Dr. Shahad Alshehri
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I had an open wound on my hand that came into contact with sperm. I am concerned about sexually transmitted diseases. If infected with chlamydia or gonorrhea, would these infections show up in a urine test, as the site of infection is my finger and not any sexual organs? Would this infection show up in a urine test? How long would this take? Would these be evident in a urine test? Please help.
Thank you.
Hi,
Welcome to icliniq.com.
I read your query and I can understand your concern.
The transmission of sexually transmitted diseases (STDs) like chlamydia or gonorrhea is due to sexual activity with an infected patient rather than bloodborne. They usually spread through any kind of sexual activity. However, some STDs like hepatitis B, C, and human immunodeficiency virus (HIV), are also transmitted through contact with blood through sharing syringes or other equipment to inject drugs, body-piercing equipment, or tattooing needles. But please note that the only way for chlamydia and gonorrhea to be passed between people, apart from sexual contact, is from a pregnant person to their baby during childbirth.
Both diseases can be passed when the mucous membrane comes into contact with the mucous membrane secretions or semen of an infected person, not through the skin or small wounds. For your satisfaction, chlamydia and gonorrhea blood tests named polymerase chain reactions (PCRs) can be done to detect the infection. You can be tested one to three weeks after the exposure. Even if this is only a suspicion, you can always do the test to be confident. It does not appear in urine tests - they are tested by PCR from blood samples or swabs. Your genitals will not be affected without direct contact.
I hope this information will help you. Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thanks for the quick response.
Chlamydia and gonorrhea do not spread from semen to blood. Am I correct?
Thank you.
Hi,
Welcome back to icliniq.com.
Glad to have you back.
I am here to help you get the best medical advice.
Chlamydia and gonorrhea cannot be transmitted unless the semen contacts the eyes or mouth.
I hope this information will help you. Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
Semen potentially infected with gonorrhea, chlamydia, or even trichomoniasis cannot infect a person through a cut in the hand, because they are not blood-borne diseases. They only spread through sexual contact when the mucous membranes come in contact. What exactly are blood-borne diseases?
Hi,
Welcome back to icliniq.com.
Once more, thank you for allowing us to be of service to you.
We value the high level of confidence you have in us.
Chlamydia, gonorrhea, and trichomoniasis are all sexually transmitted diseases (STDs) that are transmitted through direct sexual intercourse or direct contact of the infected semen with mucosa-like mouth or eyes. Trichomoniasis can present with itching or irritation inside the penis, a burning sensation after peeing or ejaculating, and discharge from the penis. It can disappear after weeks without treatment, unlike chlamydia or gonorrhea. The following are the various bloodborne infections:
You can refer to the internet for more information. These infections, whether bloodborne or due to direct sexual or mucosal contact, are considered STDs, and you have to be cautious in choosing your sexual partner. Always encourage protected sex with one sexual partner. Remember that oral sex transmits diseases just like anal or vaginal sex. So always be cautious. Sexual awareness and protection are the keys to staying healthy and safe.
I hope this information will help you. Please revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
Thanks for the reply.
I read on the internet about gonorrhea that if it is left untreated, it can spread through the bloodstream and infect other areas. So, my question is if gonorrhea can spread through the bloodstream, then how can one not get infected by gonorrhea if sperm touches an open wound and contacts the blood? Does that question make sense? Please let me know about this.
Thank you.
Hi,
Welcome back to icliniq.com.
Glad to have you back.
I am here to help you get the best medical advice.
First, gonorrhea infection is a bacterial infection, and bacteria enter the body through oral, anal, or vaginal sex. When it enters the body, it causes local symptoms, and it may resolve on its own, but the bacteria will not go away and will be crawling up and getting into the blood and starting to reach places like the joints and tendons. This happens because it will not be treated as soon as it enters but will be treated only when it has traveled far away from the genitals resulting in a complicated infection.
Chlamydia, for example, does not behave this way, but it will move close to organs like the ovaries in females and cause infertility. So, the ability of gonorrhea to get to other areas does not mean its mode of transmission is different or that it can be more broad or aggressive. For example, in a person with a urinary tract infection secondary to the bacteria E. coli (Escherichia coli) who is not treated; the bacteria may enter the bloodstream and cause sepsis. But the same person may have a wound that gets exposed to multiple bacteria, including E. coli, but the body manages to kill it, and it does not cause any sepsis.
I hope I have answered your question.
Thank you.
Patient's Query
Hello doctor,
Thanks again.
I would like to go back to my original question on possible exposure to sperm in an open wound. Not sure if the wound has healed or not but let us assume that it has not healed. Also, there is no risk for chlamydia, trichomoniasis, or gonorrhea, as we had previously discussed since these do not transmit from sperm to blood. Am I correct? There could be a possible risk of human immunodeficiency virus (HIV), hepatitis B and C, and syphilis. I feel like if I was exposed, but it would have been a really small amount. If exposed to a really small amount of sperm, would this delay the incubation period and maybe not show up on tests?
I see that 99 percent of HIV cases are picked up at six to seven weeks with fourth-generation tests. Syphilis seems to pick up cases within a few weeks. Hepatitis B and C seem to take longer, up to six months. I guess my question is about possible exposure to a small amount of sperm. Because of such a small amount, would this delay the diseases from being picked up with testing? How far should I test to know whether I am in the clear zone? Could I still test negative, even after say eight to nine months for these diseases, but maybe still have them as I was possibly exposed to such a small amount of sperm, and it would take longer to be picked up on a test? Kindly let me know about this.
Thank you.
Hello,
Welcome back to icliniq.com.
I hope you are doing great. I will address your concern.
Well, regardless of the amount, if you are exposed to infected semen, there will be a chance that you might get the infection. And yes, the durations you mentioned were right for each disease, and to be sure, you have to be tested for each disease after the incubation periods you mentioned. The incubation period has to be passed to make sure the test is accurate. So, there is no rush for the time being. You can visit your physician and ask for these tests, and if they are negative, you will be reassured for good, and you do not have to worry about it at all. But you have to wait for at least six to eight weeks before performing any tests so that the test is not falsely negative. Regarding hepatitis C, it can be done with HIV (human immunodeficiency virus) screening at six weeks and 12 weeks, and then at four or six months. As for hepatitis B, most people are vaccinated, and if your antibodies are at a good level, you are protected. Antibody-level testing is also available and can be performed anytime.
I hope I have answered your queries and reassured you.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
So, the amount of virus that one is exposed to does not change the incubation period or the time frame for being picked up by a test. Is that correct? So, if one is exposed to a very small amount of sperm, say through a possible small open wound vs. sexual intercourse, this would not change the time frame of testing positive, is that correct? Can you explain why? I just want to be sure so that if I test negative after six months of possible exposure, I no longer need to worry.
Hello,
Welcome back to icliniq.com.
I hope this finds you well. I will address your concern.
Yes, what you typed was absolutely right. The reason behind that is that bacterial and viral infections in cases like sexually transmitted diseases are independent of the amount of virus entering the body because the virus will replicate inside the body and cause the symptoms and signs later on. Some people get infected with bloodborne diseases like hepatitis C or B or HIV through needle sharing, like in cases of drug abusers or sometimes when healthcare workers injure themselves through a needle prick. So, the amount does not matter here, as the organisms can replicate inside the body to cause the infection. Some bacteria can enter the body and be defeated by our immunity, but that is not the case in diseases like the ones we are discussing. So, as I reassured you previously, you absolutely do not have to worry after being tested negative after the incubation period, as you will be on the safe side.
I hope I have answered your queries and reassured you.
Thank you.
Patient's Query
Hello doctor,
Thanks for your answers; they are very helpful.
Does all of the above also apply to rabies? About 22 years ago, a bat (or a bird) flew into my neck area while I was jogging at nighttime. I did not give it much thought as I did not feel any bite. However, I was reading on how sometimes one might not feel a bat bite, as their teeth are so small. Based on the normal incubation period for rabies in humans which is about 20 to 90 days, I am obviously out of this window. My question is, if it was a small amount of virus, could the incubation period take a long time? I was reading that the time of incubation depends potentially on the location of the bite and proximity to the brain, as well as the amount of virus that went in. Does the amount of virus matter with rabies, and are they just saying the incubation period varies from 20 to 90 days based on these factors? Meaning that regardless of how much virus goes in, the incubation period will be in this time frame? And do I need to be worried about rabies? Kindly let me know about this.
Hello,
Welcome back to icliniq.com.
Glad to have you back.
I am here to help you get the best medical advice.
The answer is no. You need not worry about getting rabies at all. The longest possible incubation period, as per the WHO (World Health Organization), is up to one year only. And no rabies can be transmitted through a bite from an infected animal regardless of the amount of the virus, as the contact with the infected saliva transmits the disease. In your case, you definitely do not need to worry or think about this after 22 years. You are safe.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
Thank you for your prompt reply.
I came across this information regarding infections. Factors involved in determining the length of the incubation period are diverse and can include the strength of the pathogen, the strength of the host immune defenses, the site of infection, the type of infection, and the size of the infectious dose received. In terms of 'the size of the infection dose,' this line confused me a bit, as we have previously discussed how the initial size does not matter. I guess hypothetically, maybe the size of the infection dose could potentially affect the incubation period, but only a little if at all, correct? It would not change it from, say, an incubation period that is usually around 30 days to an incubation period of a year, correct? In general, the amount of the initial infection does not really matter as the infection will replicate in the body at the same pace regardless of the initial size because it is the same virus and would replicate at the same pace. Is that correct? I do appreciate your expertise and answers very much.
Hello,
Welcome back to icliniq.com.
Hypothetically and theoretically, we include the size of the infection dose in some diseases, like in cases of food poisoning. For example, the one who ate a spoonful of the infected dish is not the same as the one who had eaten the whole dish. This will reflect on the disease severity and symptoms, but this does not apply to all diseases, though. So yes, as you mentioned, in general, the amount of the initial infection does not really matter as the infection will replicate in the body and will replicate at the same pace regardless of the initial size, which is correct. It would not change its incubation period which is usually around 30 days to an incubation period of a year, which is correct as well. So, I reassure you again because you got it all right. You need not worry at all.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hello doctor,
Thank you again for your time; I greatly appreciate it.
Another random question. My wife and I have been married for 13 years. Both of us tested for the presence of any sexually transmitted diseases (STDs) 13 years ago. I recently got retested for all STDs because I am neurotic and know that the tests done in the present are more sensitive. All tests are negative. I recently learned that there is now extra genital testing for chlamydia and gonorrhea (anal swab and cheek swab). We both tested negative for chlamydia and gonorrhea in the past testing but it did not include extra-genital testing. We have no symptoms. Is this testing necessary? Would you recommend it? Could we have these diseases in other areas and not know it or have latent symptoms for 13 years? Please advise.
Thank you.
Hello,
Welcome back to icliniq.com.
Glad to have you back.
I am here to help you get the best medical advice.
People who undergo screening for extra genital sexually transmitted diseases are individuals with high-risk sexual behavior and are usually human immunodeficiency virus (HIV)-infected. Non-HIV-infected people are rarely screened for this unless they have symptoms after a known high-risk sexual encounter (oral or anal). Having sex with the same, well-known, negative partner poses no risk at all. You do not need to be screened, and there is no need to do any investigations at this time.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hello doctor,
I have a question for you.
I came across an article that said they found the presence of Chlamydia in the prostate of seven men by running a NAAT test on a biopsy of prostate tissue. They did a urethral gram stain smear for Chlamydia as well (this seems like an older technology), and all of these patients were negative in these seven patients. This caused some concerns in me.
Is it possible for chlamydia to live in just the prostate alone, and not the urethra?
I was tested last year for Chlamydia by NAAT test (Aptima combo 2 test) and was negative. This study makes me wonder, could the NAAT test I took last year possibly have missed Chlamydia, because the Chlamydia was living in my prostate and not my urethra? I understand modern NAAT STD tests are highly accurate with very high sensitivity and specificity. I understand chlamydia can sometimes travel to the prostate, as it spreads, but would the Chlamydia leave the urethra in this process? It tends to thrive in the urethra, correct? It does not make sense that it would just leave the urethra.
Also, let us say, hypothetically that chlamydia travels to the prostate, then the Chlamydia would be in the seminal fluid. Every time you ejaculated, would not that chlamydia in the seminal fluid just reinfect the urethra? It seems like Chlamydia being in the prostate and not in the urethra seems very odd. My urologist called the study BS and that he had never heard of this being the case of chlamydia being in the prostate and not the urethra. I wanted to see what you thought as I do appreciate your knowledge and expertise.
Thank you.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
I am delighted to hear from you again. I hope you are doing great.
Using NAAT (nucleic acid amplification test) for Chlamydia is still the gold standard for diagnosis of this particular infection. Chlamydia infection can present in the body differently with different clinical syndromes, and each clinical syndrome has its approach and management. Regarding the prostatitis cases, Chlamydia is one of the known causes of chronic prostatitis, and the patient may have a negative urethral swab or urine sample. The bacteria in such cases theoretically are cleared, but resided in the affected area. But in some cases have probably been partially treated for acute STD (sexually transmitted infection) or infection, which resulted in partial clearance of infection. Patients with prostatitis in general are rarely missed, and regardless of the etiology of their infection, they are treated empirically for all the possible organisms. Taking biopsies is rarely done and is done for research purposes or as a part of extensive investigations. I reassure you that you do not need to worry. The diagnosis of STDs and other urogenital infections is rarely missed.
I hope I have reassured you.
Thank you.
Patient's Query
Hello doctor,
Thanks for the answer.
I have heard that some STDs like chlamydia and or gonorrhea can potentially lead to prostate cancer or have been associated with an increased risk of prostate cancer. It seems other papers have shown this not to be the case and that there is no association between common STDs and prostate cancer. What do you think about this, and if shown to be a causing factor is it a big factor?
Thanks.
Hi,
Welcome back to icliniq.com.
I read your query and understand your concern.
In infectious diseases, we see the opposite. People who have cancers are prone to infections due to their medical status and their immunity status. Prostate cancer was rarely reported due to STDs (sexually transmitted infections) or infections. The risk is always there because theoretically, prolonged inflammatory processes and infections can progress to cancers in some other diseases. Please remember all infections in immunocompetent patients are treatable, and the rate of success is high.
I hope I have answered your concern.
Please revert in case of more queries.
Thank you.
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Infectious Diseases
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