[Question #13099] STD Risk - Handjob HIV

2 months ago

I wanted to update you, Dr. H. Recently, I went to urgent care after a soap shower “hand job” exposure and was diagnosed with NGU. I was prescribed a 7-day course of Doxycycline and a single 1g dose of Azithromycin (Z-Pack), although I haven’t taken the Z-Pack yet. My urine tests for gonorrhea, chlamydia, and mycoplasma all came back negative, but the sample was collected in the afternoon after I had urinated an hour earlier — I’m not sure if it was concentrated enough.

After finishing the Doxycycline, the burning sensation in my pelvic area has improved, but I still feel burning at the tip of my penis, especially after ejaculation. No pain during urination. I’m now 17 days post-exposure and worried I might have contracted something.

I also forgot to mention that I’m on Cosentyx, a biologic immunosuppressant.

My questions are:

✅ Given this exposure (soap shower hand job), what’s my real risk of contracting an STD?
✅ Could these symptoms be from irritation rather than infection?
✅ Could Cosentyx delay my antibody response to HIV?
✅ Is there any real risk of HIV or syphilis from this exposure?
✅ Does Cosentyx affect the window period for HIV testing?
✅ What testing schedule do you recommend?
✅ Should I repeat STD tests, and if so, when?

My partner hasn’t had any new partners.

Thank you.

2 months ago

I also wanted to add that I’m not hyper-focused or stressed out if I didn’t have urethral stinging (penis tip burning). If I hadn’t experienced any symptoms, I would have moved on. However, the fact that I had to take Doxycycline for 7 days to stop the pelvic burning sensation, and I’ve also been prescribed a Z-Pak—which I will take after hearing back from you—makes me nervous about the possibility of HIV infection.

Also, I do have an appointment with a in person Urologist two weeks from now.

H. Hunter Handsfield, MD

2 months ago

Welcome back. But sorry you felt the need.

How did urgent care diagnose your NGU? If based only on your symptoms, I continue to disagree -- as we discussed last time. Did you develop urethral discharge? Did the urgent care provider examine you and find abnormal discharge? Did they insert a swab into your urethra and examine the sample under a microscope for increased WBC? Or at least collect an initial urine stream (the first half ounce) and test it for WBC? These are the steps required to reliably diagnose NGU -- and as we discussed, you were not at risk for it. If you had some sort of urethral inflammation, it wasn't due to any STD. Having urinated an hour before specimen collection had no effect: your negative tests were valid. Even if you had NGU, you didn't need both doxycycline and azithromycin. That urgent care prescribed both might be another indication of their suboptimal knowledge about NGU and maybe other STDs. Cosentyx (sekukinumab) suppresses some immune functions but not most of them. It has no effect at all on any of the tests you have had or other aspects of your symptoms or next steps.

For those reasons, I'm not surprised your symptoms did not clear up entirely after azithromycin and doxycycline. And the symptoms you describe still are not consistent with NGU or any other STD. To your specific questions:

"Given this exposure (soap shower hand job), what’s my real risk of contracting an STD?" Discussed last time. Still zero.

"Could these symptoms be from irritation rather than infection?" I can't explain your symptoms with certainty. Conceivably a prostate problem? For sure no STI, probably no infection at all. I have to strongly suspect a psychological component, magnifying otherwise minor symptoms or even normal body sensations that otherwise would not be bothersome or perhaps not even noticed.

"Could Cosentyx delay my antibody response to HIV?" and "window period for HIV testing?" No. There are no medications or medical conditions that have any effect at all on reliability or timing of any of the modern HIV blood tests (except for anti-HIV drugs, of course).

"...any real risk of HIV or syphilis...?" No.

"Testing schedule" or "repeat STD tests?" No. There is no point in any further STI testing of any kind. The only additional medical evaluation you might consider, if your symptoms continue, is seeing a urologist who might look into prostate gland issues.

I hope these comments are helpful. It is important you understand that you could not have acquired NGU or any other STD from the events described; that your symptoms do not fit with any STD; and that all things considered, most genital symptoms have explanations other than STDs. Do not keep barking up that tree: there's no cat up there.

HHH, MD

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H. Hunter Handsfield, MD

2 months ago

Sorry I neglected to to review your follow-up comment before replying. I'm glad to see you're already planning to see a urologist. I thought you had already taken the azithromycin. There's absolutely no reason to take it now. No genital infection of any kind would fail to respond to doxycycline but be successfully treated with azithromycin. It is entirely redundant. And any antibiotic might interfere with a urologist's assessment of a possible prostate problem or other urological explanation. In other words, no likely benefit and a risk of interfering with further evaluation. Don't take it. ---

2 months ago

Thank you. I won’t start Azithro until I see the urologist and hear what he says about the other aspects. I’m relieved you don’t think it’s an STD, but the burning pelvic pain and sharp pain at the tip of my penis are back.

What worries me is that I had a hand-genital exposure 10 years ago and ended up with reactive arthritis. Same situation then: symptoms started a few hours after a hand job, but no STD was ever found. The arthritis was so bad I needed biologics and had ongoing pain which turned into chronic spinal arthritis. I did the same thing again and got symptoms again… but your assessment at least gives me hope it’s not an STD.

Could it be just a regular skin infection, maybe from normal skin flora? But no HIV, right? I really need to put that worry out of my mind. Just one last reassurance, please. As you can see, I’m nervous , I can’t believe how unlucky I am. I hope it's nothing serious.

2 months ago

Sorry, I forgot to answer your question about urgent care. They didn't do any swabs, just a regular urine test. The doctor made an assessment and started the treatment. He said he sees hundreds of cases like this a week and it's usually caused by some bacteria or something. He did do Urine Analysis which was clean.

H. Hunter Handsfield, MD

2 months ago

OK, follow the urologist's advice about azithromycin. I see no need for it, for the reasons discussed.

Sorry, but I am exceedingly skeptical that the hand-genital event 10 years ago triggered your reactive arthritis. ReA has many possible triggers, including some STDs, but there are no infections transmissible by hand-genital contact that could do this. And many ReA cases have no apparent triggering event. I have to believe your ReA was just a coincidence in timing with the sexual event.

"symptoms started a few hours after a hand job". This is further evidence that your symptoms both then and now were not due to any STD and not from an infection acquired during either hand job. No infection of any kind can start to cause any symptoms sooner than 24-36 hours after being exposed. This also applies to infection due to skin bacteria. And for sure HIV is not possible and not an issue here.

You misunderstood or the urgent care doctor was exaggerating. I guarantee you nobody sees "hundreds" of such cases per year, and probably not in 10 years -- and certainly not in a week. And clearly did not do any of the tests or procedures necessary to diagnose NGU or other STDs.

That completes the two follow-up comments and replies included with each question and so ends this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one about your hand-genital contact and concerns about NGU, which you do not have and never did. Future new questions about these issues may receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding.

I do hope the two discussions have been helpful and that you have absorbed the truths we have discussed about NGU and how STD are (and are not) transmitted. Best wishes and stay safe.

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