HHH, MD

I had a suspicious encounter with a sex worker on July 25th and August 1st. I had unprotected oral sex and protected vaginal sex. On August 3rd, I noticed discharge from my penis. I took an STD10 test at a private lab on August 5th, which came back negative. After describing my symptoms (burning during urination, penile discharge, anal itching) to a urologist, I was given a diagnosis of gonorrhea and treated with a single dose of Novosef injection and a course of Tetradox antibiotics. After the injection, the discharge from my penis stopped, but I still occasionally experience a burning sensation during urination and feel like there's discharge from my penis even though there is none.

Could the treatment be incomplete, and what should I do about this? Additionally, regarding my HIV tests:

On August 10th (16 days after the first encounter and 10 days after the second encounter), my RNA PCR test was negative.

On August 22nd (28 days after the first encounter and 22 days after the second encounter), my HIV Duo Ultra test was negative.

On August 29th (35 days after the first encounter and 29 days after the second encounter), my Vidas HIV Duo Ultra test was negative.

Do I need to have another HIV test, and if so, when should I have it?

Thank you in advance, Doctor.

Your symptoms certainly fit with gonorrhea. However, presumably the "STD10" test was a panel of several STD tests, right? If it included urine or urethral swab testing for gonorrhea, that negative result is reliable and shows you almost certainly didn't have it. However, if it was a gonorrhea blood test, it is meaningless:  that test is worthless. If not gonorrhea, you could have had nongonococcal urethritis (NGU), which can be caused by normal oral bacteria that are not detected by STD testing. Interesting that you were treated with Novsef®, generic name cefotaxime. It is not a recommended antibiotic for gonorrhea, although it likely would be effective:  do you know if it is commonly used in your country? The doxycycline (Tetradox®) is a standard treatment everywhere and usually effective against NGU (and chlamydia, although that's unlikely). You can expect the discomfort in your penis to continue to improve.

As for HIV, this was low risk even if you did acquire gonorrhea. There has never been a proved case of HIV transmitted mouth to penis; and of course condoms are highly protective during vaginal intercourse. In any case, the combination of your various HIV tests is conclusive -- i.e. negative RNA/PCR 10-16 days plus negative AgAb ("Duo") blood test at 29-35 days. You definitely do not have HIV and do not need any more HIV tests.

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

HHH, MD

Doctor, first of all, thank you for the information you provided. I had an STD10 test done as a urine test. Two urology doctors I consulted in the country where I am currently located recommended Novosef injection treatment. What treatment would you apply? After the injection, the discharge from my penis stopped the next day. However, I still have ongoing burning during urination, occasional itching in the anal area, and a sensation of discharge from the penis (though there is no visible discharge). Do you think it is necessary to check the prostate fluid and apply another treatment, or should I wait a bit longer to see if the issues resolve on their own (it has been 20 days since the treatment ended)? Two days ago, I visited a doctor due to pain in the lower right abdomen, and I had blood and urine tests done. The CRP value in my blood test was 11.58, and RBC was observed in my urine. The doctor said it was due to kidney stones. Is this condition related to gonorrhea or could it be a coincidence?

Secondly, if I had gonorrhea, could it have been transmitted through unprotected oral sex? I used protection during vaginal intercourse, and there was no condom rupture.

Regarding HIV, you mentioned that my test results were conclusive. I just want to confirm whether I should retake the test at 42 days or 90 days.

Interesting that cefotaxime (Novosef®) is advised in your country (Turkey?). The main world-wide recommendation is ceftriaxone, but cefotaxime is a similar antibiotic and clearly was effective in your treatment.

I agree that the combination of abdominal pain plus blood in your urine could be caused by a kidney stone. I have no comment about your CRP. Keep working with your doctor, ideally a urologist.

Indeed your current HIV tests are conclusive. You will have to decide whether to follow your doctor's advice about future testing.