[Question #4407] Symptoms - STI or not

30 months ago
Thanks for your service.  I've visited a number of escorts: Most higher-priced and a few at brothels.  I've used condoms consistently for oral and vaginal sex, except for two occasions where the escort gave me a blowjob without a condom (maybe lasting 2 minutes each time).  I've visited probably one escort per week for the last 6 months. Recently, I've been feeling sick with strong headaches that last for hours, an upset stomach, general tiredness, sore throat and a small patch of blotchy redness on my neck (10cm x 5 cm; although it appears to be dry skin, not a rash and it is very mild).  The headaches and sore throat are getting better today and have lasted about 4 days.  Also, my bladder has been sore and my urethra tingles after urinating.  There is no pain while urinating and I haven't seen any discharge. I've had trouble expelling all of my urine with a few drops coming out a minute or so after leaving the bathroom.  These symptoms have lasted a week or so.  Further, I have noticed today that the opening on the tip of my penis (meatus) is slightly swollen.  I haven't been tested for STIs in a while.  Are these symptoms anything to worry about? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Welcome back to the forum. Thanks again for your continued confidence in our services.

In your previous thread a few months ago, we addressed your low but not zero risk for STDs. It sounds like the nature of your exposures and partners are the same as before, so I have nothing to add about your low risk level.

Most of the symptoms you describe, both individually and considering all of them together, are nonspecific. In medical terms, that means they do not point to any specific medical problem. Stated another way, they are consistent with many health conditions but do not point to any particular one. While some of them could go along with some STDs, none of them are typical or common in people with STDs. The symptoms that come closest to raising STD concerns are those involving your urinary tract:  possible swelling of your urethral meatus, urethral tingling, dripping after voiding. However, STDs rarely cause these things. Most men who perceive meatal changes (swelling, increased redness, etc) usually are just paying closer attention than normal and seeing subtle, insignificant but normal variations in appearance.

So almost certainly these symptoms are entirely unrelated to your sexual exposures and lifestyle. That said, you probably should have another round of routine STD and HIV testing at this time -- i.e. urine gonorrhea/chlamydia testing, blood tests for syphilis and HIV, and (because of the sore throat) a throat swab for gonorrhea. Almost certainly they will all be negative, but the negative results should help clear your concerns in regard to STDs. Then if the symptoms persist, you can work with your doctor to figure out what's going on.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
---
---
30 months ago
Thanks for your advice.  I just saw another Chinese escort. She didn't want to have vaginal sex. She said she felt unwell.  So, she gave my a blowjob and then a handjob. The blowjob was unprotected (no condom).  Afterwards, I saw the medicine that she was taking: Hiprex (Antibacterial; Suppression or elimination of urinary tract bacteria; Contains Hexamine Hippurate). I've googled the medicine and it doesn't appear to be a treatment for any STI. But now I am freaking out.  The escort said she's only been in New Zealand for 3 days and didn't do sex service in China.  She assured me that she didn't have any STI.  However, she didn't appear to know that she needed to be tested regularly and didn't think that anything can be transmitted by oral sex.  I asked her when she was last tested and she didn't give me a straight answer; she was very evasive. Initially saying she hadn't been tested and then when I appeared worried, saying she was tested in China.  She spoke good English so I don't think there was a miscommunication issue.  She is a younger escort - early 20s.  Her reaction to my questions was genuine shock/ignorance.  I really think she doesn't have a strong sex education.  I've read many of your replies before and I know the statistics that you may quote regarding oral sex.  So, my question is simply: Should I be worried about receiving an unprotected blowjob from an escort who is complaining of a sore genital area, is taking Hiprex medicine and hasn't been tested recently?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Follow-up questions are intended for clarifications of the initial question, not risk assessment or other information about new symptoms or an entirely new exposure. My brief response is to affirm that oral sex is safe sex. HIV has never been proved to be transmitted mouth to penis -- if it occurs, it's very rare -- and most STD also are rare after such exposures. A sore genital area does not imply an elevated risk of STD by oral sex. You are correct that Hiprex helps prevent UTI, but not STD.

I agree it sounds like your partner is new to commercial sex. She may have been forced into it, with little education or preparation. I hope your knowledge about risks helps her understand about precautions she should be taking.
---
29 months ago
Thanks Dr Handsfield for your reply. I've had my test results back and everything was negative (throat and rectal swabs; urine sample; syphilis and HIV quick tests - finger prick).  My only question was regarding the HIV test: It was a 3rd generation, not 4th. The clinic said they switched from 4th to 3rd because of too many false positives. While I don't feel I've engaged in any sex acts that puts me at risk of acquiring HIV, I'm wondering how many days since a "risky event" does it take before a 3rd generation test is accurate? (Just curious, not anxious.) Thanking you in advance of your reply.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Congratulations on the negative results.

I'm unaware of any data in increased risk of false positives with 4th vs 3rd generation tests. The 3rd gen tests are conclusive after 6-8 weeks.

Thanks for the thanks. I hope the disucssion has been helpful. Best wishes and stay safe.
---