Hi,

About 54 days ago I had protected vaginal sex and unprotected oral sex (giving and receiving) with a female sexual worker in Canada. 45 days after the exposure, with no symptoms, I had an STI test for Chlamydia and Gonorrhea which consisted of a urine sample and oral swab. The test came back negative for Chlamydia but positive for Gonorrhea (positive in urine, negative in swab). After the results, they treated me with ceftriaxone IM and 1g Azithromycin oral, all on the same day.

About 4 days after the treatment, I started with a sore throat which has progressed into a mild sore throat, which I would say does not hurt that bad, but it's very annoying. I'm also experiencing diarrhea (which I'm not concerned with, taking into account all the antibiotics I took), but I'm concerned that the treatment did not work and the oral swab was a false negative.

Also, I got scared and thought I may be experiencing HIV symptoms, so I took an INSTI HIV test (3rd generation) on days 45, 51, 53, and 54 post-exposure. On day 54, I also took an INSTI test for syphilis. All these tests came back negative. I'm aware that because these tests came back negative, the symptoms cannot be due to HIV, but the fact that I did not do these tests after 3 months got me scared. All of this has got me stressed out and scared, I cannot live my life normally. So my question is...

1. Could it be possible that my throat sore is Gonorrhea and the swab was a false negative? Or is it more likely that given my depressed immune status (due to stress and the antibiotics), I got a common viral or bacterial throat infection?

2. Should I call my syphilis and HIV test conclusive and not be concerned with that possibility anymore?

3. Could this be a side effect of gonorrhea treatment?

Your situation is quite unusual. Although asymptomatic urethral (penile) gonorrhea occurs, it is quite rare -- and it's very unusual to test positive for gonorrhea a month and a half after exposure, with no symptoms in the meantime. In addition, your risk was low on account of the condom use. Gonorrhea can result from receiving unprotected oral sex but not often; and here too, most infected men have very obvious symptoms. It is possible that your test was falsely positive, but tat's rare itself. All things considered, I think it is a 50:50 guess whether you were actually infected or had a false lab test result. It was reasonable for you to be treated, of course.

Oral gonorrhea also is rare, and very rarely acquired by cunnilingus (oral-vaginal contact); and your negative throat swab test was reliable. And oral gonorrhea usually causes no sore throat or other symptoms. Also, it not possible to start having gonorrhea symptoms 4 days after receiving ceftriaxone. Almost certainly you just happened to catch a mini cold virus at about that time.

As for HIV, your negative tests prove for certain you don't have it -- and your exposure was close to zero risk for HIV as well.

Those comments pretty well cover your questions, but to be explicit:

1. Almost certainly not. Antibiotics do not suppress the immune system, and neither does stress (despite common beliefs about these things). And of course people get common cold viruses all the time regardless of their immune status.

2. Both your HIV and syphilis tests are conclusive. It is certain you do not have either one of these.

3. No, your symptoms are not likely due to any kind of side effect from the antibiotics.

I understand how stressful all this has been for you. But you definitely can move on with no further worries. If you actually had urethral gonorrhea, it is gone now; and for sure you do not have (and never had) oral gonorrhea; and it also is certain you no have syphilis or HIV. You can go about your life with no further worries about any of this!

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

HHH, MD