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What Are The Risks Of STD After Protected Intercourse?
Question: Dear Doctor,
i am just another fool like many others on this page who decided to have intercourse with an escort for reasons that I cannot explain to myself, as I am in a very healthy and happy relationship...
After having intercourse for a while I realized my condom ripped so i stopped right away.. this happened 3 nights ago...The intercourse lasted maybe 5-6 minutes, but im not sure when the condom ripped.The condom was fully ripped off. I am circumcised and never had an std before.
Also I have no information in regards to her status..
Now I am absolutely freaking out...There is one slight darker bump on the rim of my genital but I am not sure what it is..Also under the rim the skin seems to have become dried..Im the most scared about hiv and herpes obviously, as there are no cures for these two diesases...
What do I do? Im totally freaking out and I cant focus on my upcoming job interview which I have been preparing for for the past four years..
I want to get tested right now, but I know its pointless because results wont show anything meaningful..
I live in Toronto, Canada...
i am just another fool like many others on this page who decided to have intercourse with an escort for reasons that I cannot explain to myself, as I am in a very healthy and happy relationship...
After having intercourse for a while I realized my condom ripped so i stopped right away.. this happened 3 nights ago...The intercourse lasted maybe 5-6 minutes, but im not sure when the condom ripped.The condom was fully ripped off. I am circumcised and never had an std before.
Also I have no information in regards to her status..
Now I am absolutely freaking out...There is one slight darker bump on the rim of my genital but I am not sure what it is..Also under the rim the skin seems to have become dried..Im the most scared about hiv and herpes obviously, as there are no cures for these two diesases...
What do I do? Im totally freaking out and I cant focus on my upcoming job interview which I have been preparing for for the past four years..
I want to get tested right now, but I know its pointless because results wont show anything meaningful..
I live in Toronto, Canada...
Brief Answer:
Get screened for HIV and other STD's at appropriate intervals
Detailed Answer:
Hello. Thank you for writing to us.
I have gone through the details of your query and I have understood it.
A ruptured condom amounts to unprotected sex,therefore you should adequately rule out possibility of an STD including HIV.
You must screen for HIV and other STD's like gonorrhea, chlamydia, genital herpes and syphilis at appropriate intervals.
Moreover if you develop any signs & symptoms of an STD like urethral discharge, burning on passing urine, genital erosion/ ulcer, growths/ warts etc you must get yourself checked with a venereologist.
Since, STD's may not always present with obvious signs Or symptoms and also because most STD's are not immediately detectable by a lab test therefore is is important to screen at appropriate interval and by serial lab tests
.
Screening for gonorrhea and chlamydia should be earliest at 2 weeks with a "Swab test/ NAAT (Nucleic acid amplification test)".
"HSV ELISA" screening for genital herpes is usually performed at 2-4 weeks after a risky sexual contact.
HIV can be screened earliest at 4 weeks.
This need to be repeated at 12 weeks (to cover for the window period of HIV detection) for a definitive result in case the initial screening test at 4 weeks is negative.
For HIV screen you may take up an "HIV DUO/ HIV COMBO test".
This screening test has a high sensitivity of 99.8% at 4 weeks. The sensitivity increases to 99.9% at 12 weeks.
Screening for syphilis is with a "VDRL/ RPR test" and can also be taken up along with HIV and Herpes testing at 4 weeks.
VDRL also needs to be repeated at 12 weeks for a definitive result because incubation period of syphilis can vary from 9-90 days.
As far as the bump on rim of your penis that is concerning you.. I suggest you to upload a digital Image for my review.
You may upload Image either at "Reports Section"
Or
You may also mail me the Images at YYYY@YYYY . Kindly mention the subject of this mail as Attn:Dr. Kakkar.
Regards
Get screened for HIV and other STD's at appropriate intervals
Detailed Answer:
Hello. Thank you for writing to us.
I have gone through the details of your query and I have understood it.
A ruptured condom amounts to unprotected sex,therefore you should adequately rule out possibility of an STD including HIV.
You must screen for HIV and other STD's like gonorrhea, chlamydia, genital herpes and syphilis at appropriate intervals.
Moreover if you develop any signs & symptoms of an STD like urethral discharge, burning on passing urine, genital erosion/ ulcer, growths/ warts etc you must get yourself checked with a venereologist.
Since, STD's may not always present with obvious signs Or symptoms and also because most STD's are not immediately detectable by a lab test therefore is is important to screen at appropriate interval and by serial lab tests
.
Screening for gonorrhea and chlamydia should be earliest at 2 weeks with a "Swab test/ NAAT (Nucleic acid amplification test)".
"HSV ELISA" screening for genital herpes is usually performed at 2-4 weeks after a risky sexual contact.
HIV can be screened earliest at 4 weeks.
This need to be repeated at 12 weeks (to cover for the window period of HIV detection) for a definitive result in case the initial screening test at 4 weeks is negative.
For HIV screen you may take up an "HIV DUO/ HIV COMBO test".
This screening test has a high sensitivity of 99.8% at 4 weeks. The sensitivity increases to 99.9% at 12 weeks.
Screening for syphilis is with a "VDRL/ RPR test" and can also be taken up along with HIV and Herpes testing at 4 weeks.
VDRL also needs to be repeated at 12 weeks for a definitive result because incubation period of syphilis can vary from 9-90 days.
As far as the bump on rim of your penis that is concerning you.. I suggest you to upload a digital Image for my review.
You may upload Image either at "Reports Section"
Or
You may also mail me the Images at YYYY@YYYY . Kindly mention the subject of this mail as Attn:Dr. Kakkar.
Regards
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Thank you for your reply Doc...
So are you saying that I can get checked for everything at four weeks? i don't have to wait 3 painful months?
i understand that in order to ensure accuracy i should get rechecked again at three months and then again at 6, but how likely are the chances that if I'm fine within the first 4 weeks, that ill be fine for good?...are the chances high or rather very grim...
and are there any tests that you can pay extra for to have done quicker, which are more accurate for example? I just want to have this be over with Doc., i learned my lesson.
Its so anxiety evoking knowing that i feel perfectly fine right now but in reality a ticking time bomb is being developed in my body...
Also what are the chances that the person who most likely infected me had more than one disease? is it possible to have all stds at once? and to pass them all on at once? .. i really learned my lesson I want to reverse time so bad or for this process to speed up so i have my closure and to finally come to terms with what i got myself into..
I have submitted two pictures by the way..this is what it looks like after 4 days...any idea what those are?
I'm seriously freaking out. One small mistake can ruin your life forever...if anybody is reading this, please think before you make stupid mistakes..
So are you saying that I can get checked for everything at four weeks? i don't have to wait 3 painful months?
i understand that in order to ensure accuracy i should get rechecked again at three months and then again at 6, but how likely are the chances that if I'm fine within the first 4 weeks, that ill be fine for good?...are the chances high or rather very grim...
and are there any tests that you can pay extra for to have done quicker, which are more accurate for example? I just want to have this be over with Doc., i learned my lesson.
Its so anxiety evoking knowing that i feel perfectly fine right now but in reality a ticking time bomb is being developed in my body...
Also what are the chances that the person who most likely infected me had more than one disease? is it possible to have all stds at once? and to pass them all on at once? .. i really learned my lesson I want to reverse time so bad or for this process to speed up so i have my closure and to finally come to terms with what i got myself into..
I have submitted two pictures by the way..this is what it looks like after 4 days...any idea what those are?
I'm seriously freaking out. One small mistake can ruin your life forever...if anybody is reading this, please think before you make stupid mistakes..
Brief Answer:
Screen with an HIV DUO test along with HSV ELISA and VDRL/ RPR at 4 wks
Detailed Answer:
Hi.
Yes, testing at 4 weeks after sexual encounter for HIV as well as other STD's like genital herpes, syphilis would be good.
Most of the healthy individuals who get infected with Hiv have detectable antibodies against it at 4 weeks. Therefore the chances are that a negative test at 4 weeks is fairly conclusive.
However, a repeat screening test at 12 weeks is to cover for the window period of Hiv detection in those few individuals who may not have detectable circulating antibodies at 4 weeks.
Most of these few will subsequently develop detectable circulating antibodies by 12 weeks. Therefore 12 weeks testing is taken as final/ conclusive.
Alternatively, may take up an "HIV DUO/ HIV COMBO test" at 4 weeks. This test reduces the window period to 4 weeks.
It tests both for circulating Hiv antigens (P 24) as well as antibodies against Hiv and has a better predictive value at 4 weeks as compared to an antibody based test.
P24 antigens appear as early as 2-4 weeks and therefore would also be detected by this test in those very few in whom antibodies have not yet appeared.
HIV PCR for RNA can be performed even early because it has a short window period of detection i.e 2 weeks however this test is not routinely used for screening.
HIV PCR RNA is more commonly used to measure the viral load in those who are Hiv positive.
This test is expensive though.
An individual can be affected multiple STD's at a time and the same can be passed on during a single sexual encounter.
I have reviewed the Images and I don't see any cause for concern in these.
The bump at the rim if glans is most likely a benign, swelled up gland. You may just observe it over a period of time.
Regards
Screen with an HIV DUO test along with HSV ELISA and VDRL/ RPR at 4 wks
Detailed Answer:
Hi.
Yes, testing at 4 weeks after sexual encounter for HIV as well as other STD's like genital herpes, syphilis would be good.
Most of the healthy individuals who get infected with Hiv have detectable antibodies against it at 4 weeks. Therefore the chances are that a negative test at 4 weeks is fairly conclusive.
However, a repeat screening test at 12 weeks is to cover for the window period of Hiv detection in those few individuals who may not have detectable circulating antibodies at 4 weeks.
Most of these few will subsequently develop detectable circulating antibodies by 12 weeks. Therefore 12 weeks testing is taken as final/ conclusive.
Alternatively, may take up an "HIV DUO/ HIV COMBO test" at 4 weeks. This test reduces the window period to 4 weeks.
It tests both for circulating Hiv antigens (P 24) as well as antibodies against Hiv and has a better predictive value at 4 weeks as compared to an antibody based test.
P24 antigens appear as early as 2-4 weeks and therefore would also be detected by this test in those very few in whom antibodies have not yet appeared.
HIV PCR for RNA can be performed even early because it has a short window period of detection i.e 2 weeks however this test is not routinely used for screening.
HIV PCR RNA is more commonly used to measure the viral load in those who are Hiv positive.
This test is expensive though.
An individual can be affected multiple STD's at a time and the same can be passed on during a single sexual encounter.
I have reviewed the Images and I don't see any cause for concern in these.
The bump at the rim if glans is most likely a benign, swelled up gland. You may just observe it over a period of time.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doc, thanks for the reply,
So just to clarifiy once more, provided that i use a rapid test, i could know whether im completely free of diseases or not by the 4th week mark ?? How about herpes, is there an accurate early detection test for that as well?
Or even then, lets say im completely free by 4 weeks, what is the probabilty that these results are not final? 50/50? I know i musta caught something anyways... I just hope its nothing untreatable/ serious..
There is no way to test for every single std accurately at the 4 week mark to know whether im good or not right? Reality is , syphillis and herpes ( and probably hiv if i cant find any clinic) i have to test for over and over again? Or am i wrong?
So just to clarifiy once more, provided that i use a rapid test, i could know whether im completely free of diseases or not by the 4th week mark ?? How about herpes, is there an accurate early detection test for that as well?
Or even then, lets say im completely free by 4 weeks, what is the probabilty that these results are not final? 50/50? I know i musta caught something anyways... I just hope its nothing untreatable/ serious..
There is no way to test for every single std accurately at the 4 week mark to know whether im good or not right? Reality is , syphillis and herpes ( and probably hiv if i cant find any clinic) i have to test for over and over again? Or am i wrong?
Brief Answer:
Window varies for different tests. Beyond that negative test rules out STD.
Detailed Answer:
Hi.
Rapid test is an antibody based test. A negative test at 4 weeks almost rules out HIV.
However as I said before, you need to take a repeat test at 12 weeks for it to be conclusive. This is to cover for the window period.
If negative at 12 weeks by rapid test for HIV there is no need for any further test.
Antibody based tests have a longer window period i.e 12 weeks and this repeat 12 weeks test is to cover for that.
An HIV Combo test (Antigen/ Antibody based test) has a shorter window period i.e 4 weeks as compared to a rapid test and therefore a negative HIV combo test is conclusive at 4 weeks
PCR for HSV is a gold standard test for HSV detection and can be performed early (within a week) as compared to HSV ELISA which requires a window of 2-4 weeks.
PCR is comparable or even better than viral culture.
A negative ELISA for HSV at 4 weeks rules out genital herpes and requires no further testing.
Similarly a negative PCR for HSV is conclusive.
If you are negative for HIV by 4 weeks by rapid test most likely you would be negative at 12 weeks too because as I already mentioned, most of the infected individuals have detectable antibodies by 4 weeks.
However, a negative HIV Combo test at 4 weeks is final/ conclusive result.
Average incubation period of syphilis is 3 weeks, therefore a VDRL test at 4 weeks is a protocol. However the range of incubation period of syphilis is 9-90 days therefore there should be a repeat test at 90 days Or 12 weeks/ 3 months for syphilis too.
A negative test at 12 weeks is conclusive. Beyond that there is no need to test for syphilis.
No need to panic just go ahead with the tests and hope for the best.
Regards
Always practice safe sex with a condom!
Window varies for different tests. Beyond that negative test rules out STD.
Detailed Answer:
Hi.
Rapid test is an antibody based test. A negative test at 4 weeks almost rules out HIV.
However as I said before, you need to take a repeat test at 12 weeks for it to be conclusive. This is to cover for the window period.
If negative at 12 weeks by rapid test for HIV there is no need for any further test.
Antibody based tests have a longer window period i.e 12 weeks and this repeat 12 weeks test is to cover for that.
An HIV Combo test (Antigen/ Antibody based test) has a shorter window period i.e 4 weeks as compared to a rapid test and therefore a negative HIV combo test is conclusive at 4 weeks
PCR for HSV is a gold standard test for HSV detection and can be performed early (within a week) as compared to HSV ELISA which requires a window of 2-4 weeks.
PCR is comparable or even better than viral culture.
A negative ELISA for HSV at 4 weeks rules out genital herpes and requires no further testing.
Similarly a negative PCR for HSV is conclusive.
If you are negative for HIV by 4 weeks by rapid test most likely you would be negative at 12 weeks too because as I already mentioned, most of the infected individuals have detectable antibodies by 4 weeks.
However, a negative HIV Combo test at 4 weeks is final/ conclusive result.
Average incubation period of syphilis is 3 weeks, therefore a VDRL test at 4 weeks is a protocol. However the range of incubation period of syphilis is 9-90 days therefore there should be a repeat test at 90 days Or 12 weeks/ 3 months for syphilis too.
A negative test at 12 weeks is conclusive. Beyond that there is no need to test for syphilis.
No need to panic just go ahead with the tests and hope for the best.
Regards
Always practice safe sex with a condom!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your answer doctor...Those were exactly the answers I was looking for...
I am having difficulties finding locations that do HIV combo tests,VDRL test for syphillis and and PCR for HSV.
I understand that you are in a different country but do you have any idea where in XXXXXXX Canada such options are offered? maybe there is a doctor network or something i don't know...
Also, my final question is: my girlfriend gets coldsores and i have been with her for three years ( again i know I'm an idiot and whatever i caught i deserve...).
are there any chances that i have the Herpes (type 1 i assume) virus already? i never had any outbreaks anywhere...is there the possibility that the test for herpes comes out positive but its due to my girlfriends coldsores? if i am found to be positive for hsv, would she be infected if i had intercourse with her? even though she already gets coldsores around her lips?
you have been very very helpful doctor, god bless you.
I am having difficulties finding locations that do HIV combo tests,VDRL test for syphillis and and PCR for HSV.
I understand that you are in a different country but do you have any idea where in XXXXXXX Canada such options are offered? maybe there is a doctor network or something i don't know...
Also, my final question is: my girlfriend gets coldsores and i have been with her for three years ( again i know I'm an idiot and whatever i caught i deserve...).
are there any chances that i have the Herpes (type 1 i assume) virus already? i never had any outbreaks anywhere...is there the possibility that the test for herpes comes out positive but its due to my girlfriends coldsores? if i am found to be positive for hsv, would she be infected if i had intercourse with her? even though she already gets coldsores around her lips?
you have been very very helpful doctor, god bless you.
Brief Answer:
HSV type 1 can cause both type both oral as well as genital herpes
Detailed Answer:
Hi.
You can Google search for information regarding places where you can take up these tests.
Cold sores are usually caused by Hsv type 1 whereas genital herpes is usually caused by Hsv type 2 but this distinction does not always hold true.
It is a definite possibility that you have the virus already, from your girlfriend.
Hsv type 1 can cause both Oro-labial herpes as well as Genital herpes.
The virus can stay clinically silent inside body for months and years & therefore not everyone is aware of infection.
Yes, you can pass it back to her even if you got from your girlfriend.
Even if she has it already on her oral mucosa that does'nt make her immune to infection on genital mucosa.
If you carry this virus on Lip you may pass it back to her genitalis through Oro-vaginal sex, whereas if you have got it on your Genitalia from her, you can pass it back to her through peno-vaginal sex.
Regards
HSV type 1 can cause both type both oral as well as genital herpes
Detailed Answer:
Hi.
You can Google search for information regarding places where you can take up these tests.
Cold sores are usually caused by Hsv type 1 whereas genital herpes is usually caused by Hsv type 2 but this distinction does not always hold true.
It is a definite possibility that you have the virus already, from your girlfriend.
Hsv type 1 can cause both Oro-labial herpes as well as Genital herpes.
The virus can stay clinically silent inside body for months and years & therefore not everyone is aware of infection.
Yes, you can pass it back to her even if you got from your girlfriend.
Even if she has it already on her oral mucosa that does'nt make her immune to infection on genital mucosa.
If you carry this virus on Lip you may pass it back to her genitalis through Oro-vaginal sex, whereas if you have got it on your Genitalia from her, you can pass it back to her through peno-vaginal sex.
Regards
Note: Consult a Sexual Diseases Specialist online for further follow up- Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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