, in the absence of symptoms and based on your results to date, the chances that you acquired these is close to zero but blood tests at any point beyond 3 months would be considered definitive.

Hope this helps. EWH


Hope thishelps.  EWH

[Edward W Hook, MD]

You are correct.  Take teh results at 90 days (which I predict will be negative) and accept them.

Hepatisi A is spread throguh fecal oral contact.  Thus your mouth had contact with his anus or some other part of his or your body went directly from his anus to your mouth there is some slight risk,  If not, no reason at all for concern.  Parethetically, more people get hepatitis A from resturants than through sex - far, far more.  Take care.  EWH

[quite_concerned]

Thanks again for your time and your replies, Dr Hook.

So to wrap up this inquiry, based on your initial and subsequent replies, it would seem that in your professional opinion, I could (and should) accept the 90 post exposure test results for any and all STD/STI's referenced above as definitive. Is that correct?

Finally, given my history, do you think there is *any* risk for Hepatitis A, especially given the receptive rectal intercourse with Person B?

Thank you in advance for your time and reply.

Kind regards,
Kate

[Edward W Hook, MD]

Your request is repetitive and I really can't repeat myself.  Please re-read my answer.  In my  opinion, 6 month re-testing for any of these is a waste of time and money.  

Your risk of hepatitis C remains so close to zero that I really do not think it is worth testing.  If you must, a 3 month result will be reliable.

Over 60% of American adults have HSV-1.  The great majority of them have oro-labial herpes.  That your test is postive menas the virus is in your body, probably living in a nerve root gonglion.  You may occasionally have asymptomatic shedding of that virus even in the absence of lesions such as cold sores.  On rare occasions, asymptomatic shedding can lead to transmission of the virus to another, un-infected person.  EWH

[quite_concerned]

Dear Dr. Hook,

Thanks so much for your very comprehensive and expeditious reply. I really do appreciate your time and effort as well as the valuable service you and Dr. H provide via this forum. I do, however, have a few follow up questions.

Given that my last sexual encounter of *any kind* was 3/21/09, in order to be completely confident that I am indeed free of any and all STD/STI's,  including *all* of the following:

Bacterial Vaginosis
Trich
Chlamydia
Gonorrhea
HIV
Syphilis
Hepatitis B
Hepatitis C
HSV2

would it be best to test at 90 days (3 months) post exposure and then again at 180 days (6 months) post exposure to ensure definitive test results, or would tests taken at the 90 day mark prove definitive for all of the STD/STI's listed above?

As for Hepatitis C, I did have receptive rectal intercourse with Person B, so do you think I have cause for concern, even though my test for that on 4/20/09 came back NEG. That said, should I also be concerned about Hepatitis A?

Finally, with regard to testing positive for HSV1, am I correct in my understanding that a majority of the population will test positive for this; it is something that I could have accquired in my childhood; and just because I tested positive for it does not mean I have an active case of HSV1, only that I have, at some time in the past, been exposed to it and have the antibodies in my system.

Dr Hook, I apologize for asking such specific questions as well as what may appear to be the repetitive nature of my request, however, I am trying to bring closure to my concern and your expertise with regard to these specific questions will help me do just that.

Kind regards,
Kate

[quite_concerned]

I apologize for condensed and rather direct the format of this question, however, I kept running up against the 2k character limit and wanted to be sure you had all of the details. I also wanted to thank you for the valuable service you provide through this site. I sincerely appreciate your time and effort in answering my inquiry and eagerly await your reply.

Kind regards,
Kate

[quite_concerned]

Once again, Dr. Hook, thank you for your quick and comprehensive reply.

I sincerely appreciate your time and expertise and my mind is now at ease, except for this new concern about dining out (just kidding, of course!)

But on a more serious note, thanks again for your time and for providing such a valuable service. It is much appreciated.

Kind regards,
Kate