[Question #13451] Could my wife’s joint pains be due to an STI I might have transmitted

1 months ago

Ten months ago I had a single encounter with a sex worker in a licensed/regulated setting in Germany. We had vaginal intercourse only, with a condom throughout. No oral or anal sex, no kissing.

My wife and I have only resumed sex in the last ~8 weeks. We have had intercourse five times since then, always with a condom and only vaginal. No oral or anal sex. There were no condom failures that I’m aware of.

My testing after the encounter:

HIV (4th‑generation lab test/CMIA): negative at 9, 12, 13, and 28 weeks post‑exposure (different doctors/labs).

Syphilis (serology): negative at 9, 12, and 13 weeks.

Chlamydia (NAAT): negative at 13 weeks.

Hepatitis B and C: negative once at 13 weeks.

My wife’s symptoms over the past several weeks: migratory joint and muscle pains, beginning in the back/neck, then moving to elbows and wrists; currently elbows and fingers are most affected. No fever, no rash, and no red spots on the skin. Symptoms are worst in the morning and after prolonged computer work. She has also been more fatigued in the evenings. She returned to work about 2 months ago.

Questions:

1) Based on the exposure described (condom‑protected vaginal sex) and my repeated negative tests, how likely is it that I could have transmitted an STI to my wife?

2) Specifically, what is the likelihood of gonorrhea transmission under these circumstances?

3) Could my wife’s joint pains reasonably be due to an STI (e.g., disseminated gonorrhea or reactive arthritis), or should we primarily consider non‑STI causes (e.g., ergonomic/overuse, rheumatologic, endocrine)? What initial evaluations would you recommend for her?

1 months ago

P.S. The overview states, that my question has been updated 5h ago - but I do not see an answer yet. Maybe it's just a technical glitch, but if the question has been answered, would you please so kind to repeat that?

H. Hunter Handsfield, MD

1 months ago

Welcome. Thanks for your question.

The "update" probably was my assignment as the respondent to your question.

Your wife's symptoms do not fit with any STI. I am completely confident they have absolutely nothing to do with your sexual indiscretion nearly a year ago. They certainly could not be due to HIV, syphilis, or viral hepatitis. You may have a very inflated view of the risks of these infections from the sexual event you have described. Your test results afterward are very reliable; and the STIs you mention could not cause symptoms your wife has had. To your specific questions:

"1) Based on the exposure described (condom‑protected vaginal sex) and my repeated negative tests, how likely is it that I could have transmitted an STI to my wife?"

Zero or close to zero.

"2) Specifically, what is the likelihood of gonorrhea transmission under these circumstances?" Nil.

"3) Could my wife’s joint pains reasonably be due to an STI (e.g., disseminated gonorrhea or reactive arthritis...?" Realistically, no. I cannot say much about other causes, but those possibilities are far more likely than any STI. What evaluations...? She should see her primary care physician if she is concerned about them. Not if YOU are concerned, but if she is. They are entirely unrelated to your non-marital sexual experience(s).

I hope this response is helpful. Let me know if anything is uncertain.

HHH, MD

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1 months ago

Hello Dr. Handsfield and thank you very much for your response.

I agree with you that my mind is playing tricks on me regarding the the likelihood/actual risk. I am very aware of that, as I suffered from HIV-related anxieties in the past. I was controlling them well in the last weeks and months, as my HIV results were very reassuring. But the fact that my wife feels unwell got me thinking again. I am trying not to fall into the rabbit hole and follow the strategy that helped me best with my initial anxiety.

Let me please ask this follow up:

I understand that my risk of being HIV positive myself is actually almost 0, as I got 4 tests after window period, the last one being very long (7 months) after window period. I do understand that HIV transmission is not that easy as I suspected. It requires blood and infected fluids to have contact with vulnerable skin.

1. What I do not fully get yet (and I wonder, why this is not taught at school): When it comes to gonorrhea, is a condom still good prevention? It does not require contact to blood, right? So in your experience, is a condom still a good way to prevent transmission of the bacteria? Or is it just like syphilis where contact with infected skin, which might not be covered by a condom, is enough to transmit it?

2. Regarding the issues my wife has: If she would suffer from DGI, she would most likely also have fever, right?

1 months ago

and #3: I learned that men can have asymptomatic gonorrhea. Is this true even for this long period or would I have mentioned after this long time, if I were indeed infected?

H. Hunter Handsfield, MD

1 months ago

1. Yes, condoms are excellent protection against gonorrhea, which is not transmitted by blood contact. Any gonorrhea transmission despite condom use almost always involves condom mis-use, such as partial penetration before applying the condom; or condom breakage.

2. DGI is nothing like your wife's symptoms. (This is something I know intimately. Here are links to a handful of my scientific publications: https://pubmed.ncbi.nlm.nih.gov/39150142/, https://pubmed.ncbi.nlm.nih.gov/804363/, https://pubmed.ncbi.nlm.nih.gov/820229/

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1 months ago

Thank you, Dr. Handsfield.

I guess my 3rd (and last) question was just overseen. I'd appreciate an answer to the third question I added in the separate post.

It is great to hear that DGI is a field you are experienced at in depth. That is reassuring, as my online search returned that joint pains can likely be gonorrhea-related and of course I have no expertise to differentiate between useful and misleading information.

H. Hunter Handsfield, MD

1 months ago

Asymptomatic gonorrhea generally is cleared by the immune system within a few weeks. This also is something I know a bit about. Although this publication is 50 years old, it's still the defining research on asymptomatic gonorrhea in men: https://pubmed.ncbi.nlm.nih.gov/4202519/

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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