Stupid Mistake Advice needed

[scaredguy22]

Dear Doctor,
I have made 2 mistakes:  the first was receiving unprotected oral sex from a CSW (a female, I am male) while intoxicated, the second was trying to self-treat with antibiotics.  I took 1.5 g. of Zithromax and began 7 days of Doxy (this was prescribed, for a sinus infection), 2x100mg/day about eight hours after the event.

Next day, in a panic, convinced that 1.5 of zithromax would not be enough, I took 2 g of Biaxin at once.  I plan to take 500 mg/day for the next 3 days.

This entire issue is the culmination of years of heavy drinking, which I am finally coming to terms with by stopping drinking and seeking professional help.  I want to move on, fix my marriage (which I probably will lose if this information "goes public") and be a responsible, sober person again.

That being said, I live in a foreign country and would prefer not to test.  I've been reading that the combination of Doxy and zithromax/biaxin probably isn't ideal for eliminating gonorrhea or ngu.  In spite of my concerns about being in a foreign country, I am considering going to a GP and asking for a single dose of ciprofloxacin 500 mg.

I understand that you will probably be upset about my taking antibiotics such as these without the advice of a doctor, but could you please let me know what my chances are of having contracted gonorrhea/NGU and whether it might make sense to take the cipro?  Believe me I am never, ever doing this again.

thanks!

[scaredguy22]

Dear Doctor,
I understand.  I would have ended my thread, too.  My concern was with the possibility of negating any effects the doxy might have had on aborting incubating syphilis.  The grandmother of a friend of mine has been struck by lightening 3 times :).

Thanks again, and Merry Christmas to you and your family.

[Edward W Hook, MD]

This will be your last answer.  Doxycycline shoul not be taken with milk or milk products as they hinder its absorbtion.  So, the medicne you do not need will not be well absorbed and if your were infected cannot be counted on to reach effective blood levels.  

This will end this thread.  EWH

[scaredguy22]

Dear Doctor
I am very sorry for bothering you again. I have a question about doxy. Do i need to worry about its absorption given the fact I've been taking it with meals including yogurt and cheese? I'm actually taking 100mg x dayx ten days.
I would appreciate a response. I can't find an answer in the forum.

[Edward W Hook, MD]

Yes, I would believe your results.  that is the reason we have the tests.  EWH

[scaredguy22]

New information.  I went to an STD health care provider and he concurred with everything you have already said.  He did a swab exam for gonorrhea and examined it under a microscope.  He did say beforehand that if there were any doubt about it, we would need to wait for lab results.  He seemed very thorough with the examination of the swab -- examining it several times, adding several solutions and examining it again, etc. -- and he said that not only did he see no gonorrhea, he saw no signs of any kind of infection.

Can I believe these results, in lieu of the antibiotics I am taking?  

I understand that you will probably want to delete my further post, but I thought maybe this might influence your answer to my previous post.

thanks

[scaredguy22]

Dear Doctor,
This will be my last post.  You have my word on it, and you can hold me to it.  I am beginning therapy for my alcohol problem, and I just want to make sure that I understand this very last concern I have.

It has been 5 days since this oral encounter.  I have no signs of penile infection.  My only remaining concern would be that the antibiotics I am taking might simply delay onset of gonorrhea.  Is this possible?  Should I wait longer after finishing the antibiotics to have unprotected sex with my wife, and if so, how long?

I will take this information with me and not return again.  I know you hear this a lot.  I thank you again for being patient with me.

[Edward W Hook, MD]

The chance of your getting syphilis from the encounter you described, with the partner you described is about as likely as your getting hit by lightening.  Even if you had been exposed, between the doxycycline and azithromycin you took, you would not have gotten infected if exposed.  Syphilis is not a concern.  EWH

[scaredguy22]

Dear Doctor,
Just one last question, if I may.  I hope you will humor me and then I will forget about this whole thing.
In the extremely unlikely chance that I might have picked up Syphilis from this oral encounter, would the medications I have taken/am taking have prevented an infection from taking hold?  (1.5g Zithromax taken at once, 2g Biaxin taken at once plus 500mg/day for 3 days, 100 mg doxycycline 2x/day for 7 days)
thanks very much, I hope I'm not pushing any boundaries here.

[scaredguy22]

Dear Doctor,
Please disregard my last question.  You have alleviated my fears.  Thanks very much.  I will indeed spend my energies on other issues.

Thank you for your wonderful service.

[scaredguy22]

Dear Dr. Hook,
Thank you very much for responding so quickly, and on a Sunday.  It means a lot to me.
My only last question would be this:  when you say most gonorrhea, do you have any idea of a %?  >99%?
thanks, this will be my last question.

[Edward W Hook, MD]

Welcome back to our Forum.  Your risk of any STD from the exposure you describe is low.  Most commercial sex workers do not have STDs and of those who do, few have oral infections. Further, oral STDs are poorly transmitted to other people.  There is no meaningful risk for HIV.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection).  The amount of medication you have taken is in excess of recommended therapy for NGU so that is no longer a concern and is a dose which would cure most gonorrhea.  At this time, your chance of having an STD of any sort is so low that there is no need for additional testing, therapy or concern.

I hope this is helpful to you.  I suggest you spend your energies on other issues, not on worrying about STDs.  EWH

[scaredguy22]

I realized that "foreign country" is rather vague; I live in western Europe.  The encounter was 3 days ago.  For what it's worth, no elevated nitrites or leukocytes on a urine home test strip.