[Question #1790] Very worried about an Encounter

42 months ago

Background: I am 30, and I have been extremely conservative with sexuality so far as a gay guy.  Never had anal penetration neither active or passive.

I had an encounter with a friend 1/22.  Claims he is negative for everything.  I was still conscience to be as safe as possible.  We engaged only in kissing, naked OUTER intercourse (naked dry humping without anal penetration), penis to penis frottage.  I sucked on his scrotum and ONLY shaft of penis avoiding the head.  I made sure my mouth was only on intact skin. 

By 1/24 (two days later), I could feel a minor sore/scratchy throat coming on.  It felt irritated when I swallowed for the rest of that week.  By the SECOND week, I developed a hoarse voice, laryngitis, and could barely speak (still with an irritated throat when I swallowed, which drinking water seemed to relieve a bit).  Something was definitely affecting the vocal cords.  No other symptoms as far as I could tell.  By the THIRD week, the vocal cords where clearing up with some coughing, but I still felt the irritated throat when I swallowed.  By Friday(2/10) of that third week post, my throat and vocal cords had cleared up completely.  No further symptoms as far as I can tell; I feel perfectly fine now.

This might be a garden variety upper respiratory illness and a coincidence with my encounter, but I have never had anything like that before.  I would be more convinced of it if I had had runny nose, nasal congestion, etc., but I did NOT. 

The anxiety over possible STIs/HIV related to that encounter is killing me.  Is there a medical need for testing?  I thought I was adhering to relatively safe practices, but really can’t explain the throat symptoms.  The aforementioned symptoms did happen; they weren’t just a product of anxiety.  Thank you in advance for any wisdom/advice you might share.  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your question.

This sounds like a pretty average upper respiratory viral infection -- hanging on a bit longer than average, but otherwise nothing special. Many such infections don't cause stuffy nose etc. No STDs cause such symptoms, and neither does HIV -- and in any case, the exposure described was no risk for HIV or any other STD. It sounds like a good bet you caught the virus from your partner, but it could have been anyone else in your environment in the several dayse before symptoms started. You can expect it to clear up pretty soon.

Based on the exposure and symptoms, I don't recommend testing for any STDs. But you are free to do that if the negative results would give you more confidence about it, in addition to my reassurance. For example, enough time has passed for  a conclusive HIV 4th generation test. (This doesn't mean I believe there is any chance of it. I don't. Strictly for reassureance. Otherwise, if you remain concerned, see a doctor. But if I were you I would sit tight for a while.

I hope this has helped. Best wishes and stay safe!

HHH, MD

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42 months ago
Thank you Dr. Handsfield for your reply.  I've been reading your answers to questions other users ask over the years on Med Help and here.  I've learned quite a bit from all of your replies, and I try to take everything you say to heart.  You've helped me tremendously.  You are so right that on-line research is mostly anxiety provoking, but you help a lot with that and putting things into proper context.  I am so grateful to you, because the anxiety is crushing.  

By the way, I did ask my partner, and he says he's been feeling perfectly fine.   I assured him that I wasn't accusing him of anything, but it still bothered him that I asked, and he thinks I have problems controlling my anxiety.  He does get tested periodically and says he would never put anyone at risk though he is definitely more experienced sexually than me and is not as susceptible to anxiety as I am personality wise.  I did read a statistic from the Fenway website that fueled anxiety, which stated that 70% of gay men that test positive go in for testing believing that they are honestly negative, which makes me believe there may not be enough anxiety in the gay community.  

Anyway, I won't keep probing you with anxiety driven questions, so if I get tested in a few weeks or so, I'll let you know - maybe just for the benefit of other anxious users who might read this.  But thank you so much for your reassurance.  God bless you!  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Thanks for the follow-up comment, and for your kind words.

That many gay men who test positive believed they were negative doesn't mean much. The fact remains that the large majority of those who believe they are negative in fact test negative. And it sounds like your partner has a responsible perspective and probably is sexually careful. In any case, you had entirely safe sex; even if he had HIV, you were at zero risk.

As you probably know, forum policy has a limit of two follow-up comments and questions. I'll leave this thread open for a while, so it will be available for you to post your test result if you do it. I'm confident it would be negative.

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42 months ago
Hello Dr.  Handsfield,

Update on my status.  The LGBT Center in my city does  comprehensive testing.  I tested about 1 day short of six weeks following my encounter.  My results are:

HIV Rapid blood (negative)
Syhilis, RPR (negative)
Chlamydia & Gonorrhea (negative)

In addition to the HIV Rapid test, they do NAAT testing on blood as well, which took about two weeks to get the results.  That one also came back negative.  I'm pretty confident I'm definitively negative for the major STIs, but a few other questions popped into my head...hope you won't consider it anxiety driven, but more just curiosity.

1.  I think I turned 27 years old just before HPV vaccine became available to all adults 26 and under.  Unfortunately, I did not get the HPV vaccine.  Do you think it's worth discussing with my general practitioner at my next physical?  Would it be potentially beneficial for me?

2.  I read 4th generation tests conclusive at 28 days are often incorporated into rapid HIV tests.  The rapid checks for P24 as well as antibodies.  Would you know if 4th generation rapid blood tests are now the norm in all major testing centers and thus conclusive on their own at 28 days?  Or I wouldn't know unless I specifically asked at the test center?  I know 4th generation is the norm for lab based testing.  

3.  I read that NAAT is used in high risk populations with pooled blood samples for cost effectiveness.  In your opinion, would a negative result in a "pooled" sample for NAAT testing be just as conclusive as it were not pooled and NAAT tested all on its own?  

4.  I read somewhere that you do not recommend herpes testing in absence of symptoms.  I actually don't know too much about herpes and potential risks for contracting it.  Reading some of your prior responses, I came away with the impression that HSV-1 is no big deal, but HSV-2 sort of is?  Any tips on prevention?

5. I suffer from a great deal of anxiety about HIV and STIs, which may actually leave me unable to find a partner.  I never considered myself asexual, but even small risks scare me.  Any tips on coping with anxiety?  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Thanks for the follow-up information.

1) There are good reasons HPV vaccine is not recommended above age 26. New HPV infections are uncommon, and by then most peole have already been infected with several (if not all) the HPV types convered by the vaccine. I would not recommend it for you.

2,3) I cannot judge the proportion of medical facilties that routinely use particular tests. In any case, even if your test was not a 4th generation (antigen-antibody) test, the combination of negative antibody plus negative pooled NAAT testing at 6 weeks is 100% conclusive. Negative NAAT is equally reliable done either individually or pooled.

4) No particular advice about HSV2 prevention, other than common sense precautions as for all STDs:  care in choosing partners and consistent condom use for new or non-monogamous partners. Also, oral sex carries almost no risk for HSV2, even unprotected.

5) I'd like to help, but this is an STD service, not one for psychological support. The best I can suggest is to educate yourself about STDs and HIV so you have factual, accurate information about risks and prevention. If anxiety about it continues, and if it significantly affecting your life and happiness, professional counseling is a logical approach.

As you know, that concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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