[Question #4964] Atypical STI symptoms? HIV risk?

78 months ago

Hello,

20 days ago I had a sexual encounter with a bisexual married couple. The encounter involved unprotected oral sex with both male and female, and unprotected vaginal sex after the husband had ejaculated inside his wife. I also swallowed the husband’s semen.

Tt is important to note that I had a urine test on day 9 for gonorrhea, chlamydia, and trichomoniasis—all negative. I plan to have a 4^th gen HIV test at the appropriate time.

About a week after the encounter I began experiencing intermittent pressure and pain in my pelvic area and mild soreness in the testicles. A couple of days later the discomfort began radiating to the lower abdomen, lower back, hips, and upper thighs. The discomfort varies in both frequency and severity. I have not had any of the symptoms often associated with the most common bacterial infections—no pain/burning during urination or ejaculation; no difficulty urinating; no discharge that I’ve noticed.

1. Given the lack of “typical” symptoms and previous negative results, do you see any need to retest for these infections?

2. Are the symptoms indicative of another less common sti, or perhaps something like prostatitis/cppr or anxiety.

3. I was diagnosed last year with LPR. Has HIV transmission ever been linked to GERD or LPR via the swallowing of semen? I know these disorders can result in esophageal or stomach ulcers.

4. What risk level would you assign to my exposure for HIV?

5. Do you see any reason to abstain from unprotected sex with my wife?

H. Hunter Handsfield, MD

78 months ago

Welcome to the forum. Thanks for your confidence in our services.

My first thoughts are that this wasn't necessarily a high risk sexual encounter -- but of course that depends on the couple's sexual lifestiyle outside this event. If they frequently have similar adventures, and without condoms, then of course the risk could be high. The HIV test makes sense, unless both members of the couple have been tested recently with negative results. I would add a syphilis blood test at the same time.

My second thought is that your symptoms are not typical for any STD, and your negative test results are reliable. You may be on the right track in raising CPPS and genitally focused anxiety -- more below in reply to that question.

1) No, I see no need to retest for gonorrhea, chlamydia, or trichomonas. Not only are the tests done reliable, but your symptoms are not consistent with any of these.

2) There is no STD known to cause symptoms such as yours, common or otherwise. As you may have seen -- I have the feeling you have perused other forum questions similar to your own (thank you!) -- relatively unfocused genital and lower abdominal discomfort is typical for the chronic pelvic pain syndrome (CPPS) or gentially focused anxiety. GFA is not a formal diagnosis, just my own term for such symptoms -- your situation isn't longstanding, so not "chronic", but most likely it's the same sort of deal. As you may have seen, the origin of pain is believed to be similar to that of tension headaches: increased muscle tension, in pelvic muscles and head and neck muscles respectively.

3) I'm not familiar with LPR, but quick google search suggests laryngopharyngeal reflux, similar to GERD. I know absolutely nothing about LPR but very familiar with GERD, both professionally and having had it myself my entire adult life. I am unaware of any data to suggest elevated HIV risk from GERD and I very much doubt it's an issue. In general, oral exposure to HIV is low risk; it is extremely rare if ever to catch HIV from oral sex, and given the frequency of GERD, there must have been billions of swallows of HIV infected semen by persons with GERD.

4) Even if one or both members of the couple had HIV, the average risk for any single exposure by unprotected vaginal sex is around 1 in 2,500. And as already surmised, i'm inclined to doubt they are infected.

5) While I cannot say your risk of HIV is zero, all things considered I would the chance you have HIV at under 1 in a million. If I were in your situation, I would continue unprotected sex with my wife. But I'm not you, and you'll have to make the decision whether or not to abstain another 10 days, i.e. to the 4 week mark, when an HIV AgAb (4th generation) test will be 98-99% reliable (or 6 weeks for 100%).

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

HHH, MD

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