[Question #5983] Multiple Exposures - Unprotected sex with female, unprotected oral sex on male

19 months ago
Here's the timeline of events:
8/29/19 - I had unprotected sex 3 times with a woman I know well.  In fact, we've had unprotected sex multiple times before that over the last several months.  She's a white collar professional, married with 3 year old twins, and she swears she's been tested and clean on all fronts.  I've never seen evidence of her tests, but I imagine she had to get tested when she had children.
9/8/19 - I performed very brief oral sex on a black man at an adult theater.  It was probably 10 seconds total.  No precum or ejaculation.  I did it softly/lightly assuming that might help avoid transmission of anything.  I even asked him if he's clean and he said "yes", for whatever that's worth.

I'm married and have unprotected sex with my wife, who I know has HPV which I means I probably have it too.  Back in December 2018, I was fully tested for all STDs (hsv, hiv, etc.) and I was clean across the board.  Like so many on this board, I have a lot of anxiety about catching STDs. 

On the evening of 9/9/19 (last night), my anxiety kicked in because the sides of my throat/neck seemed a little swollen...not really sore.  I can't tell if it's lymph nodes of my neck muscles being worked from gym workout earlier that day.  I have no other symptoms--no sore throat, no red bumps, no fever, etc.  Is it possible that my nodes are swollen because I caught herpes from the BJ I gave the day before?  What if it's related to my 8/29 encounter?  Wouldn't more symptoms come along with just swollen nodes?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Welcome to the forum. Thanks for your question.

It sounds like your female partner is at little or no risk for STD, but of course I have no way of guaranteeing that. The oral sex event with a male, apparently anonymously, was inherently higher risk -- except that oral sex is generally safe, with overall low risk for all STDs. And given the style and duration of the exposure, there probably was little risk of any STD. That said, I cannot guarantee you weren't infected.

However, there are no STDs likely to cause the apparently vague sort of neck and throat discomfort you describe. (If there aren't obvious swellings, it isn't lymph nodes.) This sort of symptom is very common as a physical manifestation of anxiety, however. Herpes doesn't cause pain or lymph node inflammation without first causing overt blisters and sores where exposed, i.e. your mouth.

At this point, I would advise just sitting tight for a few days. If your symptoms progress -- especially if you develop fever, overt sore throat, or blisters/sores of the mouth or throat -- see a physician right away. And if you want still further reassurance, with or without symptom progression, you could see a doctor or clinic for routine STD evaluation -- urine testing for gonorrhea and chlamyida, throat swab for gonorrhea, and (after a few weeks) blood tests for HIV and syphilis. Another options is to contact your partners and ask them to be tested. But for now, it is very unlikely you have herpes or any other STD from either of the exposures described.

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

HHH, MD
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19 months ago
Thanks Doc!  Your answer was very helpful and comforting.  

On the male partner I even examined his penis as best I could to ensure there weren't any glaring open sores.  He looked clean.  

It's obvious I just need to ask my female partner to get fully tested and I'll tell her to do the same.  She and I have partners and the though of infecting myself or them causes me nightmares.  She originally got very upset when I asked her about STDs because she said it "made her feel dirty".  I then explained how safe sex is extremely important to me and to protect our partners.  She came around and has now been more understanding about having the conversation.  She said she was willing to get tested for me if I wanted.

Another question...when I first had sex with my female partner maybe 4 months ago, I came down with a viral infection right at the 3 week mark post sex.  I developed upper respiratory wheezing, had a minor fever (maybe 99/100 degrees max), and was fatigued...no sore throat.  It wasn't like I was "laid out" and didn't wanna leave the bed.   My son had been sick so I chalked it up to getting it from him, but now I wonder if it could've been HIV infection from her.   Am I being overly paranoid?  I figure I'd ask you while I have you :).
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
I'm glad to hear your discussion with your partner was diplomatic, and glad she now sees the light. (Perhaps you now owe her a nice dinner and flowers....)

Of course having sex risks non-STD infection transmission, especially of things like colds and influenza. In any case, new HIV doesn't generally cause wheezing, cough, nasal congetions, etc. I can't say for sure it wasn't HIV, but all things considered, it is exceedingly unlikely. But you probably should be tested for HIV -- not because the risk is real, but because most people in your situation gain additional reassurance from negative testing, no matter how expert the advice might be on this forum or anywhere else. I don't think you're being "overly paranoid" -- HIV is real and deadly (although less so than it once was). But it truly is extremely uncommon in sexual partnerships like this one.

Sex with men is another story, however. Sticking with oral only is safe, but intentions for safety don't always hold up in the heat of the moment. A word to the wise....
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19 months ago
Well, it’s been a couple of days and I feel like I’m getting a little bit of a sore throat.  I looked back near my tonsils and I see a couple of white spots, so I think it could be gonorrhea. I’m at urgent care now to get assessed and treated. If it is gonorrhea,  I can’t believe how incredibly contagious it is given the nature of oral sex I performed. I have no fever, no blisters, no fatigue, etc...everything else seems fine. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Gonorrhea of the throat almost always is asymptomatic. It is far more likely you have a garden variety viral respiratory infection. You should not be treated for gonorrhea (tell the urgent care doc that this nationally recognized STD expert advises against it!). They should go ahead with a throat swab for gonorrhea/chlamydia testing, however.

That normally would end this thead -- two follow-up comments and replies come with each question. But I'll leave it open so you can report your throat test results in a few days, if you wish to do so. But I will have no other comments or advice until then (or will close the thread if no comments in a week or so).
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19 months ago
Well, he’s treating me with the shot and Z-pack. He said it looked bacterial to him because of the pus in my throat, although the strep test came back negative. He also said having no other symptoms at all leads him to believe it’s probably not viral.  He said we could do the gonorrhea / chlamydia test, but treating it now would clear all that up anyway.  Plus, I’d have to wait 3-4 days for the results, which would go in my medical record and that’s not what I want.  

I’m sure that’s not what you wanted to hear, but part of me just wants to treat it and move on. If it’s viral, then I’d have to wait that out regardless. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Wrong decisions. It is untrue that pus suggests bacteria; it slightly raises the chance of strep (but NOT gonorrhrea, which almost always causes no symptoms in the throat) but most sore throats with pus are viral, and I’m very confident your gonorrhea test will be negative. There’s a somewhat better chance for positive strep (if done), but most likely that too will be negative.

That concludes this thread. Best wishes and stay safe.
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