std testing requirements and timeline

[cyclown]

I had an encounter with a csw 15 days ago.  This is my 2nd and last time using a csw.  The encounter began with a massage.  She had her fingers on my anus but not inside.  She then proceeded to provide oral sex which was unprotected.  As part of the oral she licked my balls, anus and everything between.  After the oral which lasted awhile we had brief vaginal sex.  A condom was used from start to finish and it appeared to hold up.  I always get nervous about that.  I blew air into it afterwards and it appeared to hold air. After removing the condom I finished by masturbating on her.  2 weeks the day after this incident, I woke up to redness on the tip of my penis and a whitish discharge which made a mess of my underwear over night.  I scheduled a meeting at planned parenthood and was examined for chlamydia and gohnerria.  A sample of the discharge was taken and examined under a microscope.  No sign of infecti infectihowever n however she mentioned this wasn't conclusive.  I also submitted urine and will get results next week.  Meanwhile I was prescribed one dose of a oral antibiotic which covers some bacterial infections.  I guess I just would like an assessment of the situation.  Is there additional infections I should be testing for now or in the future.  I am also concerned because the nurse suggested chlymidia which I understand to be difficult to transmit orally which makes me concerned there was a condom problem in which case many other risks would be prevalent.   I do believe the condom was intact so im suggesting my exposure then is the receiving of oral sex.  Which means hiv is not likely.  I clearly did receive some sort of infection and would like thoughts and an assessment.. thank you

[Edward W Hook, MD]

Final answer.  Fourth generation tests for HIV are conclusive at 28 days following exposure.  Third generation, antibody only tests are conclusive at 8 weeks.  For you however, as I've said before, testing is a waste of time and money.  

End of thread.  EWH

[cyclown]

Thanks again. I believe you.  I know you said I do not need to test but   When would those tests I took be conclusive?  I am about 3.5 weeks post exposure? Dang.    That's it. I will try not to bother you again.  I really appreciate it  

[Edward W Hook, MD]

Your wife's doctor has, once again, proven that he/she is not well informed about such matters.  Further, you are now susceptible to assurances from the people who are selling you the tests you took.  While the negative results that I am confident you will get from the third generation HIV antibody test and the test for HIV virus (a PCR test I suspect) are strong evidence that you were not infected (as I said earlier), they are not definitive based on published scientific studies.  

You need to decide where you want to get your information and stick with it.  You can be confident that if you ask many different people you will get many different answers.  If you wish to believe your wife's doctor, then do so and you should not need to post here again.  On the other hand, if you choose to believe what I have said, then you should do that and again, should not need to post further.  Either way however, you need to address the continuing guilt that you apparently feel over your misstep.

This will end this thread.  I hope my comments have been and will be helpful. EWH

[cyclown]

Hi again Dr.  Let me know if i am supposed to pay again or post to another forum.  Well I didn't sleep a wink last night.  My wife's doctor told her she was very surprised to hear that I contracted gonnorhea from oral sex.  This got the mind racing replaying my encounter specifically with regards to the condom material coming out of her vagina, checking the condom and thinking it was ok, blowing air into it and thinking it's ok, wondering if it was actually mine etc.  Just pure panic.  I decided I had better test or I am going to lose my mind.  I did a whole std panel which included 3rd gen hiv plus the test that can look for the virus itself?  They said that can be decisive after just 2 weeks?  I get my results back next week.  I know you think I had no risk for hiv and you absolutely know what you are doing but my mind just seems to go to dark place regarding hiv.  I emailed the csw regarding the gonnohrea.  She was appreciative that I let her know.  She said she was negative 2 months ago for hiv and she tested last week but didnt have the results yet.  Of course that got me thinking that if she does test positive I will have been with her when she was most infectious and had an active std.  Ughh.  I guess I could just use a quick pep talk if you have a second.  I need to get some sleep and your words are very meaningful and soothing.  Thanks again.  You are really helping me in a dark time.

[Edward W Hook, MD]

Your wife's doctor is misinformed about how HIV is transmitted.  There is no reason for concern.  

Your white tongue is not a manifestation of HIV.

Please do not worry.  EWH

[cyclown]

One other thing.  My tongue is white.  Is this a common effect of the anti-biotics?   Thanks!

[cyclown]

I am starting to freak a little about hiv.  My wife's doctor told her there is a risk based on my behavior and that she will need to test again in 6 months from the last time her and I had sex.  Sounded like this doc may not be up on what is and what isn't a risk for infection nor testing guidelines?  I guess my last question is if you were me would you test for hiv over this instance and what would you say to my wife related to what her doctor said. Thank you so much!

[Edward W Hook, MD]

Straight to your questions:

1. when comdoms fail they break wide open leaving no doubt that they have failed. There is no reason to test used condoms by blowing into them or filling them with water. When they fail, it is obvious.

2.  No, with oral sex risk for other STIs is independent of whther or not you got gonorrhea.

3. Azithromycin is safe and widely used for children. That your wife is breast feeding should not be a problem.  EWH

[cyclown]

Yes you were correct regarding the 2g of azithromycin.  Would this also be safe for a nursing mom as my wife was prescribed this. She only nurses 1 or 2 times daily and my daughter is 4. This is a follow up to the above.  I thought I read somewhere nursing moms need to be careful. Thanks again and this should be my final comment.  I appreciate it

[cyclown]

Thank you for the response.  I guess I would like to ask a couple more questions if I may.  1.  Are condom failures super obvious?  I blew air into it at the end of our session because I was nervous about how it looked and it held air like a balloon. Also the csw appeared to have a remnants of a broken condom inside of her which came out during intercourse. This is when I stopped as I was freaked out and was the reason I blew air into it. 2.  Does the fact I picked up gonohrra increase the likelihood of additional infections from this incident from oral or what I think was protected vaginal sex necessitating additional testing?.  3.  My wife is still breastfeeding.  Are these antibiotics safe for her.  Our daughter is 4 and nurses once or twice a day for comfort.  Thank you so much.  I really appreciate it.  This is a very tough time for me and I really hate myself for my behavior and you are helpful

[Edward W Hook, MD]

With a positive test for gonorrhea, it s more likely that your infection was acquired from receipt of oral sex than from condom failure.  

I presume the antibiotic you receive was 2.0 grams of azithromycin.  If it was, this should be effective therapy.   EWH

[cyclown]

Sadly I tested positive for gonohrrea.  I have received an additional 2 grams of antibiotic.  I am very concerned about this.  I understand its harder to get this via oral so I question condom failure.  I dont think it did.  Is it obvious when this happens.  Given this diagnosis does anything change regarding your assessment or recommendation?  Thank you!!

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  This may or may not have been an STI.  I'll address each possibility.  First, STI-wise your major risk is from receipt of unprotected oral sex.  Following receipt of unprotected oral sex, if you were going to get anything, the most likely consequence would be nongonococcal urethritis, followed by gonorrhea, and then very, very rarely, chlamydial infection.  Your symptoms really don't sound like any of these.  You don't mention burning or urination and the discharge you describe is larger than what we usually see with these infections, being large enough to "mess up" your underwear overnight.  If you did have these, I suspect that you received azithromycin, the medication recommended for NGU and chlamydia and which would cure most gonorrhea.

My guess however is what you experienced was a "nocturnal emission" of genital secretions.  Such things do occur from time to time as men sleep and are unrelated to sexual activity.

Either way, I suspect there is little to worry about at this time.  If this were one of the more common STIs, you have received curative treatment while if not, this may have been an occasional but normal event.  Unless your STI tests come back positive which I doubt will happen, I would not worry further.  I see no need for additional testing for STIs.  EWH