Confused about exposures

[concernedscaredafraid]

Thank you in advance Dr. HHH and Dr. Hook. Oct. 13 I had unprotected oral sex with a former co-worker (Im a male she is a female) and protected vaginal sex. I had no symptoms or problems after this encounter. On Oct. 18th I had lap dances / bare penis to vagina frottage (no penetration) with a stripper/csw. Monday Oct 21  through Oct 27th I had numerous protected vaginal sex encounters with a new partner (she had just got out of a relationship said she wouldn't put it past her ex-boyfriend cheating on her towards the end) throughout that week I performed unprotected oral sex on her numerous times for long periods of time. She performed unprotected oral sex on me twice. We had a lot of protected vaginal sex but always protected with no condom breaks. There was unprotected frottage without penetration the first night we were together. Throughout the week I had painful urination and a white discharge in my underwear. I got a full STD screening (which included HIV DNA test which as negative) syhphillis test negative, ghonnorea negative, but my chlamydia came up positive. Ive seen Dr. Hook indicate chlamydia is vanishingly rare through oral sex without obvious sores but what doesn't make sense to me is that all my vaginal exposures have been protected so it seems I could have only contracted chlamydia via oral sex. Could the frottage have caused me to get chlamydia? and if so should I fear more serious STDs or HIV? I have been treated for the chlamydia and I will follow up to make sure I'm now negative but I'm not sure if I should reasonably fear any other STDs in this situation. I told my partner and she will get checked out as well I hope she is ok. Thank you for your time and expertise Drs.

[Edward W Hook, MD]

Your chlamydia was explained in my earlier reply.  There are cases of chlamydia acquired through oral sex but it is quite rare.  You were unlucky.  Repeat testing soon after treatment for chlamydia is not recommended because tests can detect DNA from dead chlamydia.  It is not clear that you needed further therapy although it probably not needed.

As for HIV, no change in my assessment or advice.  You are not at risk and do not need further testing. EWH

[concernedscaredafraid]

I recently tested positive for chlamydia took four pills from the doc and re-tested a week later with another positive test. I've since received anti-biotics again and I hope it is gone, when should I re-test?

I see you all repeatedly saying that chlamydia is not transmitted orally but besides frottage I only had protected vaginal sex so I don't understand how I  could have become positive for chlamydia and if it came from vaginal contact should I fear HIV as it is much easier to contract during co-infection or when you already have an active std (+ its csw contact)???

The only other possibility I can think of is unprotected intercourse I had with a female four months ago for which I reliably tested negative for hiv afterwards but I never had any common std symptoms however the reason I don't think that is entirely plausible for the chlamydia is that I only had symptoms the last week of Oct 2013, would it be possible to have caught it four months ago and take that long to develop symptoms? wouldn't my bodies immunes response be quicker? Does that mean I must have got chlamydia from the csw/stripper? and if so how much does a negative NAAT test at 11 days help in ruling out HIV?

Thanks docs!

[concernedscaredafraid]

Thanks so much Dr. plus I also have a negative PCR 11 days post frottage with csw/stripper and 8 days after any frottage with my new g/f. Does that prove in the case of frottage HIV would be impossible? Thx so much for the help you and Dr. HHH provide its an invaluable service. Also thanks to the Docs on international forum thx so much.

[Edward W Hook, MD]

the treatment would be the same whether you had chlamydia or NGU. the only reason I mentioned the difference is that non-chlamydial NGU is more common following oral sex.  It sounds like you have responded to thearpy.  I would not worry further.

Your repeated questions about HIV do not change my assessment or advice. There are no instances of HIV related to frottage or receipt of oral sex.  EWH

[concernedscaredafraid]

I also performed oral on new g/f unprotected many times over the last week if that helps your analysis any. Thanks again Dr.

[concernedscaredafraid]

CSW was only frottage / lap dances (no penetration sex) + no oral sex

former co-worker was protected vaginal sex with no condom break and unprotected oral she performed on me

my new g/f we had frottage, we gave each other oral sex, and had protectd sex with no condom breaks.

Thank you Dr.

[concernedscaredafraid]

Thank you Dr. I read some of you and Dr. HHH's previous posts and I thought NGU made the most sense but the nurse told me I was positive for chlamydia. She gave me some pills but actually shortly before I took any pills my symptoms had been improving. I'm no longer having symptoms but really based on what I read from previous posts I thought for sure it must be NGU so I was surprised when the nurse said chlamydia. Is there a difference in what kind of treatment/medicine I need to receive assuming my health care provider may have mistaken chlamydia for what could in fact be NGU? or should I not worry since I'm having no symptoms at all in the days after taking the pills? I also went to planned parenthood earlier today and got another test for ghonnorea and chlamydia. I hope both will be negative since the treatment and previous testing from last Tuesday. What really concerns me and eats at me is the frottage is it really 100% for sure I couldn't have got HIV from that? Further, if it is in fact chlamydia,  must I have got it orally considering all vaginal penetrative sex was protected (without condom breaks)?

[Edward W Hook, MD]

Welcome back to the Forum.  I'll be pleased to comment.  The exposures you describe were low risk.  There is no meaningful risk for HIV or other STIs from masturbation or frottage.  You are also correct that I have indicated the to get chlamydia infection from receipt of oral sex is vanishingly rare and indeed that is the case.  But vanishingly rare is not none and you have been a busy fellow in the past few weeks.  It is entirely possible that  you acquired chlamydial infection from receipt of oral sex from one of your recent partners.  Simply a matter of being in the wrong place at the wrong time, i.e. bad luck.  (Just as a clarification, are you sure that your test for chlamydia was positive.  You are also a candidate to have gotten nongonococcal urethritis from the oral exposures you describe and many health care providers mistakenly think that all NGU is due to chlamydia.)  Either way, the fact is that you had urethritis of some sort (chlamydia  or NGU) and should be treated, as should your recent partners (difficult to say which person you acquired your infection from).  I would not worry about other STIs, including HIV.   Despite having gotten chlamydial infection however, there is still no meaningful risk for HIV from the exposures you describe.

I hope that these comments are helpful to you. EWH