Preventive treatment for a potential infection - a good idea?

[Jay606]

I live in a country where if an STD is diagnosed, it will be reported to the health authorities and might result in deportation. I had protected intercourse and unprotected oral sex one-night stand with a stranger who turned out to have been promiscuous which adds to the risk of infection - but have no guarantee she was or not. That happened about 10 days ago.

3 days ago a single sore appeared on my scrotum. It's of the same color as the sac, no discharge, no puss, 1/4 inch across (fairly small) and just itches. It could be an infection or could be a mosquito bite. I have no idea. I'm wondering - should I take a 2g dose of Zithromax, and then getting fully tested at the very first chance to be in the US - around mid-April, or should I wait it out. What are the risks for each?

[Edward W Hook, MD]

I would suspect this is a coincidence.  STDs very rarely cause blood in the ejaculate.  On the other hand, the trauma of many bike seats can do this.  EWH

[Jay606]

Doc, I have just seen slight blood traces in my sperm. The sore went away a couple of days back. I'm not sure if it's biking, or a result of an infection by potentially herpes as you mentioned above - which is usually not associated with this symptom.

Is it another coincidence or do you think all the events are related?

Thanks.

[Edward W Hook, MD]

No there is no major risk to you in delaying the diagnosis by a few weeks.  EWH

[Jay606]

Thank you for valuable insight. this is fairly helpful. i have one last concern which is if i wait it out for 6 weeks is there a direct medical risk or consequence for whether it's the case of herpes mystic rare case of syphilis. thank you in advance

[Edward W Hook, MD]

Welcome to the Forum.  You will have to make decisions as to what to do (obviously).  I can provide some information and perspective to try to help.

For starters, let's get our terms straight.  You have a lesion that concerns you, thus if it is an STD, treatment would not be preventative but therapeutic, meaning that you have the infection and are treating it.  That said, a single 2.0 gram dose of azithromycin would represent therapy for gonorrhea, chlamydia, NGU, chancroid and probably syphilis, depending on where you are.  What you describe is not gonorrhea, chlamydia or NGU, chancroid is very, very rare worldwide and syphilis is also rather rare.  As to what the lesion might be, that is difficult to say.  The lesion is not in a location of the body where STDs are common and your exposure was condom protected, further reducing the already rather small risk that this is an STD.  As to what it might be, it is tough to say but in addition to an insect bit (odd place for it however), folliculitis is a possibility, as is a fungal infection or just a local "irritation" which has cause the normal irregularities present on the scrotum to become more apparent. .  If it were an STD, herpes would be the most likely bet and azithromycin would not help.

Finally, regarding issues of diagnosis, if you take the azithromycin, it will make accurate diagnosis of the things treatable by azithro more difficult.

My bias is to watch it and to not vigorously engage in self examination which could make it more apparent.  You however will need to make the decision.  

Finally however, I would add that in most countries where STD diagnoses result in the sorts of consequences you describe there are almost always places where people can be discretely be evaluated.  Your needs would be best served by being evaluated by a health care professional - I'd ask around.  EWH