Need help

[mike199]

I have recently had sex with a prostitute, during this time the condom broke.
It was virginal intercourse. I went to a clinic within 36 hours of the incident. Since the prostitute was of high risk the doctor put me on PEP. 6 day later I have a burring felling when I urinate, suspect gonorrhea . If I assume she was HIV+ what are the chances I get it, considering I got gonorrhea. ?

Facts
1. Don’t know how long the condom was broken for
2. Prostitute was of black African descent
3. incubation period for gonorrhea is 5-7 days

What are my chances and what else can I do.

If I get it will PEP help will the virus eventually die if it cannot reproduce?
And what are its chances of reproducing without PEP?

[Edward W Hook, MD]

Your questions need to be clearer.  You said you had symptoms of gonorrhea.  Did you get tested?, Do you know you had gonorrhea?  Did you get treated?  

As for PEP (which I still think is a waste of time and money),- of course it could delay development of evidence of infection.  Through PEP (which you probably didn't need) you will need to wait longer to find out if you were infected.  The 6 week test will be less definitive and you will need to wait longer to get definitive word that you are not infected.  The suggestion of waiting till three months after completion of PEP is reasonable.  EWH

[Edward W Hook, MD]

If I was your doctor I am not sure I would have put you on PEP.  Even though she is a commercial sex workers(CSW), other than a very few places in the world, the majority of CSWs do not have HIV,.  If she had HIV, your odds of getting HIV from a single unprotected exposure such as yours is still less than 1 in 1000.  Your odds of side  effects from the PEP are higher although the consequences are not as dire.

As for your burning on urination- you need to be examined and tested.  A swab test from your urethra can be used both of Gram stain to tell if you have gonorrhea, chlamydia or NGU.  The stain of the swab would give preliminary information.  For the swab (in some places they might do a urine test on a specimen collected at the beginning of urination) will give you the best results if you have not voided for at least two hours before testing.

PEP is designed to help prevent you from getting HIV.  At the present time there are no good published studies of how much PEP reduces your chance of infection but it is substantial.  EWH

[mike199]

Hi Doctor,

Sorry to bother you again but I have a couple of questions.

I can the symptoms of gonorrhea subside, as this is what is happening to me. I also never had any discharge. Could it have been something else. I am having the test on Tuesday anyway.

After my PEP course has finished, when can I have a conclusive test. I read that I have to wait 3 months after the last dose is administered ergo 4 months after possible infection date. Is this true?  and if so will the 6 week test be effected?

Thanks again for your time.

[mike199]

Thanks,

Sorry for the misunderstanding, my question is, can the symptoms of gonorrhea subside after 3 or 4 days of having a burning feeling when urinating? Taking into account that I have had no discharge of any kind.

I will get tested on Tuesday

Finally what is the percentage of correctness for a 6 week test after PEP? Without it I know its about 95-98% correct

Thanks

[Edward W Hook, MD]

Still tough to answer your questions.  Symptoms deserve evaluation.  Without therapy, they can resolve, usually over a number of weeks.

The issue of the 6 week test is not known.  EWH