[Question #13396] Risk for HIV, STD?

1 months ago

I had two exposures:

First was protected vaginal and oral

Second (2 days later) was protected vaginal but unprotected oral (insertive)

Gonorrhea symptoms started 3 days after the second exposure, treated on day 5 with 1g IM ceftriaxone + 7 days doxycycline.

I began PEP within 3 hours of the first exposure and continued for 29 days (missed 30th due to kidney strain, eGFR just above 60). No exposures after the second. Since PEP is systemic, some sources say it should cover the second unprotected oral exposure.

At moment, tested HIV-negative using 4th-gen Elecsys combi PT at:

PEP completion

+17 days post-PEP

+30 days post-PEP

Question: Can gonorrhea spread from genitals to throat, rectum, or eyes without direct contact(like in clothes)? No kissing, rimming, anal play, or oral receiving. Kept my hands clean since I got diagnosed.

CDC recommends swabbing only exposed sites. Had negative urine PCR 2 weeks post-treatment (25 days post-exposure), but results took 10 days—can that delay affect accuracy?

1 months ago

I tested negative for syphilis 25 days post-exposure using RPR. Could the gonorrhea treatment I received (ceftriaxone + doxycycline) have suppressed or aborted a possible syphilis infection?

It’s now about 2 months since the exposure. Do I need to be concerned about other viruses like herpes or HPV if no symptoms have appeared?

My 30-day post-PEP test (around 8 weeks post-exposure) included HBV surface antigen and HCV antibody—are these reliable at this stage? I was vaccinated for HBV, with antibody levels at 136 four months before exposure (I understand >10 is considered protective).

Is the HIV test at 45 days post-PEP (roughly 10.5 weeks post-exposure) considered conclusive, or should I stick to 12 post exposure according to CDC?

Lastly, how assuring is my last result at 30 days post exposure, some doctors say it's conclusive enough, since it's post pep not post exposure.

Apologies for the many questions, doctor—I'm just very anxious after contracting gonorrhea and want to be thorough.

1 months ago

Forgot to mention PEP regime was a generic version TLD (tenofovir disoproxil, lamivudine, dolutegravir)

Edward W. Hook M.D.

1 months ago

Welcome to the forum. Thanks for your questions. I’ll be glad to comment.

The exposures you describe or virtually no risk for HIV. There are no proven cases of HIV, which have been required from receipt of unprotected oral sex, and condoms provide excellent protection against STI‘s including HIV. It is possible that you acquired gonorrhea from your Receipt of unprotected oral sex, and the medications that you received in treatment would’ve prevented development of syphilis as well as curing gonorrhea and, if present chlamydia.

No, gonorrhea does not spread from one site of infection to another on clothes or through transfer on the hands. You’re gonna re-infection was localized and you have proven that it has been treated. There is no reason for further testing for gonorrhea. We would need to ask your laboratory or the person who ordered the tests why test results took 10 days.

Is mentioned above, even if you were exposed to syphilis, the treatment that you received for gonorrhea would’ve prevented any infection from occurring.

You are hepatitis B vaccination would have prevented hepatitis B if exposed and your follow up testing proved that you did not acquire hepatitis B or hepatitis C from the low exposures that you describe

At this time, my advice is to relax, to believe your test results, and move forward. There is no reason for further testing related to the exposures that you describe. EWH.

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1 months ago

"You’re gonna re-infection was localized and you have proven that it has been treated."

Could you please clarify what you meant, doctor?

"We would need to ask your laboratory or the person who ordered the tests why test results took 10 days."

They said they are just a collection center, and they send it to another lab, which takes up to 2 weeks.

Before diagnosis, I swam at the beach and worried that water might’ve flushed bacteria from near the penile opening and spread it to the anus. I know rectal gonorrhea usually needs anal sex, but I’ve read it can spread via discharge in women due to proximity. During exposure, could saliva dripping down from penis to anus cause infection? I doubt that happened, but I’m second-guessing. I'm scared cuz it's asymptomatic.

My follow up Qs:

Is this common?
Would treatment clear it from all sites, if it happens?
Does it change your assessment if the exposure was with a CSW? UNAIDS showed ~50% HIV cases in CSWs in that country.

I might be overthinking this TBH.

Edward W. Hook M.D.

1 months ago

There was a typo, sorry. The sentence should have said “ Your gonorrhea infection was localized to the site where symptoms occurred and could not have been spread to other parts of your body.” Your penile infection would not have spread from your penis to your rectum on your hands or by water, flushing it into your anus.

If you were infected at other sites beyond your penis, the treatment you received certainly would have cured the infections.

Who your partner was does not change the accuracy of the test. You have proven you did not acquire HIV.

You have one follow up remaining. EWH.

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1 months ago

My closing question & statement:

Dr. Hook, I’ve had flat moles (penile melanosis) on my penile shaft and scrotum since birth, but during a recent period of anxiety (frequent checks for STDs after exposure), I noticed what seemed like new flat moles after shaving. These spots haven’t changed in over months, so I suspect they may have been there earlier (They look exactly like the one I had since birth, although they differ in size).

From your expertise, do these sound like any dermal STDs/STIs (e.g., herpes, HPV, molluscum, syphilis)? From my understanding: herpes presents as painful bumps/sores that resolve in days; HPV as growing warts; molluscum as a cluster of bumps, syphilis as ulcers(primary) and palmar and plantar rashes(secondary) —not flat, dark spots. Please correct me if I’m wrong.

Thank you, Dr. Hook, for all the guidance and reassurance you provided me.

Apologies for the abrupt tone in my previous posts—I’m keeping this within the 1000-character limit.

Edward W. Hook M.D.

1 months ago

Quite obviously, I cannot examine the lesions that you mentioned however, the fact that they have been there for years suggest that they do not represent an STI, nor does what you describe sound like an STI. My advice would be to ask your dermatologist to evaluate them.

As you know, we provide up to three responses to each clients question. This is my third response and so it’s a result. This thread will be closed shortly without further responses. I hope the information I have provided has been helpful. EWH.

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