[Question #3414] No insurance, oral thrush, limited money

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90 months ago
This is follow up to Dr H question.  I suffer from PTSD 

On January 8th 2018 I went to my dermatologist where he froze off what appear to be two hpv warts towards the head of my penis.  This happened at lunch time,  I then returned to work for the remainder of the day.  After work I got a bite to eat and went for a massage.  During this session the girl offered "extras".  I weakly excepted.  She went and got a condom.  I did not see her open it nor did I see what kind it was (latex, lambskin, etc).  She placed the condom on me and began to give me oral sex.  The women was of Chinese decent.  During the oral sex I asked if I could insert my penis inside her.  I took two pumps and decided this was a bad idea.  She then finished me orally.  It appeared the entire time the condom was on. (for both the oral and very brief vaginal)  I may also have fingered her briefly with a small nick on my finger.

2 weeks latter I fingered a massage girl with a nick / cut.  I did look at it before insertion but the next day it looked worse.

Feb 2 got chest Rash.  Dermatologist saw pictures and said it wasn't ars rash.
Feb 5 thrush sore on check

Tested negative with alere rapid duos 4, 5, 6, and 7 weeks post FIRST exposure.  The six week test results looked odd(although counselor said negative)so I repeated the next day and the following week.  

Didn't know exact date of 2nd exposure but I didn't think there was a big risk.  Maybe there was

Yesterday March 4 I got oral thrush on bottom gums.  Dr. diagnosed and cleaned mouth and prescribed fluconazole.  He said take if it returns:
1.  Do I need more tests?  
2.  Was second risk worthy of test?  (Don't know exact date, probably two weeks after first)
3.  Does the thrush mean I am doomed
4. When if ever can I sleep with new partner unprotected.(she wears dentures if it matters)
5. What do I do now?

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90 months ago
Lastly I am a mail age 45 in central NJ. I do smoke a minor amount of cigarettes each day.  I haven't taken antibiotics.  Please help me doctor.  The oral thrush really has thrown me for a loop.
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90 months ago
Lastly Doctor I am hesitant to take the meds.  There is still a little thrush left.  Should I take them?  
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90 months ago
And finally do antifungal s affect his testing?  I am truly sorry for my anxiety.  I am embarrassed.
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Edward W. Hook M.D.
90 months ago
Welcome back to the Forum.  On this occasion I happened to pick up your question and will be answering rather than Dr. Handsfield.  I have reviewed his earlier interactions with you and agree with all that he has said.  Many of the questions you are asking are the same that you asked of him in the thread that ended about three weeks ago, the major difference being that you now have negative tests which are negative at 6 and 7 weeks, thereby providing further PROOF that you did not acquire HIV from the virtually no risk exposures you have reported.  I will go to your specific questions.

1.  Do I need more tests?  
Absolutely not.  From a medical perspective it is questionable as to whether or not you needed to be tested at all for the exposure and now you have proven that you were not infected and that your symptoms were not related to HIV.

2.  Was second risk worthy of test?  (Don't know exact date, probably two weeks after first)
No.  No one has ever gotten infected with HIV from either masturbating a partner or receipt of masturbation and the presence of cuts or abrasions on either person makes no difference.

3.  Does the thrush mean I am doomed
Of course not.  Most people who get thrush, like you, do not have HIV. 

4. When if ever can I sleep with new partner unprotected.(she wears dentures if it matters)
Nothing you have written about in this or your prior posts suggests any reason to not have unprotected sex with your new partner.  Her dentures in no way change this.

Regarding the fluconazole.  Fluconazole is typically well tolerated and highly effective.  I would not hesitate to take it if your thrush has not resolved.  The antifungal therapy has no effect on HIV testing either. 

In closing, I hope my comments and my complete agreement with all that Dr. Handsfield has already said is helpful.  I would also urge you to consider the interaction of your PDST/OCD with your concerns and, presuming that you are working with a counselor, would suggest that you discuss your situation with him/her. EWH
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90 months ago
Dr. Hook

Thank you for your detailed response.  My followup info / question is as follows:

My second risk was brief fingering with a nick/ cut.  The next day I  picked and pushed and proded it and made it leak fluid.   I was tested  approximately 4 or 5 weeks after this.  I believe 5 weeks.

1.  Your opinion is this 2nd risk was not a risk and didn't need to be tested for?

2.  This 2nd risk doesn't need more testing? (Regardless of thrush diagnosis and that I was tested either 4 or 5 weeks post risk)


I believe the take away points from your detailed response are as follows:

-Take the medication.

-Continue to work with my group program / therapist.

-Move along with my new relationship as it is safe to do so from a sexual standpoint.

*** If I need anything else I save my last followup for that**

Thanks!!!!  My funds are limited.  Getting over my assault has been very hard.

KS


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90 months ago
Dr.

Good morning.  I also forgot to mention I got a big cold sore / herpy in the center of my bottom lip about 5 weeks post first risk. (If it matters)
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Edward W. Hook M.D.
90 months ago
Straight to your follow-up questions:
1. The second event did not put you at risk.  No need for additional testing.
2.  See above.

Your take away summaries are correct.

The cold sore you experienced does not change my assessment of advice in any way. EWH
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90 months ago
Thank you for your response Dr. Hook.

I now have a cold.

I have been taking the fluconazole 150 mg for 4 days.  The thrush has mostly resolved but not totally.  I was given a script for 14 days.  They did check my sugar and it was fine.

As far as the new girl I am seeing.  She has had a history of drug abuse.  She has been clean for 2 years and said she dated some shady guys in her past.  She also says she does get tested every few months.  She wears dentures do to an accident.  She said sometimes she bleeds when she takes them out for long periods of time.  She said she can tell if she is bleeding and it is rare.

My followup is:

What do you usually prescribe for thrush and for how long?

If this treatment doesn't work or thrush returns should I then be concerned about HIV?

Lastly I am trying to give this new gal a chance regardless of her past.  I open mouth kissed her twice for several minutes with her dentures in.  Should I be concerned about open mouth kissing someone with dentures in case her gums are bleeding?  Is this a risk?  Am I being paranoid?

Thank you and have a nice weekend.

KS







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90 months ago
Dr.

Lastly I have a congestion, minor sore throat and cough.  Basically a cold.

The new girl I referred to I only open mouth kissed.  We never did anything else.

Thanks.
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90 months ago
Sorry doctor one last thing came to mind.  Would kissing the girl with dentures be more risky while I have thrush?

Thanks.
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Edward W. Hook M.D.
90 months ago
They typical duration of fluconazole therapy for thrush is 7-14 days, both to treat the infection and to prevent recurrence.  Thrush does recur from time to time, and this does NOT suggest HIV if it does. 

Your cold symptoms do not change my advice or assessment.  Further, I see no reason or risk to you form open mouth kissing.  No STIs, including HIV are transmitted through open mouth kissing.  gum disease, dentures, oral bleeding or oral lesions do not change this. 

It is interesting that you mention that your new GF has dentures.  Sometimes persons with dentures can be colonized with Candida, the fungus that causes thrush and they sometimes experience the problem themselves.  This of course, should not be a reason to stop an otherwise healthy relationship.  If you have doubts about this person's past, let me suggest that it might be good for both you and your new partner to go (together if at all possible) to go for a sexual health check which includes screening for STIs.  This is not an accusation but simply acknowledgement that both of you appear to have had other partners in the past, that many STIs can occur without symptoms, and that while it is unlikely that either of you are infected, knowing this based on mutually negative tests will provide a measure of confidence and trust as your relationship moves forward.  We routinely recommend this for new relationships and suggest that such testing should include testing for gonorrhea, chlamydia and for the woman and sometimes the man, depending on the test performed, tests for trichamonas using either vaginal swabs of for the male a urine test.  Testing for HIV and syphilis, while far, far less likely can be easily added with a blood test if desired.  We specifically recommend against blood tests for herpes unless one partner has a history of the infection as they have relatively frequent false positive test results and can be misleading. In the US confidential testing can be obtained for little cost at health departments.


As you know, this is my 3rd response.  thus, as per forum guidelines, this thread will now be closed.  Let me further warn you that should you post further, anxiety-related, repetitve questions, the question may be closed without a response.  This is done as there is little value to you or others from the repetition.  Please continue to work with your counselors on your recovery from your PTSD.  Take care and best wished.  EWH


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90 months ago
Thank you doctor.  Do you think the partner testing you recommended is mandatory or only if we shall advance to a more serious relationship?
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Edward W. Hook M.D.
90 months ago
No, I do not think it is mandatory.  I suggested it as an option which might strengthen/ enhance you relationship.

Thread is now CLOSED. EWH
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