Welcome to the STD forum. I'll try to help.
I'm not sure this event qualifies as such a big mistake -- except if you didn't use a condom, which you don't mention. Did you use a condom? If so, it is almost impossible you have an STD. Even unprotected, several factors are working in your favor. Among other things, STDs are all transmitted inefficiently: even if your partner was infected, most people exposed a single time to gonorrhea, chlamydia, herpes, syphilis, etc do not become infected. Anyway, most if not all Amsterdam sex workers are tested regularly for STDs at no cost, and my understanding (from Dutch STD colleagues who are also close personal friends) is that STDs are uncommon in this setting.
The only possible STD explanation of the urinary discomfort and other symptoms that you describe, starting only 2 days after exposure, is gonorrhea. It is conceivable the test missed it, although unlikely; testing at 5 days is highly reliable. However, the resolution of your symptoms after the antibiotics could mean you had an early infection that now is clearing up.
As for other STDs, your symptom started too soon. Herpes could start as soon as 2 days, but usually takes 3-5 -- and the intial symptoms are genital blisters/sores; and herpes symptoms would not be clearing up so soon. The earliest possible symptoms for chlamydia is 7 days, and its 2-3 weeks for syphilis. HPV causes no symptoms at all unless and until visible warts appear, and that takes several weeks. And no, there is no point in getting tested for HPV, and no readily available tests for it -- certainly none that are FDA-approved, as you are aware. You're going to get it someday -- all sexually active persons acquire genital HPV somewhere along the line -- and when you do, it will be asymptomatic and will cause no important health outcomes. And in the event you find someone who will test you, and the result is positive, there is nothing to be done.
As for the penile "rash", your description doesn't sound abnormal and I suspect you're just looking too closely. But if you are convinced something has changed, see a health care provider about it, preferably a dermatologist.
As for further testing, there is really little point. Syphilis makes no sense, since the antibiotics you were given would abort an incubating case, so the test would never become positive even if you had an early, undetected infection. HIV mgiht make sense, for peace of mind -- but not if you used a condom. Finally, HSV testing is never recommended in such a low risk situation. But if you want to pursue this anyway, get tested 3 months after the event.
All in all, I see no need for continuing concern. If I were in your situation, knowing what I know, I would just move on, without further testing.
Good luck-- HHH, MD
Thanks so much Doctor for the quick & detailed response.
The intercourse was in fact protected -- but the condom was provided by the sex worker, so I don't know how reliable that was. In fact, I think it was in her mouth before being placed on my penis.
I will try to patiently await the results of the latest blood tests for Herpes, Hepatitis B/C, and Syphilis and will get re-tested for these as well as HIV in a couple of months. Unfortunately, I have been having trouble sleeping as this incident has been really troubling me. I am trying to calm myself down, but it's really tough.
Thanks again Doctor.
Condom protection means no risk of any STD that could possibly explain your symptoms. I continue to recommend against any further testing, especially in view of condom use. It is not possible you caught hepatitis B, and contrary to common beliefs, hep C is not sexually transmitted (the only proved sexual transmission occurs in gay men exposed to substantial amounts of blood through traumatic anal sex).
I don't quite get why you would think a condom provided by a sex worker wouldn't be fully reliable. Sex workers know condoms! And of course they have a strong interest in using reliable ones; after all, they are at far higher risk of infection from their clients than the other way around. And what do you mean by "reliable" anyway? If a condom doesn't break wide open, it was reliable; i.e. all latex condoms are totally reliable in preventing STD/HIV transmission if they don't rupture.
Really, mellow out. You're overreacting to an emotionally frought circumstance. It shouldn't be all tough "though" to calm yourself down. Accept the common sense reality of zero risk for practical purposes and move on with your life. Further testing truly isn't necessary -- if positive for anything, it will be necessary to examine other risks for infection, because it simply isn't possible you caught anything in this event. But it's your money.
Thanks Doctor. Your comments are really helpful.
I guess my emotional distress is caused by the shame and guilt feelings that I have. I come from a religious background and I cannot stop thinking about the sin I have committed. Also, losing my virginity to a sex worker isn't exactly what I had envisioned for my first sexual experience.
From a physical health perspective however, your comments have been really helpful. I really appreciate it.
Feelings like yours are exactly one of the problems with rigid religious conservatism as a framework for education about sex and sexuality, which basically denies normal biological and psychological impulses. Compared with more tolerant approaches, such religious upbringing not only risks guilt and shame reactions, but the kids exposed to it have higher rates, not lower ones, of unwanted pregnancy, STDs, teen marriage, and early divorce. You might look up a newly published book called "Red Families v. Blue Families..." (partial title), authors Cahn and Carbone -- which I just finished reading. It addresses these and related issues. It isn't too late to learn!
This isn't intended to start an ongoing dialog about religion and politics. That should be all for this thread.
Hey Dr. Sorry to bother you again, but I have been reading a little bit about HPV, and I am really worried that I may be carrying the high-risk strains (16 and 18) that cause cervical cancer in women without even knowing it.
Is there really no test for HPV in men? According to this study, the HPV virus can be found in the patient's semen and some sperm banks actually test for that using the DNA PCR test:
The reason I am asking is that in my country, people abstain from sex until they get married. I am afraid that if I get married someday I may pass the HPV virus to my wife - who would be a virgin at the time. If I'm at high risk of having the high-risk strains, I would have to disclose the fact that I am not a virgin and recommend that she takes the Gardasil vaccine (provided that she's within the right age range). Disclosing the fact that I am not a virgin can cause some serious problems - especially for my family. What is my risk of carrying the high-risk strains?
Sorry, this is pointless. First, the odds you got infected with HPV 16 or 18 after a single episode of sex (the only one in your life), while using a condom, is almost zero. Second, do not be tempted to trust online testing sources. There are no reliable tests for HPV in men. If a test is positive, you cannot do anything about it -- and all HPV infections go away on their own anyway. And if negative, it will not prove you are not infected; the tests used in semen probably miss more than half of all infections in men, maybe 80% of them.
Please accept the reassurance you have been given. And try to stop stop beating yourself up over normal human behavior.
That will be all for this thread. I will have no further comments.
Dr. Handsfield. I am so sorry to bother you again, but I have a follow up question about my symptoms. I just got the results for the HSV I/II IgG test (taken at 23 days after the incident) and they're negative. I know it's too early to confirm that for sure.
However, I still have the following symptoms: noticeable pain in urination, intermittent tingling/itching in the penis, intermittent pain in the left testicle and epididymis (more noticeable at night when I'm lying down). Also, the urethra seems a little inflamed - more noticeable with an erect penis.
I am on the 3rd day regimen of 100mg/cap doxycycline (with 4 more days to go) and I was given 2000mg of azithromycin as well as an anti-biotic shot of some kind on May 28.
Do you think my symptoms are related to a bacterial infection? Shall I just be patient and wait for the symptoms to go away or should I be concerned about another kind of infection like a yeast infection?
"That will be all for this thread. I will have no further comments" meant what it said. Read my previous replies. You have no STD. Any more comments and I will delete the entire thread -- and you may not start a new thread with the same questions, which would also be deleted without reply (and without refund of the posting fee). Please read the Disclaimer message at the top of the fourm.
Sorry about that. No more questions. Thanks for all your help.