Brasil Sexual Contact

[almeja]

Recently I took a trip to Brasil.  I had sexual contact with a prostitute.  During the trip, before the exposure I developed a heat rash.  She performed oral sex on me and I performed oral sex on her.  We also had vaginal sexual intercouse with a condom. There may have been exposure to her with the heat rash.

I came back from my trip and my wife and I had sex.  A day later, for fear, I went to the clinic and had a shot and they gave me antibiotics for Clamidia and Gonorrhea.  I took a urine test and it was negative.  But the urine test was only 3 days after exposure.

I abstained with my wife for another week. We took a trip and had sex in a hottube.  2 days later I think I am constantly discharging ( clear like Urine ) but because of my previous problem with a colon cancer resection and being prescribe flowmax for pressure issues I was not sure. Then I started to have a burning feeling at the tip of my penis.

Since this I developed a cole sore in the mouth lasted about a week.  And my wife developed a cole sore on her lip.  She has frequently had cole sore in her mouth and lips so I was not alarmed.

I came am waiting for results of a swab test.  I have since been given more antibotics.

My questions are:

1) Can you get clamidia and/or Gonorrhea from oral sex? Because everywhere except here it says its possible.
    a)  how fast can it incubate if the exposure is from oral contact instead of penis contact? Is there a difference?
2) Can I get Syphilis from Oral sex ( either giving or recieving) ?
3) Can I get syphilis from genital contact while wearing a condom, especially if I had a rash already?
4) I received Zithromax 250 mg 8 tablets on the second Dr. visit.  Would that get rid of Syphlis?  I ask because I want to get tested for Syphlis but if its already wiped out then I will not know.

any info

[almeja]

Dr thanks.  One last point.  The sore in my mouth , actually on the inside of my bottem lip, appeared 3 weeks after my contact. I understand that this cannot be syphilis because of the first **************.  It is clearing up and is not really noticable to the eye.  I cannot say what it looked like because honestly I had too much fear. To be safe  I will get tested for herpes just to know.
Regards

[H. Hunter Handsfield, M.D.]

I missed that you had taken cipro so soon.  That treatment made the first urine test meaningless, but it also would have prevented most bacterial STDs except syphilis -- and that was covered by the other antibiotics.  And even if you had been exposed to syphils, your wife was not at risk:  syphils is not transmissible before the initial chancre (syphilitic sore) appears, and that takes at least 2-3 weeks.  Syphilis is definitely not a concern for you or your wife.

As for your genital/urinary symptoms, I suggest you follow up with your urologist.  Whatever the cause, it is unlikely you have anything that presents any health risk for your wife.

[almeja]

Doctor,

please allow me to elaborate.  I was diagnosed with stage 3 colon cancer 6 years ago.  I had a colon resection and chemo.  In January I had 2 problems..either conected or not.  I had an umbilical hernia and a lot of pressure in my prostate.  I first went to my Primary and he gave me Cipro 500mg to see if that would clear up the pressure in my prostrate.  I did not take it.  Mostly I just did not feel that was the course I wanted to take.  So I visited a urologist, he reviewed my prostate and prescribed Flowmax.  I also did not take that because I reveiwed the side effects I and they seemed a bit extreme.  And since I am only 38 I did not want to be reliant on the drug for years.
2 months later I had a hernia surgery.  Oddly that seemed to relieve some of the prostrate pressure.

I mention the Cipro because I had it in my travel bag...for no reason it was there with some other old medicine.  After the encounter I took the Cipro 3x every 12 hours. I had the Cipro before having sex with my wife.

I did not have enough space to explain that I am married w/ 2 young children.

I am not as concerned about the Gonorrhea because by my estimation that should have ridden any Gonorrhea before I went home and had sex with my wife.

I use the word heat rash but a few time a year I get "jock itch" and in my first days in Brazil I got a rash from the heat and humidity.  that happened 3 days before I had any contact.

To your point about the 1st SDT test ( urine ) that was done before the 1st antibiotics were given to me.  that proved negative.  
I returned to the Urgent Care after 3 weeks after the first visit.  Had sex with my wife just once and then 2 days later I had serious pain at the tip of my penis.  I went again yesterday and got a swab test done ( should have the answer tomorrow ) but they alos gave me a Zithromax.

I know its a lot to absorb...but my main concern is my wife having Syphlis because that seems to be the only possible STD that could be transmitted to her from my encounter.  And passing the passing of Syphlis to my wife.

After all of these antibiotics can Syphlis be detected?

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  There's a lot going on here, but I'll try to sort it out.

You had a low risk sexual exposure.  Oral sex is low risk and it is unlikely you caught an STD from vaginal sex with a condom.

I don't know what you mean by "heat rash".  That's not a standard medical term, and it doesn't mean the same thing to all people.  Heat does not cause skin rash.  Probably this did not increase the risk of any STD, but I can be more certain if you describe exactly what you mean.

Was your urine specimen collected before the antibiotics?  If so, the result is reliable; 3 days is not too soon for accurate testing for gonorrhea and chlamydia. The later discharge from the penis cannot be due to either of them.  I doubt it is due to any STD, but more likely related to your prostate/bladder problem for which you take Flomax.

Sores inside the mouth usually are not called cold sores, which only occur on the outside of the mouth.  There is a slight possibility you have a new herpes infection from the commercial sex worker, but probably not.

To your specific questions:

1) Gonorrhea is possible from oral sex; chlamydia is not.  Chlamydia rarely infects the mouth or throat, and therefore cannot be transmitted that way.  (You are correct that many apparently authoritative sources are unaware of this.  But trust me on it.  If genital chlamydia is ever caused from oral sex, it is very rare.)

2-4) Syphilis rarely can be caught by oral sex, and possibly of the penis by skin contact above the condom.  But the antibiotic treatment -- both the injection (which probably was ceftriaxone) and the Zithromax -- would have cured an incubating infection.  At this point it is not possible you have syphilis.  There is no point in testing for it now.

So at this point the only uncertainty probaly is the oral sore.  It cannot be syphilis.  Most likely it is a canker sore, i.e. not an STD and not herpes.  But if it continues, continue to work with your doctor about it.

I hope this helps.  Best wishes--- HHH, MD