[Question #4915] Std in throat or regular infection?

24 months ago
Gave unprotected sex to a semi new partner I have been seeing for a little while on a Friday night. The next day I went out and felt tired and run down. That Tuesday I woke up with a sore throat. Wednesday even worse, my tonsil was huge and has pus on it. Lymph nodes in neck hurt. Went to urgent care, strep test & culture negative prescribed augmentin. Diagnosed me with tonsillitis. 4 Days on the augmentin & no improvement. I saw my primary doc he gave me a steroid pack and said let me swab for chlamydia & Gonorrhea just in case. That came back negative as well. After 2 Days on the steroids my tonsils began to go back to normal and white pus gone. It has now been a week since symptoms appeared and I am almost completely better- still a little tired and throat sore. But I’m uncomfortable that I don’t know what caused it. I get strep often so when it came back negative I was surprised by. could it have been related to sex? And is another std? Like herpes? Or something else?  I do not have HSV 1 or HSV 2. Last time I was tested was 6 months ago. I do not get cold sores. But I feel it’s odd I don’t have many other symptoms just a slight cough. No runny nose. I tend to get lots of anxiety over my health so I want to know if you think I am being paranoid thinking it may be an STD. Or is it likely that it’s a coincidental & a virus that is only affecting my tonsils? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome to the forum. Thanks for your confidence in our services.

The bottom line is that almost certainly no STD was the cause of your tonsillitis or other symptoms. I have little doubt that you had a garden variety viral upper respiratory infection -- more severe than average, but otherwise quite typical in most respects. The timing, i.e. 3-4 days after the oral sex event, is consistent with possibly catching it from your sex partner. But of course if you're close enough for sex, you're plenty close to catch a cold. Or it was like most such infections, an unknown source.

Some scientific facts. First, oral STDs rarely cause symptoms. The most common oral STD is gonorrhea, which can cause sore throat, but the large majority of cases (over 95%) are entirely without symptoms. Herpes is another possibility, but it pretty much always causes obvious blisters and sores of the lips, mouth, and throat, and not only pharyngitis or tonsillitis. Chlamydia doesn't readily infect the throat, and there have been no reported cases in which it cause sore throat or any other symptoms. Also, chlamydia rarely causes symptoms sooner than 7-10 days after exposure. On top of all this, the fact that Augmentin didn't help is against gonorrhea or chlamydia, both of which would have been at least helped and probably cured by Augmentin. That the antibiotic didn't help strongly supports a viral infection -- for which steroids often help very quickly. (Augmentin would also rapidly improve strep throat symptoms, so that also tends to confirm the lab result against strep, even though you've had previous problems with it.) Finally, no other STDs are known to cause the sorts of symptoms you had. In addition, your negative gonorrhea and chlamydia tests were reliable. As for a continuing cough, that's typical for any respiratory viral infection, and no STD causes coughing. 

So I return to my bottom line above. You really needn't worry about any STD in this scenario. I'm sure the problem wasn't an STD -- even if it could have been due to a virus you acquired from your partner.  Or whereever.

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

HHH, MD
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24 months ago
That definitely answers my question— thank you for being so thorough. I felt it best to ask the question as it seems my primary doctor, although a great one, is not that well versed on STDs (especially in a throat) & I wanted to hear an answer from an expert. Thank you! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Thanks for the thanks. I'm glad to have helped!---