Possibility of STD exposure

[student22]

Hi Doctor -

I screwed up really badly last night. I've been in a 4 year+ relationship and have been doing long distance with my girlfriend for the past year and a half. I've never cheated her before last night. I drank way too much and had unprotected sex last night with a girl who's sexual history I know nothing about. I'm freaking out and scheduled an appointment to get tested on Friday. Is that waiting long enough and can I go sooner to ease my mind? Is there anyway to estimate the liklihood I picked something up? If she did have one, say HPV, what are the transmission rates and probability that I now have it?

My GF doesn't have HPV and I have never had an STD, so if I picked it up and give it to her - she'll obviously know something was up. Somewhat unrelated, but while I have you, I'm struggling with whether or not to come clean to her (though I definitely will I have an STD); I want to because I feel so guilty, but I can't imagine losing her. Any thoughts?

Thanks -

[Edward W Hook, MD]

Friday, or even Thursday would be fine.  By then any STD like gonorrhea, chlamydia or nongonococcal urethritis will be detectable.  These are the most likely consequences of your lapse.  Syphilis is very rare in the US and most common amongst men who have sex with other men at this time.  HPV infections are common but not acquired all that often.

As for transmission rates, the per episode transmission rates very greatly, from as much as 20% per exposure for men exposed to gonorrhea to less that 1 in 1000 for acquisition of HIV, IF YOUR PARTNER WAS INFECTED and most women in the U.S. are not.  No STD however is transmitted with every exposure and in fact, most are transmitted only a small proportion of exposures.  Thus the odds are in your favor since it is likely a.) the she was not infected and b.) that if she was you did not acquire her infection.

Another possibility which may help is for you to discuss it with your recent partner and ask her to help you by getting tested with you.  In that way you can remove the major concern- that she was infected.

Finally, I cannot help with how to deal with disclosure to your GF.  Clearly honesty is the best policy but there are risks.  Only you can judge what is the right path.  EWH

[student22]

Thanks Doctor!

I wanted to follow up with a quick question. I checked with my most recent partner and she said that she gets tested regularly, every pap she's ever had has been clean, and she's been with one other partner (protected) since her last pap a few months ago. So I figure that bodes well, assuming by pap she means the battery of STD tests and not merely HPV. Is that a safe assumption/standard practice? She said that she already planned on getting tested as well.

I have one more source of consternation. I have an abrasion right beneath the head of my penis. I've looked at various herpes photos on the web and it does not look like any I've seen, however, I have become sick over the past few days (swollen lymph nodes, cough, sore throat). The abrasion is shallow and looks much like you might expect from friction, with perhaps just a thin mucous layer covering the bruise. Can HSV 2 manifest like this? It also seems too early for syphilis (< 5 days) and the bruise is still soft and slightly painful to the touch. Also - I imagine even if it is just a bruise my chances of HIV, et al. are significantly increased?

[BlueGirl13]

Depending on her doctor, she may not have been tested. You can have routine pap exams but with some doctors, unless you specificly ask to be tested for STD's, they won't.
I know my doctor didn't test me for STD's during my pap exam and when I found out I had to request them along with my pap exam. Some women are under the impression that while having a pap exam, they are tested for STD's but this isn't always the case.

If she was tested for HIV and/or Syphilis, then she would have had to have blood drawn, especially for the Syphilis. HIV can be done with a rapid swab test of the cheekline/gums. Again, doctors do not test for these unless you ask for them. If she is assuming her doctor is testing her... well, you know what assuming gets you.

Good Luck.

[mayflowers]

A PAP test doesn't test for STD's.  It may pick up abnormal cells but that would most likely be related to HPV.   Regardless, many women have a normal pap and still have HPV.  Unless she was specifically tested for STD's, she can't be sure she doesn't have one.  Go get tested yourself.  It will ease your mind.  There is no test for HPV in men but you can be tested for everything else.

[student22]

Thanks. I anticipated this response, but am hoping it is just a case of imprecise terminology on her part. At a minimum, it seemed like she honestly thought she was clean from STD's, but maybe there is some failure of doctor/patient communication in this respect. It does seem like not knowing that a pap smear is not an STD test could be a very common source of confusion.

Doctor, if it makes a difference I was going to be shocked if I did not get sick this week (flu/cold sick, not STD). My personal life is in shambles, I have anxiety and haven't been able to sleep all week, I already weakened my immune system from drinking to such excess on Saturday night, and I'm in the middle of a high pressure grad program.

[Edward W Hook, MD]

The earlier posts are correct. Unfortunately, for many people the term PAP smear has come to mean any pelvic examination rather than just the test for cancer and cancer precursors.  On the other hand, if she has regular reproductive health exams, then odds are that she is being tested for STD.  

As for your lesions.  You plan to be seen-- that is the right thing to do.,  While I suspect that what you describe is not herpes an examination is far better than for me to guess what is there based on your description (which was fine, it's just that there is no substitute for direct examination.  EWH