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Question/worry related to recommended STD testing
I've been in a relationship with a former SW (she worked for 6 months approximately 3 years ago and claims to have had only protected anal and vaginal), We've been in a relationship for the past 7 months and we are monogamous. Before we were together she had ~ 20 other partners in her lifetime who she engaged in unprotected sex. She has never had an STD. I have only had unprotected sex with one other person in my life and have always tested neg for chlam, gono, hep c, syphilis, hiv.
5 weeks into our relationship (and 5 weeks since her last unprotected anal/vaginal sex encounter), she was tested for HIV ag/ab assay, hep c, hep b, gono and chlam (urine test because she was menstruating), and syphilis. All tests were negative. At three months into the relationship she had some dysuria and was diagnosed with a UTI and the physician double checked and retested her for gono/chlam (cervix swab), syphilis, HIV, hep b and hepc. All the tests came back negative. a pap smear was negative as well at that time and we were both prescribed gardasil.
Around two months ago she had unilateral inguinal lymphadenopathy accompanied by fever, fatigue and malaise (no pharyngitis or tonsillar exudates, no hepatosplenomegaly). A mono spot was positive. I was concerned that perhaps she could have LGV but the doctor assured me this must be mono (2 months prior i LIKELY had mono given that i had fever, malaise, bilateral tonsillar exudates unresponsive to antibiotics). her LN is now normal.
She was never tested for trichomoniasis or ANY other "exotic" STDs, but she is consistently negative for gono, chlam, syphilis, hiv, hep b, hep c. Given this unilateral inguinal lymphadenopathy and her very risky path I feel worried that maybe she warrants testing of other exotic STDs, but I don't know which ones! We are both asymptomatic. Please let me know if we should be going for any further investigations (does she need to be tested for trich? LGV? ANYTHING???).
5 weeks into our relationship (and 5 weeks since her last unprotected anal/vaginal sex encounter), she was tested for HIV ag/ab assay, hep c, hep b, gono and chlam (urine test because she was menstruating), and syphilis. All tests were negative. At three months into the relationship she had some dysuria and was diagnosed with a UTI and the physician double checked and retested her for gono/chlam (cervix swab), syphilis, HIV, hep b and hepc. All the tests came back negative. a pap smear was negative as well at that time and we were both prescribed gardasil.
Around two months ago she had unilateral inguinal lymphadenopathy accompanied by fever, fatigue and malaise (no pharyngitis or tonsillar exudates, no hepatosplenomegaly). A mono spot was positive. I was concerned that perhaps she could have LGV but the doctor assured me this must be mono (2 months prior i LIKELY had mono given that i had fever, malaise, bilateral tonsillar exudates unresponsive to antibiotics). her LN is now normal.
She was never tested for trichomoniasis or ANY other "exotic" STDs, but she is consistently negative for gono, chlam, syphilis, hiv, hep b, hep c. Given this unilateral inguinal lymphadenopathy and her very risky path I feel worried that maybe she warrants testing of other exotic STDs, but I don't know which ones! We are both asymptomatic. Please let me know if we should be going for any further investigations (does she need to be tested for trich? LGV? ANYTHING???).
MEDICAL PROFESSIONAL
Welcome back to the forum. I reviewed your discussion with Dr. Hook last summer. You are to be congratulated for your willingness to look beyond your partner's sexual past and to concentrate on the things that made you fall in love with her. That said, in my view this question has drifted away from STD risks --- even though that's how you word it --- and into the realm of emotional acceptance of your partner's former lifestyle.
I would first point out that many CSWs are very cognizant of STDs and their prevention, and very good at avoiding them. And it sounds like your partner didn't have so many clients anyway. There are many, many women who have never been sex workers who have had unprotected sex with far more than 20 partners!
Your partner's repeated negative STD tests are to be believed, and she doesn't need any more testing. Your statement that she has "consistently" tested negative suggests to me that she may be getting unnecessarily retested because of your anxieties. If so, it is time to stop.
Heterosexually transmitted LGV is virtually absent in the US. In my 40+ years in the STD business, I have never seen a case except in immigrants or travelers who caught it elsewhere (especially Africa). This uncommon STD has recently had a mild resurgence among men having sex with men, but with little if any spillover into heterosexual men or women. And the mono-like illness you and your partner had a couple of months ago doesn't sound at all like LGV anyway.
As for trichomonas, it's unlikely she is infected if she isn't having any abnormal vaginal discharge; and in any case, trich is generally pretty harmless and not a serious health risk for either of you. That said, much more accurate testing is now routinely available (by nucleic acid amplification, such as the GenProbe Aptima test). I do not recommend testing at this time, but perhaps it is something she would like to request during her next routine annual reproductive health care visit.
My main advice is that you continue to do your best to accept your partner's past history. It is clear she has sustained no important health effects from it. It would seem you still have some mental adjustments to make about it, but don't focus on the STD part of the equation. It is no longer an issue for you and you should drop all concern about it (and probably all discussion of it with your partner).
Best wishes for a lasting, loving, romantic relationship-- HHH, MD
I would first point out that many CSWs are very cognizant of STDs and their prevention, and very good at avoiding them. And it sounds like your partner didn't have so many clients anyway. There are many, many women who have never been sex workers who have had unprotected sex with far more than 20 partners!
Your partner's repeated negative STD tests are to be believed, and she doesn't need any more testing. Your statement that she has "consistently" tested negative suggests to me that she may be getting unnecessarily retested because of your anxieties. If so, it is time to stop.
Heterosexually transmitted LGV is virtually absent in the US. In my 40+ years in the STD business, I have never seen a case except in immigrants or travelers who caught it elsewhere (especially Africa). This uncommon STD has recently had a mild resurgence among men having sex with men, but with little if any spillover into heterosexual men or women. And the mono-like illness you and your partner had a couple of months ago doesn't sound at all like LGV anyway.
As for trichomonas, it's unlikely she is infected if she isn't having any abnormal vaginal discharge; and in any case, trich is generally pretty harmless and not a serious health risk for either of you. That said, much more accurate testing is now routinely available (by nucleic acid amplification, such as the GenProbe Aptima test). I do not recommend testing at this time, but perhaps it is something she would like to request during her next routine annual reproductive health care visit.
My main advice is that you continue to do your best to accept your partner's past history. It is clear she has sustained no important health effects from it. It would seem you still have some mental adjustments to make about it, but don't focus on the STD part of the equation. It is no longer an issue for you and you should drop all concern about it (and probably all discussion of it with your partner).
Best wishes for a lasting, loving, romantic relationship-- HHH, MD
MEDICAL PROFESSIONAL
There has been a lot of media attention about certain throat cancers and HPV, but that remains a very rare cancer. In any case, such malignancies are not due to the HPV types that cause warts.
Gardasil has little effect after only a single dose. Protection starts to become effective after the second dose but isn't fully effective until after dose 3 (6 months).
You are not significantly more likely to have HPV at this time than you were before this relationship. All sexually active people get HPV somewhere along the line; most of us probably have several infections. Your future partners will not be at any higher risk than otherwise on account of this issue. It would be a kindness to inform future partners you have been exposed to someone with genital warts, but you can all have not had them yourself. In any case, after your second dose of gardasil, you can be even more confident.
Gardasil has little effect after only a single dose. Protection starts to become effective after the second dose but isn't fully effective until after dose 3 (6 months).
You are not significantly more likely to have HPV at this time than you were before this relationship. All sexually active people get HPV somewhere along the line; most of us probably have several infections. Your future partners will not be at any higher risk than otherwise on account of this issue. It would be a kindness to inform future partners you have been exposed to someone with genital warts, but you can all have not had them yourself. In any case, after your second dose of gardasil, you can be even more confident.
How about ENT cancers related to HPV? Am i at risk?
I had a shot of gardasil on october 14th but actually forgot to go for the booster on dec 14th. Does that offer me any protection?
It's unfortunate for me that she wants to break up upon our return home. This was our plan prior to our vacation. Now I'll be spending the next year afraid of dating women out of fear of infecting them...
life ***** somtimes
I had a shot of gardasil on october 14th but actually forgot to go for the booster on dec 14th. Does that offer me any protection?
It's unfortunate for me that she wants to break up upon our return home. This was our plan prior to our vacation. Now I'll be spending the next year afraid of dating women out of fear of infecting them...
life ***** somtimes
MEDICAL PROFESSIONAL
Genital warts take many months to show up -- at least 2 months and often 6-12 months before catching the virus. It is likely, therefore, that this isn't really a new problem. If you and your partner have been having regular unprotected sex, it's too late to do anything about it; the HPV causing her warts is no more infectious now than it has been for quite some time. Her warts should be properly treated, and you'll need to start keeping an eye out for penile warts and get treated if and when anything shows up. But in the meantime, there is no point in stopping your sexual activity at this time. All things considered, genital warts are a minor inconvenience, not an important health threat.
I hope you continue to enjoy your Hawaii holiday. Don't let this minor problem stand in the way of a good time, including romance and rewarding sex.
I hope you continue to enjoy your Hawaii holiday. Don't let this minor problem stand in the way of a good time, including romance and rewarding sex.
As an addendum she is 22 and I'm 30 years old
Hello Dr. Handsfield,
Your answer has been very helpful to me and has given me a lot of peace of mind. I do have another question for you however. My girlfriend and I are currently in Hawaii and a few hours ago she noticed a "ball" like lesion at the entrance of her vagina. We just returned from the ER where the Dr. told us to go see a gynecologist because she thinks it's genital warts. I'm now freaking out as we've been having a lot of sex and i've been performing oral sex on her frequently as well.
I'm having panic attacks about whether I'm going to break out with warts on my penis (as i often have small cuts on my penis giving easy access to virus particles) or whether I will develop some sort of HPV related upper airway malignancy at some point in the future. I don't know what to do with myself. We have a week left to this hawaiian vacation and I can't seem to calm down and enjoy as I'm too worried sifting through information on the internet related to this. What should I do with myself? How at risk am I?
Your answer has been very helpful to me and has given me a lot of peace of mind. I do have another question for you however. My girlfriend and I are currently in Hawaii and a few hours ago she noticed a "ball" like lesion at the entrance of her vagina. We just returned from the ER where the Dr. told us to go see a gynecologist because she thinks it's genital warts. I'm now freaking out as we've been having a lot of sex and i've been performing oral sex on her frequently as well.
I'm having panic attacks about whether I'm going to break out with warts on my penis (as i often have small cuts on my penis giving easy access to virus particles) or whether I will develop some sort of HPV related upper airway malignancy at some point in the future. I don't know what to do with myself. We have a week left to this hawaiian vacation and I can't seem to calm down and enjoy as I'm too worried sifting through information on the internet related to this. What should I do with myself? How at risk am I?
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.
