I appreciate your time so I will keep it as short as possible. My exposure was nothing exotic, unprotected oral and rimming (received), protected sex with a WG. The exposure was last week, and I have had a swab test done at the private clinic, negative for gonorrhea, but found a bit of thrush (was told that it's normal). However, the result was inconclusive, because i tested too soon, and peed an hour before.

I have been experiencing some pain (comes and goes) inside the tip/opening of the penis, and yesterday I found redness/some white spots that resemble canker sores inside the tip. I dont know if this is normal or not, as i never really looked inside the tip before, but I'm also not sure if it might be the symptoms of STDs or consequence of the swab test. The redness/sore is pretty hard to describe, I tried taking a picture of it but it's also hard to zoom in and focus on the area. 

What could this possibly be (the pain and the redness/sore)? 

Given my exposure and the swab test, can i rule out STDs and HIV? is it necessary to re-test in 2 weeks?

Thank you.
  

Some aspects of your question are unclear -- I'll need more detail to answer more precisely. I don't understand WG in relation to the exposure. Presumably the swab test was from the urethra, not the rectum -- please confirm. What was the time from exposure to the negative gonorrhea test? Anything more than 2-3 days is sufficient for a conclusive result; if tested later than that, you can rely on the result. Was chlamydia testing done? That requires more time for a conclusive result, so even that result would be OK, if done more than 4-5 days after exposure. Also clarify urethral vs rectal. Finally, are you circumcised? If not, is there also any redness or white spots under the foreskin, i.e. in addition to those in the meatus (urethral opening)?

We do not examine posted photos. We are not here to diagnose anything, and examining rashes comes close to distant diagnosis so we don't do it. So don't go to any trouble to take and post a photo. 

With the incomplete information available, it seems unlikely an STD explains the white spots and perhaps inflammation in your meatus. Herpes often causes ulcers similar to canker sores, but herpes in the urethra usually is excrutcating -- minor pain that comes and goes doesn't fit very well. This well could be your apparent yeast infection (thrush). Nongonococcal urethritis (NGU) might be possible, but usually doesn't cause white spots.

Fill in some of the missing information and perhaps I will have more to offer. However, pretty much regardless of what you say, or expanded advice I may have, my main recommendation is that you return to the clinic where they did the gonorrhea test and diagnosed possible yeast infection. They're by far in the best position to sort this out. Or if cost in the private clinic is an issue, an NHS GUM clinic. (I'm guessing your in the UK.)  In the meantime, I wouldn't be seriously worried. The likelihood of an STD or anything serious is low.

I look forward to hearing more. In the meantime, I hope these comments are helpful.

HHH, MD

Thanks for your reply. You are truly amazing, I don't even know how could you have guessed that I'm in the UK. 

To answer your questions:

By "WG" I meant "working girl (prostitute)", I thought that might put my exposure in context.

The time from exposure to my swab test (urethral, not rectal) was 4 days, they didn't find gonorrhea, but I was told that because i peed around an hour before, I might have "washed away some of the bacteria", thus making the swab invalid. I took a urine test (for chlamydia, etc) as well, but that would need to wait until next week for the results to come back. Nonetheless, I was offered an appointment to come back in 2 weeks to re-do the tests for a conclusive result.

I am not circumcised, there are no redness or white spots under the foreskin at the moment.

Perhaps "white spots" is not the correct term to describe what I'm having, it kinda looks like the mild canker sores that people would get on their gums, but not as concentrated. And yes, I do understand that you do not examine photos. Prior to asking on this forum, I took some pics and sent it to an online genital clinic for assessment, but instead got refunded and told it was impossible to have a precise diagnosis, and that I should wait it out and see what happens.

I am not sure that it could be due to a NGU, it is in my understanding that NGU would indicate that there is white blood cells present, but the docs at the clinic failed to find anything other than a bit of thrush from the swab test (which I was told to just leave it alone).

I am also not quite sure about chlamydia, from the education that I have gathered, I thought it was fairly rare to get chlamydia from receiving oral sex?

All in all, my main concerns are syphilis and HIV,  and I am experiencing the HIV/syphilis-paranoia symptoms in its full effect ever since my exposure (itchy throat, persistent dry cough, constant low-grade fever, fatigue, you name it). 

I have not experienced any excruciating pain from inside the tip of my penis (yet), the pain does not get worse when I'm peeing, and it feels more like an annoyance ( burning sensation might be the right description?) rather than anything else.

I hope this bit of information helps, thank you for your time.

Just wanted to add another observation, it has been 2 days and I hope you could find the time to reply to my messages soon.

I have discovered a red and raised bump on the side of my buttocks, I am pretty concerned about it, as it is round (also pretty big) and painless. From the looks of it, it resembles the shape of syphilis chancre that I have found on google. But at the same time, it seems to be at a pretty odd place to get a chancre, as it was no where near my gentials and anus.

The bump is not open and wet, and there is no pus coming out of it. Given the time of my exposure (around 7 days) to the time I discover this "bump" on my buttocks, is there a chance that this is a syphilis chancre? 

Thank you.

I concluded UK because in my experience, the term "private clinic" is commonly used there, in contrast with NHS clinics, but it's not in common use in North America (although I can't comment on elsewhere, e.g. commonwealth nations).

Your private clinic provider is more concerned about the theoretical problem of time since last voiding, and perhaps time since exposure, than most experts. The "wash out" issue really applies only to urine testing, not swab; and even with urine, most experts think it's a theoretical issue with no real world impact. Your negative gonorrhea test at 4 days is conclusive. However, 4 days might be a little soon for chlamydia, so a follow-up test makes sense -- but it certainly isn't necessary to wait 2 weeks for reliable result. And I can't imagine why a clinic would do a swab test for gonorrhea but urine for chlamydia. Swab is (slightly) better for both. Too bad your clinic uses a lab with such long turnaround. The chlamydia test actually requires 2 hours in the lab -- all the rest of the time is in specimen transport and delay in reporting results, and the lab probably does a chlamydia run at least once daily. (My guess is you would find most NHS GUM clinics have results more promptly.) Having said all that, you are exactly right that urethral chlamydia is extremely rare from oral sex, so no serious worries about it.

NGU doesn't typically cause white spots. With your further description, I suspect this indeed is a mild yeast infection (thrush). 

As for the bump on your buttock, almost certainly it is no STD and I'm sure it has nothing to do with your recent sexual exposure. Syphilitic chancres occur only at points of sexual contact:  You cannot receive oral sex and have a chancre appear anywhere other than the exposed parts of your penis. And by the way, the same applies to herpes, the other main cause (other than syphilis) of genital ulcers. Perhaps it's just a developing pimple or folliculitis.

So my guess is you have no STD and nothing to worry about. For sure nothing at this time points to syphilis or HIV.

And speaking of £££, my anxieties got the best of me so I went ahead and did a HIV RNA PCR test (also included a complementary DUO test) at 10 days post-exposure and the results came back negative. The doc also took a look at the bump on my buttock, and concluded that it probably has nothing to do with STDs at all.

To be complete honest, I feel like I have wasted enough time and energy searching for STDs. Perhaps I just wasn't lucky enough to catch any after all. That being said, I would like to ask:

1. Can I rely on the HIV RNA PCR at 10 days (9.7 days to be exact) to be conclusive and move on?

2. Do you think it is still necessary for me to go back to the clinic and get my urine test done at 2 weeks and syphilis/hep b/hep c test done at 6 weeks? 

3. Can I get back to having unprotected sex with the wife? (That is if I can find one in the near future first)

Thank you for your time.

Whether your time and money have been wasted is pretty subjective. If you have been reassured, perhaps the price in both time and pounds sterling were worth it. But from a strictly medical/risk standpoint, you had an extremely low risk exposure with no appreciable risk for HIV and very low risk for all STDs.

1) PCR testing alone usually is not considered conclusive. A negative antibody or AgAb test at 4 weeks would nail it. OTOH, with the chance you caught HIV at say 1 in a million to start, and 1 in 10 million with the negative PCR, isn't that close enough to zero to move on without further testing?  If somehow I had been in your situation, or if I were counseling someone close to me, I wouldn't have been tested in the first place.

2) I see no need for additional testing of any kind. For sure don't waste money on viral hepatitis testing:  your exposures were zero risk for hepatitis B and C. There was theoretically a small risk of syphilis, and a blood test 6 weeks after the event still would be reasonable. But low enough risk that it should be considered optional.

3) Again if I had been in this situation, I would never have stopped having sex at home. Certainly there is no reason you cannot do it safely now.