[Question #6730] Worried about potential exposure

11 months ago
Good morning,
I am in my late 30s, but made the mistake while intoxicated of having a night with a 21 year old male. I remember unprotected oral sex both giving and receiving and some very rough fingering. I remember telling him no insertive sex and I don’t remember having it, but the night is a blur. I messaged him the next day and asked about that and if he had ever had STD/HIV testing. He replied saying we didn’t and that he was clean.  I was very anxious he was just telling me what I wanted to hear so about 15 hours after the incident I took 1,500 mg of Zithromax hoping to prevent STDs. Yesterday was day 4 started with a sore throat just on my right side that is only when I swallow and I can’t tell if lymph node or muscular type pain. Also I feel like I can palpate my lymph nodes on my inner thighs. My temp is 99.8 this morning.  I’m trying to trust your previous advice to people in my situation, but should I be concerned about a STD or HIV? I’m concerned we had sex and I was too intoxicated to remember. I know you’ve said this would maybe not even be a situation where you would recommend testing, but I’m a little scared with these symptoms! Thank you in advance,
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago


Welcome to the Forum and thanks for your confidence in our service.  I'll be glad to comment.  I am going to presume that there was no penile-vaginal penetrative sex during this encounter, both because your partner says there was not (why would he not tell the truth after the fact) and because intoxicated or not, you would have remembered.  Moving on to oral sex, this was a virtually no risk event as well.  Performing oral sex on a male partner is very, very low risk- the CDC suggests that the risk for acquisition of HIV from performing oral sex on an HIV-infected partner (and it is very unlikely that a heterosexual 21 YO male has HIV) is less than 1 infection for every 10,000 sex acts.  As for your receipt of oral sex from him, again the risk is very low- probably even lower than the risk of performing  oral sex on a male partner.  Neither Dr. Handsfield nor I have ever seen a woman who acquired HIV from receipt of oral sex.


As far as other STIs are concerned, again, the risk for infection was very low even before you took the azithromycin because most people do not have STIs and even when they do, most single exposures do not result in infection.  The azithromycin you took would lower any risk even further, killing much gonorrhea and most chlamydia. 


Your sore throat is likely a coincidence.  Most oral STIs do not cause symptoms. 


All in all, this was a very low risk event, both for HIV and for other STIs and I would not worry about having been infected.  I hope that this perspective is helpful.  If there are further questions or any of this is unclear, please use your up to two follow-up questions for clarification.  EWH


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11 months ago
Thank you for your advice. On the off chance there was any penetration would you  still recommend a test or just trust and let it go?  I don’t know when he last tested or how active he is, but being 21 and heterosexual makes him unlikely to have HIV? Can you get herpes in your throat? I didn’t see any sores, but couldn’t see that far down. I had thought a sore throat due to HIV would be your whole throat and later after exposure, but didn’t know about the other infections.  In reading on here I’ve seen advice that after a one time exposure to unprotected vaginal or oral sex you don’t even necessarily recommend testing because STIs/HIV are not that easily transmitted, but the evil google makes it seem as if it’s super easy. You are the experts giving advice though and I do appreciate your help. Thank you so much.
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago

The decision to test is a personal one.  given the circumstances you describe, I would not test but if you choose to test, that is fine although the timing of testing is important for accurate results..  Tests for gonorrhea and chlamydia can be done at any time more than three days after the encounter.  Trichomonas can be tested for at that time as well.  Tests for HIV and syphilis will not be reliable until at least 4 weeks and preferably 6 weeks after the encounter.  If there are visible lesions, they can be tested for herpes but we specifically recommend AGAINST blood tests for herpes as these tests are often misleading due to both false positive and false negative test results. 

When persons get oral herpes the lesions are typically on the lips, no the throat. 

The sore throat of HIV is typically accompanied by high fever (over 101, muscle and joint aches and occurs between 7 and 21 (28 at the outside) days after acquisition of infection.

Your experience with google is all too common.  So much of what is there is overstated, taken out of context, out of date or just plain wrong.  I urge you not to use Google to guide your manage care.

Hope this helps.  Again, please use your final follow-up question if I have missed something.  Please don't worry.  EWH

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11 months ago
Following up on the sore throat, it started on my right side and I couldn’t see anything, but then got a little better when I got two more sore spots. One on my back gum and another on the opposite side of my throat. They are tiny white spots. I’ve had my tonsils out as a child. I think they are just canker sores although I’ve never had one on my throat before.  Could they be caused by the Zithromax? Or unfortunately google says they could be due to HIV? But is that an early sign or much later in the disease? Do you think that they could be due to anything from my exposure?
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago

Please re-read my comment above regarding Google.  This is not HIV!!!!  Fungal infections in HIV occur in persons who have been infected for years. 

Nor is this likely to be an STI. The great majority of oral STIs are asymptomatic and do not cause the sorts of lesions you describe which are most often causes by non-STI viral STIs of the sort most people get from time to time. 

The azithromycin you took could have pre-disposed you to getting a fungal infection but what is really much more likely is that this is a coincidental community acquired, non-STI viral sore throat.  Please don't overthink this. 

I think you know, we provide up to three replies to each question.  This is my 3rd reply, thus this thread will be closed shortly without further replies.  EWH

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11 months ago
I’m so sorry! I will stay away from google. Thank you for your time and service. 
11 months ago
Good morning,
My throat issue continues. It started off 4 days after oral sex exposure and was just on one side, sore when swallowing and feeling very dry. It got better on that side but then the other side started with the same symptoms. Then that side got better, but this morning my original side is again swollen and sore.  I don’t see any obvious sores.  Would the 1,500 mg have prevented/cures oral gonorrhea? This sounds gross, but is it possible to contact E. Coli from performing oral sex and this could be the cause? I haven’t really had any other cold symptoms so this continues to worry me.
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago

Your thread was not closed after my last reply so I will go on and reply, after which the thread will be closed.  I understand that you continue to be quite concerned about STI but once again,  want to reassure you that this is most unlikely.   The likelihood that this is an STI was negligible even before you took the azithromycin and the azithromycin would reduce your risk still more.  I suspect you have a lingering, non-STI, community acquired viral sore throat which you may have gotten from almost any acquaintance or through your activities of daily living. IF you had it, 1500 mg of azithromycin would have cure most (about 3/4) gonorrhea infections.  E. coli is not a cause of sore throat. 

Given your continuing concern, you may wish to see your own doctor.  If you do and she/he decides to test, unless a specific test is performed using a throat swab for gonorrhea, the test will not detect gonorrhea, focusing on strep.  I obviously do not know of your relationship with your own doctor or the availability of testing but my sense is that being seen might be comforting. 

Again, I hope that my reassurance will help.  This thread will now be closed.  EWH

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