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Risk assessment and guidance

Dear Dr,

I am having a lot of anxiety over a recent encounter and I wanted to get you assessment on my risk.  

I am a man...I had protected vaginal and unprotected oral (received) with multiple (2) csw's in Hong Kong about 5 weeks ago.  Post exposure I started doxycline for anti-malarial protection (am traveling/working in South Asia and was belated told to use for malaria prevention ).

I have not had any discharge or other symptoms that I am aware of...

My anxiety is based on the fact that I will be meeting my significant other in a few days and I am worried about exposing her.  I will not be able to get a screening before meeting her.  Should I be concerned and look for a way to avoid sexual contact?

It would seem my main risk would be asymptomatic ghonnerria?  Clearly I would like to get tested but until then I need to manage risk.  Avoiding contact will put a strain on the relationship (as would the truth, unfortunately)

Appreciate your thoughts and guidance.

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936016 tn?1332769204

Yes, I can see a tricky problem for you.

Doxycycline can be used to treat syphilis, chlamydia and also gonorrhoea and also NSU.

For NSU and chlamydia we typically use a dose of 100mg twcie daily for one week. For syphilis we use 200mg twice daily for one month - although doxycycline is not the ideal treatment for syphilis as at this dose it tends to cause significant side effect and this causes people to discontinue it early. Doxycycline can be used for gonorrhoea but again, typically we will use something else as gonorrhoea has a high resistance pattern and is often ineffective.

My advice would be that whilst overall that it is unlikely that you will have acquired gonorrhoea etc the best course of action would be temporary abstinence. I can see that that would cause issues - as would telling her as you say. I suspect though that accidental infection with something would cause a mega disruption.

best wishes, Sean
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