[Question #66] STD including HIV Risk

39 months ago

I did research online but can't find to much on male to female transmission: BACKGROUND - I am in a monogamous relationship for 8 years. This year broke up for short period time and I had an encounter with a male friend (I'm female). We all are over 40 and my male friend isn't a high risk person. I did ask if he was tested for std's and he "claims" he has and all is negative and never had symptoms. minimal sex partners not drug user. EVENT: we had oral sex (I understand that risks for this is low to nonexistent) genital to genital contact where he rubbed his penis around my vagina for a minute on 2 occasions but don't believe he penetrated( I was drunk) I did ask if he did and he said no. I went on vacation and got back and everything went wrong physically.

On 6/20, had a bump in bikini line top part of labia  majora but closer to pubic area. I also started arithomizyn for abysses tooth. then on Monday 6/29 started having burning and irritation bad in vagina and surrounding areas.. like my inner thighs and everything was on fire...figured yeast infection from anitbiotics so I stopped taking antibiotic after only 2 doses. Wed 7/1 I started monistat which cleared up most of the yeast but unfortunately went away for 4th weekend and forgot so by Saturday yeast came back and back on fire in private area and thighs burning. I go to std clinic on Monday 7/6. She does pelvic exam and cultures (only said had yeast infection) - also looked at bump.. said no herpes bacterial probably from shaving and swimming in lake. I don't worry about stds cause she said was really low risk and everything related to yeast or bacterial issues. it's now 6 weeks past exposure.. I still don't feel cleared up.. minimal white discharge,,itchy skin in vagina and minimal burning sensation. sometimes a uti burning feeling but that went away after a day or two and now my period is 5 days late but just started and it's not normal... hardly any flow and dark red/brown and now I have a sore throat and light headedness.


Do you think the initial diagnosis was not complete?  considering the risk on 6/17 is it possible the genital rubbing of his penis head to my vagina cause a std/hiv? I didn't have them test for std's cause I was only worried about herpes/syphilis (but he had no sore and not prevalent in my area) and hpv. I didn't think I really had to worry about the other stuff.   

Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago

Welcome to our Forum.  I'll do my best to help out.  As I'll explain, from the sounds of things there is little to worry about.

Your partner sounds low risk for most everything.  That is your assessment and even more importantly when you spoke to him about risk he not only said he was low risk but also said he was tested (good job, many people would not have asked).  If he said this was the case, I suspect he was tested. Further, the likelihood than any 40+ year old heterosexual male has an STD is, statistically, quite low as well (the most common STIs are far more common in persons under age 25).   In addition, and lowering the risk even more. there was no penetration (again, most people tell the truth, particularly people they know after the fact).  Lastly, you were examined by an experienced clinician who evaluated you carefully who saw nothing to concern you. 

You also have a very good explanation for what happened to you.  Yeast infections are common in persons taking antibiotics and both your symptoms and the opinion of the clinician who saw you also was likewise that this was all consistent with yeast.

As far as HIV is concerned, statistically your risk is far lower than your risk of being struck by lightening.  The rate of HIV in heterosexual men in the U.S. is less than 1 in 1000 For all practical purposes, HIV is sexually transmitted only through penetrative ano-genital sex ano-genital sex and even then the risk of transmission from any single exposure is less than 1 in 1000 exposures. 

At this juncture, I would not be worried about STIs or HIV.  On the other hand, you do have persistent symptoms and an abnormal period.  I would have tested you for the most common STIs (chlamydia, trichomonas, gonorrhea)) when you were first examined.  You may have a refractory yeast infection. I suggest you see your gynecologist, get evaluated and while you are there, get the STI tests so that you can come to closure on this and move forward.

I hope my comments are helpful to you.  EWH

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39 months ago
Thank you for your help on this. I appreciate it very much. I have an appointment on Monday for testing. That is what I thought too, but since the problems down there are still there it is hard to put behind just needed a medical opinion not to drive myself crazy all weekend!
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Glad we could help. EWH
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39 months ago
I have a follow up question if I may ask? I went for testing yesterday for chlamydia, gonorrhea, and trichomonias. Chlamydia and gonorrhea are pretty straight forward and I won't get those results for a week. But, when it comes to the other, seems like there is little or contradictory information. The only test they perform at the std clinic for trich is by wet prep of the discharge. I understand that method not to be overly reliable. They did a the wet prep at my original visit (7/6) and again yesterday (8/3). The nurse practitioner (same for both visits) said she did not notice anything abnormal on either occasion. No signs of trich, no white blood cells only yeast ( that's what I was diagnosed with yesterday- still there). Should I be confident that given the low risk of partner, event and this exam ( I questioned her at great length) that it's not trich. I heard it mimics yeast infections and often misdiagnosed. I guess my concern in believing the diagnosis is since I didn't respond to treatment most be something more sinister.    
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago

Your questions are good ones and reflect the evolving state of testing for STIs.  The wet mount that you had (twice) is the most widely used and certainly quickest test for trichomoniasis.  In the past year or two however, more sensitive, PCR-based tests (the same highly sensitive technology used for detection of chlamydia and gonorrhea) have begun to be introduced and are about 20-25% more sensitive than the wet mount.  These newer, highly sensitive tests however are best for detecting asymptomatic infections and the wet mount is nearly as sensitive as the newer tests for detection of symptomatic trich. 

You've been troubled by your symptoms for quite a while now.  You appear to have an answer-(refractory, hard to treat yeast which does occur from time to time).  Further, while the wet mount test is less sensitive than the PCR-based tests, two wet mounts are more sensitive than a single test so I would be fairly confident of your test result  I suggest that you see how you respond to yeast therapy before pursing the trich diagnosis.  If you do not improve however, I would return to the same provider if you are comfortable with that (it sounds like the clinician you saw was willing to discuss your concerns- a good thing).  In these more difficult cases, it is often helpful to be seen repeatedly by the same clinician who can judge how much your physical finding/discharge have changed since your last visit and take that into account in helping to address your problem.

I hope this is helpful.  EWH

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