[Question #11065] More STI testing required?

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17 months ago
Hello and thanks in advance for your help.

Jan 28 2024 I hand unprotected oral with a csw of unknown status. I recieved felatio and performed cunnilingus and analingus on her.  

10 days after exposure I completed a 4th gen HIV, syphilis, chlamydia and gonorrhea test, all negitive. 
 
39 days after exposure I completed the tests again, all were negitive.

Would you consider these tests conclusive or would you recommend to test again at 3 months.

I'm also concerned about oral chlamydia and gonorrhea.  

About a week after the encounter I started having symptoms. Which made me get the original tests. The symptoms are as follows.
1. Minor sore throat
2. Bright red rash on back of hands (lasted two days)
3. Sore wrists and ankles
4. Tingling in my legs below the knees
5. Small red streaks under my skin that come and go.

Would you recommend any additional STI testing with these symptoms in mind?

Thanks again for your help.



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H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thanks for your confidence in our services.

There is little chance you have any STI and I do not advise any further testing. None of your symptoms fit with any STI and all your negative tests are conclusive.

The only slight wrinkle is a minor one:  urine or urethral testing does not detect oral gonorrhea or chlamydia. In theory you could have been at risk for them by performing cunnilingus and analingus. However, these exposures are very little if any risk even with an infected partner. (As it happens, my colleague Dr. Hook was senior investigator on the best study on cunnilingus and gonorrhea transmission.) By far the main risk for oral gonorrhea is fellatio, i.e. performing oral sex on a male partner -- which is why oral gonorrhea is dominantly a problem in men who have sex with men and in women who give oral sex. Even in these settings, oral chlamydia is rare -- despite being the topic of much misleading online buzz. When oral gonorrhea IS present, it rarely causes symptoms -- and chlamydia never has been reported to cause sore throat or any other symptom.

For those reasons, you can move on with no further concern. Theoretically, you could consider a throat swab for gonorrhea and chlamydia, but if somehow I were in your situation I wouldn't do it. If you do, you definitely can expect negative results.

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

HHH, MD
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17 months ago
Crystal clear and very helpful!
Thanks again Dr Handsfield
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17 months ago
Sorry one last question.

Could I be experiencing reactive arthritis due to oral chlamydia?

Thanks
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H. Hunter Handsfield, MD
17 months ago
Oral chlamydia is not an issue. It's rare (much more rare than you might assume from online buzz about it), and when present is almost always cleared by the immune system within a couple of weeks. It is not known to trigger reactive arthritis, and in any case ReA as a result of chlamydia or any other STI is not a likely cause of the symptoms you report. ---
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17 months ago
Thank you Dr Handsfield.
That follow up question was definitely a result of internet rabbit holes...
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H. Hunter Handsfield, MD
17 months ago
Anxious persons usually do best by avoiding internet searching on the topic they are concerned about. Anxiety leads persons to "see" and over-interpret information that inflames their fears. The statistician Nate Silver, formerly of fivethirtyeight.com, wrote a book about popular perceptions around statistics and data, "The Signal and the Noise". In it he writes -- approximate quote -- "Give an anxious person a computer in a dark room with an internet connection and soon he'll believe his cold is the bubonic plague." If you're compelled to keep searching, you'll reduce the chance of misinformation by sticking with professionally run or moderated sites, and avoid sites by and for people with the same sorts of concerns -- like Reddit, for example.

That concludes this thread. I hope the discussion has been helpful. Take care and stay safe.
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