[Question #199] Follow-up

37 months ago
Doctor - 

I previously submitted question #188 regarding an unprotected oral sex encounter that resulted in a positive gonorrhea test.  I am happy to report that the urinary urgency and testicular pain I had experienced for the past several weeks seemed to suddenly disppear over the weekend.  So odd.

In any case, Dr. Handsfield's final response to me indicated that I should escew additional testing absent new symptoms indicative of an STD.  Starting Friday, I began to suffer a sore throat, dehydration, fatigue, and muscle aches.  I don't think those are likely symptoms of the "low risk" STIs mentioned in Dr. Handsfield's response (HSV-1, Hep B), but I wanted to confirm that.  (And, after 19 days from exposure with no outbreak, presumably HSV-1 is unlikely)

Finally, after reading a bit about HIV symptoms, there are some articles that list my symptoms as among those experienced by recently-infected persons.  Dr. Handsfield characterized my encounter as "essentially no risk" of HIV, but I'm nevertheless suffering extreme anxiety about this.  With apologies if this is considered "repetitive posting," am I being completely irrational?  It would help me tremendously, I think, if you could advise me that these new symptons are entirely innocuous and that I am at no risk of HIV.

Thank you.  (I expect to have no follow-up)
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Welcome back to the Forum.  As you probably know, Dr. Handsfield interchangeably answer questions and today you happened to get me.  I did review your earlier exchange, agree with all that was said, and hope that this interchange will be of further to help you.

I will confirm what was said earlier to the effect that to get any STI from receipt of oral sex is quite uncommon but does happen.  Further some STIs such as HIV have never been convincingly shown to be acquired from receipt of oral sex.  So, what could be going on here?  I think this may be a case of "true-true but unrelated".  The symptoms you describe sound like those of the sort of viral, flu-like illness that most of us get from time to time, particularly in times of stress and or after travel.  The symptoms you suggest do not suggest a typical STI and are most likely to be coincidental rather than related.  Admittedly, they do overlap with the symptoms sometimes reported with acute, recently acquired HIV but even when truly high risk persons with such symptoms are tested, the vast majority have other, community acquired, non-STI viral infections and not HIV.  as I said earlier, nothing you have reported suggests you are at high risk, or for that matter, any risk for HIV.

My advice would be not to worry that this is related to the encounter that gave you gonorrhea.  I see no need for further testing either.  I hope my comments are helpful.  EWH 
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37 months ago
Doctor -

My symptoms seem to be getting worse.  I've got a sore throat, stiff neck, sore ribs (particularly to the touch), headache, random shooting pains all over my body, and occasional feelings of itchiness (mostly on my feet and arms).  I've come to accept that I did not contract HIV from this incident (as the odds seem to be less than being struck by a meteor), but I am completely puzzled by what is causing my symptoms.  Any idea?  I've had the flu before; this doesn't feel like the flu.  I'm completely perplexed and the symptoms are almost intolerable.  Could it be a reaction to the medication?  Is there a correlation between gonorrhea and other diseases?

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
I'm sorry you are continuing to feel poorly.  By my calculations it is more than a week since you took the cefixime (Suprax) and azithromycin and that your current symptoms started about 5 days ago- is this correct?  If so, it would be a bit unusual for an allergic reaction to follow this time course and even if it were, the medications are in your body and will need to pass out (the cefixime is now gone, the azithromycin will circulate for a few more days).  There are several possibilities however and how you might address them varies depending on what is going on.  Community acquired viral infections have varied manifestations and can occasionally persist this long and while unusual so could a drug reaction.  The fact that your symptoms are so troublesome warrants a trip to your doctor to see if he/she has any ideas or can suggest a way to address them.  This may be symptomatic therapy or something more specific.  I will keep this thread open to hear what the doctor tells you and be happy to comment (also, please be sure to be truthful with the doctor about your exposures, etc.  To do otherwise limits what he/she can say.)  EWH
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37 months ago
Dr. Hook:

I am almost to the point of tears.  At your suggestion, I visited my GP.  I shared my exposure, my gonorrhea test results and treatment, and my anxiety about other STIs, including HIV.  Consistent with the advice I received here, he suggested that persistent gonorrhea was unlikely and that my risk of acquiring HIV was miniscule.  Nonetheless, he suggested that the testing for gonorrhea (2 weeks after treatment) and HIV (27 days after my incident) could have therapeutic effect, so I gave a blood and urine samples this morning for further testing.

My problem is that while my fatigue, sore throat, and dehydration have mostly disappeared, I am continuing to suffer shooting pains all over my body.  The precise locations are different day-to-day; today my collarbones and hands hurt.  The pain in my back (particularly focused around my spinal cord) is constant.  I've also developed a new symptom - I woke up yesterday morning with three small sores on the top of my head.  I do not know what is causing these symptoms, which are severely impeding my ability to complete even basic daily activities.

My GP thought anxiety was a possible caught, but that some sort of flu or viral infection was also contributing.  He didn't really have an answer.  Any ideas?  I am feeling desperate.

Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
Bill.  Thanks for your follow-up.  I am sorry to hear that your visit to your PCP did not have better results for you.  I agree with his/her assessment.  While I don't have solid answers for you I do have several suggestions.
1.  It is time to NO LONGER connect the exposure you described to your symptoms.  Your tests are negative and you have heard from both your PCP and me ,that your symptoms are not due to an infection acquired from the exposure you describe.  I am confident that your follow-up tests will be negative.
2.  Appreciate that there are many viral illnesses that people acquire through their non-sexual activities of daily living.  To relate your current symptoms to the very, very low risk exposure you describe is a mistake.
3.  Appreciate that guilt, shame and anxiety can heighten symptoms or even lead to them.  I agree with your PCP that these may be contributing to your problems.

I hope that this information is helpful.  As you probably know, we limit interactions on this forum to three exchanges.  It is time to close this thread.  If there are further questions you will need to open a new thread.  EWH
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