time before symptoms and transmission?

[whatdewidew]

i had sex about 3 weeks ago with a stranger who told me she was "clean"... it was on a sunday. by thursday i started to feel an "itching" or vague inflammation in my penis. by saturday i had slightly painful urination. after 2 weeks , the burning persisted. so, i went to the urologist. he did a scope. he did NOT test for chlamydia or gonnorhea. he didn't see anything of concern  in the scope.  i informed him my wife was diagnosed with chlamydia about 6 years ago and we both took pills. i never had symptoms. i never had a follow up.  i asked if it was possibly the cause. he couldn't say. he never told me whether or not i had chlamydia. he prescribed doxixycline on "spec" based on what i told him. after having the encounter with the stranger, but before developing any symptoms, i had sex with my wife. in both encounters, i received brief oral, followed by brief vaginal sex without a condom (1-2 minutes), then sex with a condom. the sex with the stranger was followed by a shower in which i scrubbed my penis with soap and water. my questions are...

1. do you think the infection was caused by the soap? or perhaps the "warm sensations" condom? i read that spermicidal lubricant can cause uti's.

2. is it worth getting tested now after being on the antibiotic for 3 days? will chlamydia still show up if that's the culprit?

3. what are the chances i passed it on to my wife based on the fact that  i hadn't yet had any symptoms andshe gave brief oral (unprotected) and we had brief uprotected sex  (1 minute) and then full sex through to ejaculation (protected)?

[H. Hunter Handsfield, M.D.]

Several lessons here.  1) Your urologist might be great, but certainly should have tested you for common STDs before doing urethoscopy.  As a generalization, urologists aren't very knowlegeable about STDs.  2) Doxycycline would adequately treat most STDs likely to cause your symptoms.  3) Oral bacteria probably can causee urethritis, perhaps explaining some cases of nongonococcal urethritis in monogamous persons.  4) Soap and other chemicals, such as spermicides, indeed can cause symptoms that mimic infectious urethritis.

The bottom line is that chlamydia would be a good bet, but there is no point in testing now that you're on treatment.  If you had chlamydia, your wife is at risk.  To protect your wife's health, and to prevent possible reinfection if you infected her, it would be best for her to be tested for chlamydia and gonorrhea.

Good luck--  HHH, MD

[whatdewidew]

my wife was diagnosed with chlamydia 5 years ago. what are the chances the antibiotic they gave us at that time didn't work for either her or myself and that one, or both, of us has been carrying it this whole time? also, my wife was diagnosed with displaysia a year ago and had surgery. since, from what i've read, there's no real way to know for sure how long she had chlamydia before it was diagnosed, is it possible that they  her problems were caused by the effects of having chlamydia for a long time? final question...i don't know how to broach the subject of telling my wife she should get tested for chlamydia and gonnorhea. i really don't want to bring it up unless i'm sure it's what i had and i'm sure i didn't get it from her (i.e. got it from a stranger) and i'm sure i passed it on. so, i'm wondering again, what the chances are (percentage wise) that if i contracted chlamydia from the one time interaction described above with a stranger  that it got passed on to my wife during the brief 30 seconds we had unprotected sex...again, i had no symptoms at that time and it was a mere 3-4 days after having sex with the stranger. i read on this site that if you get tested within 2-3 days after having sex with a  partner infected with chlamydia that chances are it's too early to tell and the test will come back negative. so, is it safe to assume that if it's too soon to show up on a test, that it's also too soon to be transmitted?...especially during a brief exposure of 30  seconds or so?

also, this may be outside your area of expertise, but if my wife does have chlamydia and does NOT show any symptoms, what are the chances her ob/gyn will discover some sort of infection during regular check-ups/visits? she's been going on follow ups since her surgery. they wouldn't see any new infections in their routine check ups, would they?

please understand, if my wife has an STD, i want her to get treated. but i don't want to unnecessarily destroy our marriage only to find out she doesn't even have anything. would be very shakespearean, no?

thanks for all your help!

[H. Hunter Handsfield, M.D.]

Sorry, my friend.  You are rationalizing.  All of the business about past (treated) chlamydia, timing of sex, and brevity of sex with your wife cannot change the basic facts:

1) You had the highest of high-risk encounters.  A person willing to have sex with a stranger is, statistically, at the highest possible risk of carrying an STD, even higher than if she were a prostitute.

2) You developed symptoms a few days later; both the symptoms themselves and the timing were right for gonorrhea or chlamydia. (In my first response, I said the soap might be the cause.  That was wrong.  When soap causes painful urination, it starts immediately, ie within minutes.)

3) You had sex with your wife after your high-risk encounter and before you were treated.  That is a very high risk period for transmission.

It certainly is possible you didn't infect your wife.  But how much are you willing to risk her health?  What if there is "only" 1 chance in 10 she is infected?  What if it's 1 in 100?  Her doctor may or may not pick up the infection during a future exam, but probably not, in which case she may never know anything happened.  On the other hand, she might develop pelvic inflammatory disease; or if you and she want kids in the future, she might simply (and quietly) become infertile.  And since none of this may happen for several years, you will be anxious about the outcome all that time.

Those are the facts; the decision is yours.  I don't have special advice about how you break the news to your wife that she needs to be checked for gonorrhea and chlamydia.  She also should be treated, even if her test is negative.  Shakespearean or not, that scenario has been playing out in millions of relationships since STDs were first discovered.

I will be interested to see if some of the women who visit this site will have comments.

HHH, MD

[mamabear28]

Doc,
You have tempted me with your final statement about the women who visit this website weather they would leave a rsponse or not, well here I am I am going to leave that response!!!!!

I am not here to pass judgement on the fellow who has posted the original question but I do have to add that what right does he have to risk her health and her future? We all make mistakes in our lives that will haunt us for ever but what is worse knowing that he may have infected her with a STD and not telling her or telling her and dealing with all that comes with it. He should also be thinking that it could be worse he could have infected her with a life long illness, at least this one can be cured if found. If he truely loves her he would tell her because his quilt alone will ruin him. Be honest the truth can only set you free. I know alot easier said than done but it is what is right.

[Christie2004]

Years and years ago, my husband told me he "was afraid to tell me he had contracted Chlamydia from a used towel".  As a nurse, I know this is not the truth, but quietly went to be tested and then treated.  

I left him an article about Chlamydia and its modes of transmission, and let him know if he continued to pursue risky behaviours with "used towels", he had better find another place to live.  

We never had another problem.  If a relationship is strong enough, it will survive somehow.

[whatdewidew]

if your thought is that "if a relationship is strong enough it will survive", why didn't you confront your husband directly? a bit hippocritical i think. anyway, since we've delved into morality, i left out that my wife moved out on me citing she wanted a divorce and for all i know, since the symptoms showed up just after having sex with my wife, i may have gotten the chlamydia from her after someone she had slept with gave it to her. this isn't an issue of "only men cheat". so i don't know why you were so interested in seeing what the women would think.

thanks for the medical and moral advice anyway. i sincerely do appreciate it. but i'm not going to let paranoia scare me into doing something that might save us both the pain of a divorce due to infedilety. first i'll find out if and how she got infected...

[monkeyflower]

It's not "morality", nor is an issue of only men cheat. The issue here is that you may have given your wife a disease that could make her infertile. I'm certainly not judging you for having other partners, but accepting the consequences of your actions is part of being a responsible adult.

So, the ethical, honest, caring (yes, caring) approach would be to tell her what happened so she could get tested. If that results in a divorce, at least you showed that you loved her enough to be concerned about her health. The other approach would be to let her find out on her own, once she develops PID and becomes infertile. I wonder which one would make her angrier... and which one would really drive her out the door.

I would strongly urge you to get counseling, either together or individually. I think there are clearly much deeper issues at work in your relationship that need to be addressed.