[Question #1273] Extreme anxiety and worry over STI exposure and risk to partner

47 months ago
Thank you in advance. I am in a LTR with another male. Over the last 90 days I was stupidly unfaithful. In June and July I met with the same man on three  occasions. Mutual oral, mutually masturbated,  kissed and I was fisted with lube/gloves. No ejaculate contact. 4 days later I was tested for all STIs. All negative. I was given single oral dose azithromycin. Met with another man in August. We kissed and I was fisted with with lube/no gloves. Worried, I visited the health department. I was tested for gonorrhea/chlamydia. No blood test for HIV or Syphilis. Tests negative. I was given an injection and a pill.  I had unsafe receptive and passive anal/oral sex with my partner between and after these incidents. 2 weeks ago, I discovered a painful open sore on my frenulum / under foreskin. A second was emerging close by. 1 week before I had unsafe sex with my partner. 2 days before finding it I was with another man. We kissed and I was the bottom for safe sex.  48 hours after discovery a Dr.  said it was candidiasis OR staph. He gave a cream and antibiotics. Told to switch to the latter if the sore didn't change in two days. Cream did not work. I finished the antibiotics.  My partner now has painless red bumps on his ankles. In the context of the sore I am worried about syphilis. I realize my last encounter likely isn't a source as it occurred after we had sex last. Could he have syphilis/anything from my previous infidelities? What is the realistic risk here?
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Welcome to the Forum.  I'll try to help. Your history of exposures and antibiotics is more complex than can be addressed fully on-line.  I will make some initial comments but strongly recommend that you seek evaluation by a knowledgeable clinician and work with them to sort this out.   As I understand it, since June you have had sex with three partners other than your regular partner.  Until recently most of those exposures were rather low risk although there was unprotected oral involved. More recently you have also had unprotected receptive rectal sex.  Over this time course you have had antibiotics several times.  I am guessing that the shot you received was ceftriaxone a drug which would be expected to have some activity against syphilis (azithromycin works for some but not all syphilis).  I cannot tell what the other antibiotics you received most recently were. 

What you describe may not be an STI.  If it is, statistically the most likely STI that would cause lesions of the sort you describe is herpes, not syphilis which could certainly have been acquired through some of the activities that you described, including receipt of oral sex.  At this time however what is needed is thorough testing.  From the sounds of things, syphilis is unlikely but if you have syphilis, at this time your blood test should be positive.  I would also recommend having a herpes PCR performed on the sores if they are still present.  Finally, sorting this out may require repeated examinations by a health care provider.  Rather than seeing multiple providers, I suggest that you find a health care provider who can see you both at this time and subsequently, rather than being seen by different people who do not have the benefit of having seen the you before.

I hope my comments are helpful.  EWH

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47 months ago
Dr. Hook, 

Thank you again for taking the time to respond. In my anxiety ridden attempt to be clear, I was the opposite. Thankfully you followed most of my rambling.  The unprotected sex was with my partner and was both receptive and insertive. I'll try and make the last few weeks more clear time-wise. 09/25 my partner and I have sex, unprotected with me  in insensitive role. 09/27 I meet with a man for protected sex, receptive role. No oral, some kissing.  09/30 discover sore on penis. 09/30 visit doctor. 10/02, begin antibiotics. 10/12, finished  antibiotics.  They were 100mg doxycycline twice daily for ten days. Would testing post antibiotics reveal anything? If so, I will gladly get it done.  
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Thanks for the additional information.  It does not change my advice much.  If this were Syphilis, the medications you have taken, including the doxycycline would probably had cured Syphilis and led to healing of the ulceration.  Herpes remains a possibility but as I hear more from you it is a bit less likely that this is an STI.  My advice is unchanged, including my suggestion that you work through this with a health care provider who can see you repeatedly to help you sort this out.  Sorry I cannot be more specific.  Please let us know what you tests show.  EWH---
47 months ago
Dr. Hook, 

Thank you for your help. I still feel anxious but reassured. I am inclined to believe that the sore was indeed a general bacterial infection as diagnosed. I have a history of staph infections so it isn't outside the realm of possibility that a break in the skin during sex introduced such an issue.   I have visited my GP for a  screening, including syphilis and HIV.  I am not overly concerned about the latter but know it is never a bad idea. He tells me that it should show positive if I were recently infected despite the recent antibiotic treatment and that a negative would be essentially conclusive.  Would you concur with his assessment? I'm also scheduling some mental health visits to deal with this seemingly endless  health anxiety and to correct my unfaithful behavior. I will no long risk my health nor that of my partner. I will update with test results in approximately one week as you requested. 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Congratulations on your mature and appropriate response to your situation.  You have a lesion, and you want to have the problem addressed.  Given all that you have told us, I too agree that non-STI causes are more likely than STIs but that testing is warranted.  I also agree with your doctor that if these lesions were due to syphilis, even after antibiotic therapy, your test would be positive.  Likewise, HIV testing is always a good idea.  You can have confidence in the result you get. 

Health-related anxiety and unfaithful behavior are two different problems with the former sometimes being influenced by guilt related to being unfaithful.  Once again, you have impressed me with your decision to talk this through with someone.

As you probably know, we provide up to three comments per question and this is my third response to you.  thus I will not be providing further answers as part of this thread and the thread will be closed later today.  Take care.  I wish you the best.  EWH

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