[Question #1833] At a loss.

44 months ago
I sincerely apologize for returning to this site, but I honor and value your guys' opinion more than my own medical provider (providers). I'm just so frustrated and cannot figure out whats going on with me.

 Quick review- hsd protected sex and unprotected oral with a man on 1/27. I was sick prior to the incident with a cold. 2 days after the sexual encounter, i got a really bad sore throat with white spots on my tonsils. However, after being on amox-clav for a day, my symptoms resided. The white spots on my tonsils persisted, but with no symptoms. fast forward 3 weeks later, I came down with congestion and bronchitis. The white spots on my tonsils returned, however the other night i took a q-tip and swabbed the white spots and they came off- there was mucous and blood left on the q-tip after swabbing. The second time i got sick, it started with post nasal drip. Now, my bronchitis is gone but i still have post-nasal drip and extremely bad sore throats in the morning and at night. The weird thing is the sore throat diminishes during the day. I'm at a loss here. I've been sick for 2 weeks now and i thought i was getting better when the bronchitis went away. But now, towards the end hopefully, i still have post-nasal drip and red bumps in the back of my throat. I believe these bumps are known as "cobblestones" in the medical industry.. My worry is that it's herpes. I've been tested for mono and strep, and that came back negative. I was also just tested at the local clinic for chlamydia, gonorrhea, hiv and syphillis and everything came back negative. I tested at 5 & a half weeks after the incident, so i hope that means I can assume that i do not have hiv and that this illness is not from hiv. I am going to test for hsv 2 when i am better!

1) Do you believe this lingering sickness is hsv 2 or hiv?
2) Do you believe the bumps at the back of my throat are hsv 2? They appeared 5-6 weeks after incident. 
3) is there a chance this could be gonorrhea or chlamydia in my throat?

Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

Welcome back to the Forum.  I'm sorry to hear of your lingering/recurring symptoms and will be happy to expand on my earlier comments.  You can be confident that you did not acquire an STI of any sort, including HSV-2 from the encounter you have described.  The "cobble stoning" you describe is a good description of the way that lymphatic tissue in the back of the throat (including your tonsils if they are still present) react to virtually any infection in the area.  The most common cause of the sorts of findings you describe are community acquired, non-STI viral infections that most people get from time to time and can linger for several weeks.  You have effectively ruled out most STIs, about 70% of mono (30% is not detected by the most widely used mono tests) and strep.  Oral HSV-2  is extraordinarily rare and does not present with pharyngitis of the sort you describe without also being accompanied by sores on the outside of the lips.   Similarly, your HIV tests prove that you did not get HIV- if you had, your HIV test would have become positive within a few days of the onset of your symptoms.  

In answer to your specific questions:

1.  No, I am confident that your lingering symptoms are not due to either  HSV-2 or HIV.  Nothing you have described is compatible with either of these illnesses.

2.  No, please see above.  This is normal, non-specific swelling of the lymphoid tissue in the back of throat.

3.  When you say you were tested, I presume that included throat swabs for gonorrhea and chlamydia.  If so, the tests would prove that you were not infected.  If you were not tested, I still doubt that you have pharyngeal gonorrhea or chlamydia.  this infections, when they occur are usually asymptomatic.

I wish I could give you a specific diagnosis and make your symptoms resolve more quickly.  Unfortunately, I cannot.  I think you will probably just have to wait this out a bit longer and am confident that things will get better.  EWH .

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44 months ago
Dr. Hook, thank you so much for your advice and expertise. I'm sure you hear this quite often, but you are wonderful and so knowledgeable. I find that a lot of doctors these days are far behind on up to date information regarding illnesses and such. 

Yesterday I had clear mucus, but was very stuffy. This morning I woke up and my mucus was green- which I know is a sign of infection, ugh. I'm on antibiotics already though called cephalexin, which I know would take care of bacterial infections such as strep throat. This is my third round of antibiotics in two months and the only one that was ever effective was amox-clav the first time i got sick. I know it could be because now i have a viral infection and antibiotics don't cure those, but i'm just at a loss. I've been to the doctor 5 times in the past 2 months as well- im over doctors, I feel like I have the flu today- aches, chills, congestion, fatigue and headaches but no fever. Maybe it's just a cold?  I do work in retail and all of my coworkers have been sick with strep, bronchitis, UPI's and colds, so i don't know if its possible that i keep getting re-sick?? This morning i woke up and checked my throat and my tonsils don't seem to have too many white spots or patches, but the area between my tongue and epiglottis was very bumpy. Is this normal?

Also, as i stated before- i have a new partner. We've only had sex twice, but we always use a condom and we've never had oral. However, it freaked me out friday night when we had sex and his entire penis was in me, to the point where my butt was touching his pubic area. I stopped him after that, because i didn't know if that kind of skin touching or rubbing could put me at risk for an std. This evening  i noticed that my anus would sting in a certain area. I looked but didn't see anything too concerning. I did have two bowel movements this morning, so i don't know if that could of irritated it. The irritated spot is at the top of my anus, where the skin retracts and spreads.

1) do you believe i'm at risk from an std from the sexual encounter friday night?
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago
I understand that this (or these) lingering problems can be frustrating and with a new sexual partner it is reasonable to be a bit concerned but nothing you had described makes me the least bit worried about any STI including your skin to skin contact Friday night.  I congratulate you in your wish to stay sexually healthy and would suggest that you might have a discussion with your knew partner, telling acknowledging that you have both (I presume) had prior sexual partners and want to make sure that your relationship is sexually healthy and therefore, why not go (together) and get checked for the common STIs (gonorrhea, chlamydia, trichomonas for you) and for HIV so that your relationship can move forward uninhibited by concerns about possible STIs.  I would suggest that you state this not as a lack of trust but as a vote of confidence and respect.  EWH 
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44 months ago
Thank you again Dr. Hook for all of your help and advice. 

Once again, I had sexual intercourse with my same partner Monday morning. We used protection, but I am still worried about our private parts touching that are not covered by the condom when we are being intimate. Typically, I am speaking of his pubic area that comes into contact with my private parts when we are being intimate. Does this put me at risk for an STD, or am i overthinking this?

Also, this morning (exactly 24 hours after sexual intercourse), i noticed a bump on my labia majora. I do suffer from sebaceous cysts quite often, especially during the summer. Last week I was at the gyno and had several sebaceous cysts at one time, but my gyno said there was nothing they could do for me and that they weren't an STD. These bumps were all under the skin. The bump from this morning seems to be the same possibly- no itching, no burning, a little tender. You can definitely feel the bump, but when i look in the mirror, it's hard to identify without touching to find the bump.  I have been putting hot compressions on the area to see if that will help the bump subside. 

1) does this bump sound like herpes or an std?
2) would an std present 24 hours after protected intercourse?


Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

I would not worry about the exposure you describe.  Touching of private parts in the way you describe is not a risk fact for STI unless there is a lesion or sore present which could transfer infectious material directly to you..   Our skin is a remarkably effect barrier from acquisition of infection and dies a great job of infecting us from infection.  Further, there are no STIs which would cause symptoms just 24 hours after intercourse.    In addition, person's genital regions have numerous bumps, cysts, and other irregularities which are usually unnoticed but can be noticed if one looks closely.  What you describe could well be a cyst or an inflamed hair follicle.  Folliculitis (benign inflammation of hair follicles occurs when the open in the skin that hairs grow out of get blocked and normal skin bacteria lead to cyst formation.  Folliculitis is more common in persons who shave their genital and pubic areas but is not an STI.

I hope my reassurances are helpful.  You are practicing safe sex.   Hopefully you have confidence in both your partner selection and your safe sex practices.  They work and yo are doing things right

As you know this is my third reply to this series of questions. Thus, as per forum guidelines, this thread will be closed later today. Take care.  EWH .

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