What is the likelihood I contracted an STD?

[kevindc]

I recently had unprotected sex with someone I met over the internet (a sex worker).  It was supposed to be oral only, but I couldn't climax so she mounted me for about 15 seconds before I ejaculated.  I did not have a condom on.

I take full responsibility for my actions, I sacrificed 13 years of monogamy for a moment of bad judgement, and I'm totally freaking out.

I went and saw a doctor at a walk-in clinic, and he sent me to the lab for a urine sample (chlamydia and gonorrhea) and blood work for HIV.

He said that if I did get anything, it was likely chlamydia or gonnorrhea.  He also told me that the HIV was more for my own piece of mind, as since the incident occured 48 hours ago, it would not show up right away, and to be sure I would have to be tested in the future.

Questions:

1.   If I did contract chlamydia or gonorrhea, would it show up after 48 hours?  If I get a negative from the lab, will I have to be tested again to be sure?  If so, how long should I wait?

2.   What are the chances of getting HIV?

3.   Are there other STD/STIs I should be screened for?  Should I be worried about syphilis, hepatitis, herpes, genital warts, etc?  Being monogamous for so long, I've never had to worry about this or educate myself.

4.  At which point in time (if I remain symptom free) can I breathe a sigh of relief and commit to NEVER doing this again?

By the way, I live in Canada, in British Columbia, I think the infection rates, etc, might be similar to the US, but I don't know so I offer that information for your consideration.

Thanks Doctor for taking the time to answer my question.  I am guilt-ridden, stressed to the max, and am willing to do whatever it takes to get this behind me.

[Edward W Hook, MD]

Welcome to the Forum. Your risk of getting an STD from a single unprotected encounter with a commercial sex worker is low.  Although there rates are higher than the general population, most CSWs do not have STDs and even if she did, STDs are only transmitted in about 20% of exposures.  thus, even before testing your risk of infection is rather low.  As for your specific questions:

1.  If your tests are negative, you do not have gonorrhea or chlamydia. while it can take longer for symptoms to occur, the tests would be positive at 48 hours.
2.  Miniscule. the chance that your partner had HIV is very, very low (1% or less) and HIV is transmitted at a rate of about 1 infection for every thousand sexual exposures.  
3.  The only STD I would worry about is nongonococcal urethritis (NGU) which is diagnosed by detection of increased numbers of white blood cells in the initial portion of a urine specimen or a swab taken from the penis.  The other STDs are less of a concern and the tests for them are not recommended. should you develop symptoms you should be evaluated.
4.  Your tests will tell the story for gonorrhea and chlamydia. Testing for syphilis (unlikely) would be positive by 4-6 weeks following exposure.  Testing for HIV would be definitive at 6-8 weeks.  There is no need to test for herpes. If there are no lesions by 14 days, you did not get HSV.

Hope these comments are helpful.  EWH

[Edward W Hook, MD]

You should ask the doctor if you were tested for NGU. Testing for gonorrhea and chlamydial infection is not the same as testing for NGU although the same specimen can be used. EWH

[Edward W Hook, MD]

The doctor is incorrect. Some docotrs think all NGU is caused by chlamydia.  That is wrong, less than half is.  I would ask someone else.  Perhaps your local STD Clinic. EWH

[kevindc]

My results for both chlamydia and gonorrhoea came back negative.  I went back to the doctor and asked to be tested for NGU, he looked at me really funny, and said that that is no specific test for NGU, but since I'd been cleared of chlamydia I was also clear of NGU. ??  

Granted, I don't have a family doctor, and I'm going to a walk-in clinic, so is it possible this gentleman is not fully versed in STDs?  Or is what he's saying true?

He basically told me that if I was negative for chlamydia (most common) and gonorrhoea (next most common) I should just move on.

Advice?  Should I find another doctor?

[Edward W Hook, MD]

Yes, NGU can certainly be dignosed at 5 days.  In my exerience taking antibiotics in the fashion you suggest tends to confuse things going forward.  EWH

[kevindc]

I'm getting my results back tomorrow (Monday) for chlamydia and gonorrhea.  I was unable to get in touch with the Dr to see if he could order NGU be included in the test (it was a Friday).

Over the weekend I have been having a slight discomfort, mild burn, etc at the tip of my penis. Since I'm still a little freaked out, I'm having difficulty determining if it's for real or just in my head.

Once I get my results back, assuming they're positive, I'm going to revisit the Dr and ask to be test for NGU.

If I was infected with NGU, would it show up this early (5 days)?

Is there any harm in getting a round of antibiotics without a diagnosis, or am I just being paranoid?

[kevindc]

Thanks Doctor for taking time to respond to my questions.

I feel a little better, and am looking forward to my results (Monday).  You cannot imagine the education I've taken away from this experience.

One follow up question: if NGU is a concern, do I need to specifically ask for this screening?  

Or would it be picked up in a regular urine specimen for gonorrhea or chlamydia?