[Question #10469] Strange Symptoms after sexual encounter

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22 months ago
I’m a 39 year old male, healthy and fitness minded. I’m heterosexual.

I recently had an encounter with a female that involved heavy kissing and oral sex. The encounter appeared to involve blood from her - not sure the source; menstruation or other source from her vagina. No intercourse, penetration sex happened.

2-3 days after this one time encounter I experienced flu like symptoms - slight fever, swollen lymph nodes, dry cough, tonsillitis, periods of muscle aches and fatigue. The female I had the encounter with had no symptoms but did state she had something similar to tonsillitis 2.5 months prior.

I went to an urgent care and was tested for STDs, COVID and Strep. All came back negative except HSV-1 which I knew I had already. The symptoms lasted for over a month. I feel slightly better but now my lymph nodes are still swollen and slightly tender to touch. Specifically under my left armpit area. It’s been about one month since illness onset. 

She provided recent test results and was negative for everything except Gardernella. She admitted to having another regular sexual partner who from her description seems to enjoy what most would consider homosexual activity but claims to not engage in sex acts with men. 

I’ve had two HIV RNA tests. One at 9/10 days post exposure and a second at 32/33 days post exposure. Also had a 4th Generation AbAg HIV test and other STD tests. All negative.

Could something like Cytomegalovirus be an option? Could this be COVID that did not test positive with a swab? Should I retake the HIV 4th Gen test at 6 weeks? 

Thank you for your time 
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Edward W. Hook M.D.
22 months ago
Welcome to our forum and thanks for your thoughtful questions. 

Let me start by saying that I am entirely confident that your symptoms are not due to HIV and there is no need for additional testing for that virus.  There has never been a case of HIV proven to have been acquired through receipt of oral sex, and the risk of acquiring infection from performing oral sex on an HIV. Infected partner is less than one and 10,000 for men performing oral sex on other men and most probably substantially lower for persons performing oral sex on women ( such cases are so rare that there are no studies)

 My guess is that you were symptoms were the result of the acquisition of one of the other large number of viruses transmitted through exposure to oral secretions.  It is not uncommon for persons with symptomatic illnesses to have acquired their infections from others who are asymptomatic.  These viruses certainly include cytomegalovirus or Epstein Barr Virus ( these cause mononucleosis syndromes which is what it sounds like you had), as well as adenovirus, enterovirus, and other viruses for which testing is not usually performed because there is no therapy for them In addition, most of them are self limited although on occasion, they may take several weeks to resolve. This appears to be your experience.

It is also possible that you had a Covid infection, which was missed by the testing performed. I will put this possibility somewhat lower than the other possibilities we have discussed. Irrespective, I would not be concerned that this is a classical STI or is it something to worry about, I hope this perspective is helpful. EWH. 
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22 months ago
As a follow up question Doctor, if I wanted to consider my HIV status to be 100% conclusive from this encounter would I need to retest using the AgAb 4th generation test at 45 days or is the combination of the HIV RNA test at 10 days and again at 33 days + the AgAB 4th generation test at 33 days enough to declare a 100% negative status right now?

Would you recommend testing for various Epstein Barr viruses as well?
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Edward W. Hook M.D.
22 months ago
The combination of a negative HIV PCR test at 10 and 33 days, combined  with a negative 33 day 4th generation test is conclusive result.  There is no need for testing.

 As for testing for EBV, I'm not sure testing would help in any meaningful way.  There is no therapy for EBV and many people have had had EBV in the past.  My advice is to accept that you do not have an STI from the encounter you describe and move forward.  EWH
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22 months ago
Final follow up question…

Is Gardernella indicative of any potential STIs that can cause my symptoms? Meaning, is Gardernella a by product of any STIs (or general infections)? I understand individually that it’s not a risk factor but curious if it can be some type of symptom of another infection that promotes my specific symptoms.

I forgot to mention I’ve had thrush throughout this illness as well.

Thank you again for your time.
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Edward W. Hook M.D.
22 months ago
Gardnerella bacteria are a normal part of the bacteria found in the genital tract.  There is this association of gardnerella with the sort of symptoms that you mentioned.

Your delayed mention of thrush is unusual. When people get concerned and start looking for abnormalities, it is not at all uncommon to notice gray or white discoloration of the tongue. This is not thrush. If it is thrush, it can and should be readily treated. 

At this point, I would urge you to not worry further about STI, and instead suggest that you discuss this with your regular doctor. 

I hope the information I have provided you has been helpful. As I’ve said above, there is no reason at this point for you to be worried about STI‘s.

 We provide up to three responses to each clients question. As this is my third response, this thread will be closed shortly. In closing, once again, I suggest that you , see your regular doctor for evaluation of the symptoms that concern you. EWH 
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