Unprotected sex with CSW in Korea

[Scallywag6979]

Hello Doctors,
I posted about 5 years back.  At the time, I had a girlfriend but was not married.  I quit drinking after my last incident because of how stupid I was.  I am now married.  I recently took a new job that has taken me to Korea.  My new coleagues talked me into going out with them and I wound up getting a CSW and being extremely stupid.  I gave her unprotected cunnilingus.  We had vaginal sex with a condom.  We took a shower afterwards and I had unprotected vaginal sex with her in the shower.  I am trying to gauge my risk.  I know I am at much higher risk for STD's other than HIV.  I am not extremely worried about HIV anyways, as I know from your other posts that most CSW's do not carry it.  She is from the phillipines and says she is here to support her children.  It has been 4 days and I am feeling a little bit of a tingling feeling in the tip of my penis and there is a small bump about mid shaft that I didn't notice before.  I am thinking about going to the clinic and just getting treatment without testing.  I would like to get azithromycin for chlamydia, Ceftriaxone for Gonorrhea, and a penicillin shot for Syphilis.  Do you see a problem with this?  I have 3 weeks until I go back home to my wife and I want to clear up anything I can quickly.  I am circumsized and have to open wounds/sores either on my genitals or my mouth.  She says she is clean, but I have to wonder.  I'm assuming my overall risk is low, but you never know for sure. What would you give me for advice in my situation?  Thank you for your time.

[Scallywag6979]

I realize this is most likely an anxiety fueled question, but I have to check.  I have had random tingling in my penis and scrotum on and off for the past 2 months.  Is there any way this could be crabs and I just cant see them?  It seems unlikely that I could have crabs and not be itching like crazy all the time.  Just a question, sorry to bother.  My next post will be my results of testing.  Thank you.

[Edward W Hook, MD]

The manufacturers of the RNA tests and those who make money from selling them will tell you that they can diagnose HIV at 10-14 days however these tests are not approved for HIV diagnosis in the U.S.  they do detect many infections earlier than other tests but are more expensive and have a higher false positve rate than approved tests.  The earlierst approved test of a combined HIV p24 antigen/HIV anibody test ( aso-called "DUO" test which will provide definitive results at 4 weeks.  I would ait if I were you. Your risk for HIV is low.  EWH

[Scallywag6979]

Forgot to mention it is the RNA test.  I read it is 99% accurate at 10 days and gets more reliable from there

[Scallywag6979]

Doctor,
I am back in the states and have been offered the "Early detection" HIV test, which my doctor says can detect it in 10 days.  Is this true?  How reliable is it?  Thank you.

[Edward W Hook, MD]

Your risk for syphilis is quite low.  Spectinomycin however has no activity against syphilis.  Personally I see no meaningful need to worry about syphilis however- it is a far rarer illness than gonorrhea.  EWH

[Scallywag6979]

What effect does this have on your earlier comment about the ceftriaxone and azithromycin protecting against syphilis?  Obviously, I have not taken the azithromycin, just wondering if I should

[Edward W Hook, MD]

I presume that it was a urine or penile test that was positve for gonorrhea, correct?  If so, the answer is yes, spectinomycin is highly effective against gonorrhea.  Spectinomycin however is not effective for pharyngeal gonorrhea.  EWH

[Scallywag6979]

Doctor,
I tested positive for gonorrhea, negative for chlamydia.  The doctor here in Korea gave me spectinomycin instead of ceftriaxone.  Is this as effective?

[Edward W Hook, MD]

An ELISA test tests only for antibodies to HIV and proivdes defintive results at 8 weeks.  The DUO test tests for both antibodies and the p24 antigen of HIV and is positive earlier, giving reliable reults at 4 weeks.

I suggest you stay off the internet, both for "information" and, if possible, for testing.  EWH

[Scallywag6979]

Doctor Hook,
What is the difference between ELISA and DUO test?  I used www.stdtesting.com before, just wondering how effective this is at 4 weeks.  Thank you.

[Edward W Hook, MD]

My answer has not changed.  The cefriaxone and azithroumycin would prevent syphilis.  EWH

[Scallywag6979]

Thank you Doctor, one more hypothetical question for you.  I got tested today for gonorrhea and chlamydia, after a week, when the results come back, do you still feel the ceftriaxone and azithromycin would prevent any syphilis at that point?  Thank you.

[Edward W Hook, MD]

A DUO test at 4 (not 3) weeks will provide you with defintive infomration about the likelyhood of HIV.  EWH

[Scallywag6979]

Hello Doctor,
Thank you for your reply.  When is the absolute earliest I can test for HIV?  I want to do it at 3 weeks, but I have no idea how accurate that would be.  Also, is a pins and needles feeling all over my body a symptom of any STD or am I just being anxious?  Thanks for your help.

[Edward W Hook, MD]

Welcome back to the Forum.   Your major risk related to this encounter was your unprotected vaginal sex with a commercial sex worker.  As you point out, your greatest risk is for acquisition of gonorrhea, chlamydia or NGU and that risk is rather low.  Your risk for syphilis and HIV is lower still.  We do not recommend treatment without being first evaluation for the STIs listed above at a minimum.  the reason for this is that it provides useful information should you develop concerns or symptoms in the future.  Further we don't typically recommend treatment of the sort you suggest without a diagnosis.  If you feel strongly about getting treated "just in case" I can understand this but again, urge you to be tested for.  If you do decide to go with treatment, if you take ceftriaxone and azithromycin at this time these would not only cure gonorrhea, chlamydia and NGU but would also prevent syphilis.

I hope this helps.  Please get tested.  EWH