Informative website.  I want to make sure my assumptions are correct.

I am a male,  8 yrs ago I received oral sex from a woman not my partner.   Days later i had discharge and stuck to my underwear in the morning.  I took at lest 3 online test and one at the MD, all urine, naat for trich, gonno, chlymidia.  All negative.  Also a month later they did a urinalysis to find 0-5 white cells, told nothing wrong.  Yet my tip is irritated some and itchy some then.  Later had sex with regular partner, she got a white discharge.  I never said anything to her for it went away quickly.  She had numerous routine OB appointments with no sti testing or complaints.  Jump to today, I still have irritation, no discharge and my irritation comes and goes. I do check myself a lot and that perciptates an itchyness. or irritation at the tip.  No pain when peeing.   I did not know what NGU was at the time but do now after reading this site

Also, recently I had analingus with a man of unknow status 4 days ago.  My mouth on his anus and scrotum only for 5 min. To my questions:

1. I assume I had NGU and did not know it at the time, given the other negative tests I took.  I assume that i may have given it to my wife and it has cleared both of us over the 8 yrs and my periodic irritation during this time is from my continous checking given my annually repeated negative tests for the 3 sti mentioned

2. I assume my recent analingus puts me most at risk for gastro illness and lower risk for gonno, HSV 2 and syphilis.  I assume it is only theorhetical to no risk for HIV.

Am I correct?  Are there any other tests now or in the future I or my current partner should have?  Thank you

Probably you are exactly right:  you acquired NGU from the oral exposure all those years ago. NGU from oral sex is believed to usually be caused by normal oral bacteria. The urethra sees them as strange and unexpected, and reacts with mild urethritis. However, it probably always clears up even without treatment, and probably there are no traditional STD germs present to cause infection in partners. It is unlikely that your urethritis had anything to do with your partner's vaginal discharge. So many women get vaginal discharge from time to time that It's basically normal, and your partner apparently had normal gyn exams afterward.

1. As for your current symptoms, I am confident they have nothing at all to do with the exposure or apparent NGU all those years ago. As you already have figured out, NGU from oral sex would not last this long and your symptoms actually are not at all typical for NGU. They are, however, typical for prostatitis or perhaps, as you also suggest, from irritation caused by repeated self examination. However, if they continue I would suggest seeing a urologist for professional evaluation.

2. You also are right that the oral partner in analingus is primarily at risk for various non-STD gastrointestinal infections. And yes, HSV2, syphilis, and oral HPV all are possible but low risk. There have been few or no cases of HIV documented to result from analingus, so the risk is very low -- but that doesn't mean it can't happen.

At this point, I would describe testing for any STDs as optional, and for sure I would recommend none in relation to the oral sex event 8 years ago. But for reassurance in relation to the analingus event, you might consider syphilis and HIV blood tests in a few weeks and perhaps a throat swab gonorrhea test.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Thank you for the reply.  I felt like this would be the answer.  Just a bit more information that I only assume would validate your recommendations.  I was treated after my urinalysis for NGU with both doxy and azirthomicine.  It really made no appreciable difference.  Making me think maybe this is of my own doing.  I have never been treated for trich but all test are negative and i have read oral sex would rarely if ever lead to it. 

Regarding the analingus, I was really hoping you would say that there is zero risk.  But I understand nothing is zero.  That is my biggest fear.  I plan on testing out of an abundance of caution for all you mentioned but i was hoping not to worry about HIV for 3 or 4 weeks.  I just need to come to grips with that.  Any comments you could make about that would be helpful.

Regarding one more STI related question.  I do have HSV 1 on the lip since a teenager.  Rarely do I have an outbreak, its been years.  I assume that does not really increase my HIV chance due to the analingus?

Also, I have had HSV2 blood IGG blood test from 2 different labs over the  years, both negative.  Have never had traditional symptoms but ruling out my irritation.  I assume given those tests, non-traditional symptoms and chronic irritation that HSV 2 is ruled out.

One question about HIV testing.....it seems like every one around me is getting COVID.  Hopefully i can escape it but had it once last year and paxloid worked great.  If I get COVID and end up on paxloid prior to testing for HIV, would it delay the antibodies for HIV?  Or should i do a PCR that looks for the virus?  Or would you recommend I not worry about any HIV related tests?

thank you.  Great forum. 

That your symptoms did not clear with both azithromycin and doxycycline is strong evidence it was not NGU after all and probably not an infection of any kind.

I think it is fair for you to safely assume you will not be the world's first known case of HIV acquired by analingus. I would consider it zero risk and if somehow I were in your situation I would not be tested for HIV. But nobody can prove it is truly zero risk.

Very reliable research has shown that HSV2 modestly raises the risk of catching HIV if sexually exposed but that HSV1, anywhere on the body, has no such effect.

Based on this information, you definitely do not have HSV2.

There are no medical conditions or medications that have any effect on HIV test timing or reliability, and that includes COVID. (The only exception is that anti HIV drugs delay the time to reliable testing, if taken after exposure but are unsuccessful in preventing HIV infection.)

Helpful, thanks..   

I did go for a throat swabs.  MD said i should expect negative results. He said the chance is slim i caught anything and the test window is fine.

I did develop a place on my nose 5 days post event.   MD thought it was a cold sore and not syphilis and swabbed it for HSV 1 & 2.   He said it was too early for syphilis to appear.  No meds.  No HIV test, said was too soon and no real risk.

1. assuming negative throat swab, I am done with any further testing or worries about STI of the throat.  Is this wise?

2. I am not concerned about the  nose being HSV 1 or 2.  I am a bit worried it syphilis.  So my question, is 5 days too soon for a lesion?  I have not kissed my partner nor had sex.   But if we have sex unprotected, with no oral, can I spread syphilis to my partner since my penis was not invovled at all in my incident? 

3. My plan is that if my place goes away in a week i will wait and get syphilis/hiv tested at 6 weeks.  Is that advise able?  No oral with partner but regular sex ok?

4. About the NGU, for 15 + yrs, i also have had a small pin size pimple like place that wold come up on my urthera lip, always same, painless spot.  i could pop it.  Sometimes clear liquid came out, sometimes a little whitehead. It goes away within minutes post popping, unnoticeable until it returns months to yr later,.  While I assume I could be ping pong something back and forth from the long term partner, i doubt it for something would show up on my naat tests and not be sporatic.  . MD called it a clogged pore sight unseen.  Its always in the same place and i have had several HSV blood tests for HSV 2 and all negative.  Any thoughts?

2. Syphilis is not likely to be mistaken for a herpes outbreak on the nose, and yes 5 days is much too soon for syphilis.

3. That's a good plan, but for reassurance you might also have a syphilis blood test in the next week or so. The blood test always is positive within a week or so after onset of a syphlitic chancre, so a negative result would prove your nose sore wasn't syphilis.

4. Wrong about "ping pong" herpes:  it never occurs. The immune system prevents new or repeated infections with the same HSV types someone already has. Although recurrent herpes lesions are always in the same general area, they are never in exactly the same spot year after year. And your description doesn't sound like herpes anyway; your doctor's analysis is exactly what I would advise.

It seems clear that after all these years, you are paying far too much attention to a sexual event that was a trivial non-event that has had no long term health effects. Let it go; it has nothing to do with any of your current symptoms. Your more recent analingus episode also is a big nothing-burger.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes.

Two points of clarification....one I understand ping pinging with herpes, I meant other stis but I know the answer, thank you.   

And if I need to purchase a question for this one I will......I will follow the plan I mentioned but real question for me and all readers, .....syphilis only transmits via the sore so it can't travel from the mouth-nose area to the penise to infect someone, right?    And I assume that could change in latter stages of syphilis.    

Thank you for this service!

Please go forward with the certain knowledge that you have no ongoing health problem or transmission potential from either of the sexual exposures you have described. I see no need for a new question to clarify this certainty!

Best wishes and stay safe.