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Oral Sex-Testing Periods
Good Morning Doctors,
I have spent a fair amount of time on the site, and have come to the conclusion that my risk, from unprotected oral sex would be HSV1/HSV2 and Gonorrhea / NGU. My exposure was eight days ago, and at the five day mark I decided to have confidential testing done, the full panel despite the risks to be somewhat contained to the mentioned STD's.
My tests came back negative for everything (as expected based on risk and testing window) except for HSV1, with an IGG score for hsv1 of 2.75. My questions are as follows:
I have read that the Gonorrhea and Chlam test can be accurate at 2-3 days, is it conclusive at 5 days? Should i repeat this test at 7 days if it is not conclusive? The lab provider told me it is not conclusive until 7 days.
In terms of HSV1, with my antibodies showing up five days after exposure, with no rash to speak of at this time, can i safely assume that this was a pre-existing case of HSV1? I have had cold sores previously. Do you show antibodies from a new infection that quickly after exposure (5-8 days)
Thank you for your help -
I have spent a fair amount of time on the site, and have come to the conclusion that my risk, from unprotected oral sex would be HSV1/HSV2 and Gonorrhea / NGU. My exposure was eight days ago, and at the five day mark I decided to have confidential testing done, the full panel despite the risks to be somewhat contained to the mentioned STD's.
My tests came back negative for everything (as expected based on risk and testing window) except for HSV1, with an IGG score for hsv1 of 2.75. My questions are as follows:
I have read that the Gonorrhea and Chlam test can be accurate at 2-3 days, is it conclusive at 5 days? Should i repeat this test at 7 days if it is not conclusive? The lab provider told me it is not conclusive until 7 days.
In terms of HSV1, with my antibodies showing up five days after exposure, with no rash to speak of at this time, can i safely assume that this was a pre-existing case of HSV1? I have had cold sores previously. Do you show antibodies from a new infection that quickly after exposure (5-8 days)
Thank you for your help -
MEDICAL PROFESSIONAL
The gonorrhea and chlamydia tests never reach 99% reliability; they max out at 95% or thereabouts, probalby within 3-4 days of exposure. However, the conclusiveness of a test does not depend on test performance alone, but on the likelihood of having caught something combined with the test result. Combining your exposure history plus the results you already have, you can be absolutely certain you have neither gonorrhea nor chlamydia.
You need to stop over-thinking it. Do not look for reasons that you might actually be infected; you are not. If you want to have another HIV and syphilis blood tests after 6-8 weeks, feel free. Otherwise stop testing on account of the exposure described.
That will be all for this thread.
You need to stop over-thinking it. Do not look for reasons that you might actually be infected; you are not. If you want to have another HIV and syphilis blood tests after 6-8 weeks, feel free. Otherwise stop testing on account of the exposure described.
That will be all for this thread.
So given the fact that there have not been any tests / studies on when the naat test is deemed "conclusive" for chlamydia / gonorrea?
In terms of overtesting, I was offered a pcr coupled with an antibody test from one service, that wanted 599.00 for this test. A pcr at 5 days? For something as low risk as insertive oral sex?? Luckily, I had spent some time on this forum and knew better.
Additionally, to further your point, I called a few STD / HIV helplines and much of the data was either too dated to be useful or just plain inaccurate. The thought that you could be paired with a testing service would be ideal, simply because from all my online research, there was not a single person more accessible who is as knowledgeable as you are.
Sorry for the follow up question re: my test results, just trying to determine when I can be assured I am not infected with chlamydia and gonorrhea. Sounds like such level of conclusiveness has not been studied (I.e. Negative tests at xx days post exposure are 100% conclusive etc)
In terms of overtesting, I was offered a pcr coupled with an antibody test from one service, that wanted 599.00 for this test. A pcr at 5 days? For something as low risk as insertive oral sex?? Luckily, I had spent some time on this forum and knew better.
Additionally, to further your point, I called a few STD / HIV helplines and much of the data was either too dated to be useful or just plain inaccurate. The thought that you could be paired with a testing service would be ideal, simply because from all my online research, there was not a single person more accessible who is as knowledgeable as you are.
Sorry for the follow up question re: my test results, just trying to determine when I can be assured I am not infected with chlamydia and gonorrhea. Sounds like such level of conclusiveness has not been studied (I.e. Negative tests at xx days post exposure are 100% conclusive etc)
MEDICAL PROFESSIONAL
Some additional comment about online testing services in general: DO NOT GET SUCKED IN by offers of tests that are unnecessary or, at best, controversial. For example, testing for Ureaplasma or Mycoplasma are rarely if ever recommended or necessary, even for the most comprehensive STD testing. (Testing for Mycoplasma genitalium might be useful in a few circumstances, but only as directed by an experienced clinician.) Testing for Trichomonas vaginalis is not recommended unless the online service offers a nucleic acid amplification test (NAAT); culture for trich misses most infections. Finally, standard urinalysis -- i.e. urine tests for white blood cells, protein, etc -- are useless for STD screening.
MEDICAL PROFESSIONAL
No STD can start to cause symptoms in under 24 hours; it is not possible your urethral discomfort was due to an infection from the oral sex exposure. Probably mechanical or chemical. Lack of discharge, within a couple days of onset of discomfort, is furhter evidence against gonorrhea, chlamydia, or NGU. But if symptoms are present due to gonorrhea or chlamydia at the time of testing, for sure testing would pick it up.
The NAATs (PCR is one of several NAATs) are the tests of choice for gonorrhea and chlamydia and are highly accurate and reliable.
The NAATs (PCR is one of several NAATs) are the tests of choice for gonorrhea and chlamydia and are highly accurate and reliable.
Sorry doctor, "no pain during urination" not "pain during urination"- big difference!!
Dr,
Great things come to this who wait I presume! What a solid, detailed informative response.
I agree with you that going the online route only solved a portion of the puzzle.
You are correct my exposure was insertive oral sex. 24 hours later the only symptom was a burning sensation at the tip of my penis, absolutely no discharge, no pain urinating.
I think I understand your comment regarding my chlomydia and gonorrhea testing question, but if you don't mind I would like to clarify:
If I had this burning at the tip of my penis when I had the test would the test concievably be sensitive enough to have caught it? (if my symptoms are gonorrhea)
The test was done at labcorp through naat pcr testing (I just called tstd.org to verify)? Given you now know the type of test and where I did it, does your opinion change (reliable V's conclusive)
I have read in some of your other posts that in penis from gonorrhea is typically followed up with discharge. With no discharge 8 days later, pain during urination, but some pain at rip, can gonorrhea be ruled out?
How soon after infection (in your opinion) do these tests pick up the disease?
Thank you for such a thoughtful response..
Great things come to this who wait I presume! What a solid, detailed informative response.
I agree with you that going the online route only solved a portion of the puzzle.
You are correct my exposure was insertive oral sex. 24 hours later the only symptom was a burning sensation at the tip of my penis, absolutely no discharge, no pain urinating.
I think I understand your comment regarding my chlomydia and gonorrhea testing question, but if you don't mind I would like to clarify:
If I had this burning at the tip of my penis when I had the test would the test concievably be sensitive enough to have caught it? (if my symptoms are gonorrhea)
The test was done at labcorp through naat pcr testing (I just called tstd.org to verify)? Given you now know the type of test and where I did it, does your opinion change (reliable V's conclusive)
I have read in some of your other posts that in penis from gonorrhea is typically followed up with discharge. With no discharge 8 days later, pain during urination, but some pain at rip, can gonorrhea be ruled out?
How soon after infection (in your opinion) do these tests pick up the disease?
Thank you for such a thoughtful response..
MEDICAL PROFESSIONAL
Patience, patience. The moderators are not on line 24-7 and don't necessarily answer questions in sequence.
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for reviewing other discussions before asking your own question. However, you misunderstood a few aspects. I'll try to help sort things out.
Among other things, your question offers an opportunity for a blog-like response about how people concerned about STDs should and should not use on-line testing services, versus seeing a health care provider for examination and direct advice about testing (see below), which I will save to aid in responses to future questions.
Presumably your exposure was fellatio on you, i.e. a partner's mouth to your penis -- correct? Did you also perform oral on your partner? Was s/he male or female? These make a difference in testing needs. For now, I'm assuming only the former -- oral on your penis. I'm also assuming you are male, although you don't say so directly.
If my assumptions are correct, you were not at risk for HSV-2 or HSV-1 and shouldn't spend any money on testing for them. HSV-2 is rarely if ever transmitted mouth to genital, and having had cold sores, you could safely assume you are infected with HSV-1, in which case you are immune to a new infection. Chlamydia rarely infects the mouth and throat -- even if an oral parnter is exposed to someone's genital infection. Therefore, oral sex rarely if ever transmits chlamydia, so that test wasn't warranted. There is no lab test for NGU; evaluating for that requires personal examination by an experienced clinician. Gonorrhea is fairly easily transmitted by oral sex, but almost all penile gonorrhea causes obvious symptoms -- so testing for asymptomatic infection is of questionable value. The chance of syphilis is very low if your partner was female, but testing is cheap so should be done -- not as early as your test.
You don't mention HIV, but I will comment that it is much too rare to catch it by oral sex to need testing after any single exposure. Some experts believe oral to genital HIV transmission doesn't occur at all.
That said, your negative gonorrhea and chlamydia tests were reliable; 5 days after exposure is plenty of time and advice for 7 days is arbitrary. (There hasn't actually been research on this.) You are correct that your positive HSV-1 result cannot possibly be due to the recent exposure; the window period is never shorter than 2-3 weeks. As suggested above, you could have safely assumed the result.
So in terms of your test results, the only one that has any bearing on your recent exposure is the gonorrhea test, which is reliable. All the blood tests serve only as a baseline, so if positive in the future, you will know when you were infected. If you want further reassurance about this particular exposure, I recommend syphilis and HIV blood tests, and nothing else, about 6-8 weeks after the exposure.
That brings me to my general advice for all persons considering self-directed testing without seeing a doctor or clinic, e.g. through an on-line service. These services are very useful for someone who has had ongoing risks or exposures, i.e. to pick up infections that might have accumulated over the years. Good examples are persons who have been dating a number of partners, often for a long time, and are now moving to a committed relationship or otherwise just want to be safe; or someone who discovers a regular partner has been cheating with other partners over a long period of time. Commercial sex workers and gay men with multiple partners are other good examples. Testing of this sort generally should include all STDs, both common and uncommon: gonorrhea, chlamydia, syphilis, and HIV for sure, and usually HSV-2 (with or withoutHSV-1). Tests for hepatitis B, and sometimes A and C are warranted for some persons, such as CSWs, gay men with multiple partners, and injection drug users. Others certainly can do them, but for the most part I don't recommend it.
On-line or other self-directed testing usually does NOT make sense for people who have symptoms that suggest STD (genital discharge, sores or other lesions, etc); or following a single high risk sexual exposure. In the these circumstances, it is best to see a provider in person for individualized risk assessment and physical examination. Direct exam is the only way to check the possibility of NGU, warts, or common vaginal infections (yeast, bacterial vaginosis, and often trichomonas); and after single exposures, it is rarely necessary to spend money on many tests. In general, even without health insurance, a single doctor visit plus the necessary tests will cost less than getting panels of multiple tests that are not needed for any particular exposure or symptoms. And if people use their local health department STD or genitourinary medicine (GUM) clinic, it will be still less costly.
My final advice is that not all on-line STD/HIV testing services are the same. Typically all offer the same tests, and often use the same contract laboratories, but they provide different levels and quality of advice about specific tests that are recommended. Some, but not most, offer online chat or phone options to reach a counselor to assist in decisions about what tests would be recommended; and some are more expensive than others, for the same tests. While I cannot comment on most specific services, one that does a good job is http://getstdtested.com.
FULL DISCLOSURE: I consult for and have an investment in GetSTDTested. However, I became involved only after becoming confident in the company's professional focus, counseling options, and fair pricing.
I hope this information is helpful to you and other users. Good luck--
HHH, MD
Among other things, your question offers an opportunity for a blog-like response about how people concerned about STDs should and should not use on-line testing services, versus seeing a health care provider for examination and direct advice about testing (see below), which I will save to aid in responses to future questions.
Presumably your exposure was fellatio on you, i.e. a partner's mouth to your penis -- correct? Did you also perform oral on your partner? Was s/he male or female? These make a difference in testing needs. For now, I'm assuming only the former -- oral on your penis. I'm also assuming you are male, although you don't say so directly.
If my assumptions are correct, you were not at risk for HSV-2 or HSV-1 and shouldn't spend any money on testing for them. HSV-2 is rarely if ever transmitted mouth to genital, and having had cold sores, you could safely assume you are infected with HSV-1, in which case you are immune to a new infection. Chlamydia rarely infects the mouth and throat -- even if an oral parnter is exposed to someone's genital infection. Therefore, oral sex rarely if ever transmits chlamydia, so that test wasn't warranted. There is no lab test for NGU; evaluating for that requires personal examination by an experienced clinician. Gonorrhea is fairly easily transmitted by oral sex, but almost all penile gonorrhea causes obvious symptoms -- so testing for asymptomatic infection is of questionable value. The chance of syphilis is very low if your partner was female, but testing is cheap so should be done -- not as early as your test.
You don't mention HIV, but I will comment that it is much too rare to catch it by oral sex to need testing after any single exposure. Some experts believe oral to genital HIV transmission doesn't occur at all.
That said, your negative gonorrhea and chlamydia tests were reliable; 5 days after exposure is plenty of time and advice for 7 days is arbitrary. (There hasn't actually been research on this.) You are correct that your positive HSV-1 result cannot possibly be due to the recent exposure; the window period is never shorter than 2-3 weeks. As suggested above, you could have safely assumed the result.
So in terms of your test results, the only one that has any bearing on your recent exposure is the gonorrhea test, which is reliable. All the blood tests serve only as a baseline, so if positive in the future, you will know when you were infected. If you want further reassurance about this particular exposure, I recommend syphilis and HIV blood tests, and nothing else, about 6-8 weeks after the exposure.
That brings me to my general advice for all persons considering self-directed testing without seeing a doctor or clinic, e.g. through an on-line service. These services are very useful for someone who has had ongoing risks or exposures, i.e. to pick up infections that might have accumulated over the years. Good examples are persons who have been dating a number of partners, often for a long time, and are now moving to a committed relationship or otherwise just want to be safe; or someone who discovers a regular partner has been cheating with other partners over a long period of time. Commercial sex workers and gay men with multiple partners are other good examples. Testing of this sort generally should include all STDs, both common and uncommon: gonorrhea, chlamydia, syphilis, and HIV for sure, and usually HSV-2 (with or withoutHSV-1). Tests for hepatitis B, and sometimes A and C are warranted for some persons, such as CSWs, gay men with multiple partners, and injection drug users. Others certainly can do them, but for the most part I don't recommend it.
On-line or other self-directed testing usually does NOT make sense for people who have symptoms that suggest STD (genital discharge, sores or other lesions, etc); or following a single high risk sexual exposure. In the these circumstances, it is best to see a provider in person for individualized risk assessment and physical examination. Direct exam is the only way to check the possibility of NGU, warts, or common vaginal infections (yeast, bacterial vaginosis, and often trichomonas); and after single exposures, it is rarely necessary to spend money on many tests. In general, even without health insurance, a single doctor visit plus the necessary tests will cost less than getting panels of multiple tests that are not needed for any particular exposure or symptoms. And if people use their local health department STD or genitourinary medicine (GUM) clinic, it will be still less costly.
My final advice is that not all on-line STD/HIV testing services are the same. Typically all offer the same tests, and often use the same contract laboratories, but they provide different levels and quality of advice about specific tests that are recommended. Some, but not most, offer online chat or phone options to reach a counselor to assist in decisions about what tests would be recommended; and some are more expensive than others, for the same tests. While I cannot comment on most specific services, one that does a good job is http://getstdtested.com.
FULL DISCLOSURE: I consult for and have an investment in GetSTDTested. However, I became involved only after becoming confident in the company's professional focus, counseling options, and fair pricing.
I hope this information is helpful to you and other users. Good luck--
HHH, MD
Hi,
I wondered if my questions were overlooked since there are other posts with responses over mine.....
I wondered if my questions were overlooked since there are other posts with responses over mine.....
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
