7 days after this encounter, I had pain swallowing and noticed white/yellow exudate on my tonsils. I visited a doc and tested negative for strep. I requested oral swabs for gonorrhea and chlamydia, though I understand this was very low risk. The symptoms still scare me in regard to timing and exposure. I have not received my results yet, but I did receive a positive result for non-group A strep a few days later. I was prescribed amoxicillin for that. I’m worried that this strep is merely colonized bacteria and gonorrhea and chlamydia are still possible. Is it likely?

During the vaginal sex, I felt a strange sensation that the condom may have broken on my shaft. Though it was dark, following intercourse I did not notice any breakage and the condom (of the cheap, colored variety) appeared intact. I have had a frequent urge to urinate and strange penile sensations at the tip of my penis (not during urination) over the last 7 days. I tested today for gonorrhea and chlamydia along with an HIV RNA test. Too soon for syphilis and I would think the amoxicillin for strep would negate any result. 

I am very concerned for my regular sex partner. Originally I was convinced my encounter was low risk but now I’m highly in doubt and very anxious. We have had unprotected sex on a few occasions since the CSW encounter. 

What are my risks and can I count on final results of the testing done when all results are back? 

Thanks so much. 

My initial response is after reading only the first sentence. It sounds like you had a totally safe sexual experience and that you can ignore any symptoms or other concerns you might have. There is virtually zero risk you acquired HIV or any STI, regardless of what the rest of your message says.

Now I have read the rest. Guess what?

You can rely on the strep test:  you have a strep throat. In addition to no possibility of oral gonorrhea or chlamydia with protected oral sex, oral chlamydia is very rare and never has been known to cause symptoms of any kind. And 90% of oral gonorrhea also causes no symptoms and no visible pus in the throat. Strep is the only logical explanation.

If the condom was intact after withdrawal, then obviously your sensation it broke was mistaken. The genital symptoms you describe do not suggest gonorrhea or any STI:  these do not cause urgent urination or "strange sensations":  the ONLY symptoms of urethral gonorrhea or chlamydia are discharge and uncomfortable or painful urination. The genital/urinary symptoms you describe are much more typical for genitally focused anxiety, and you can expect your urethral (or urine) gon/chl tests to be negative.

Also no concerns about syphilis. Correct that the amoxicillin would abort syphilis before the infection even takes hold. (It will not "negate" any test result -- it will just prevent infection and therefore any possibility of a positive test for it.) There is also no chance of HIV after such a protected encounter. Your HIV RNA test was too soon to be meaningful (it takes at least 10 days and usually 2+ weeks for positive results), but you don't need HIV testing anyway.

You can safely have unprotected sex with your current partner. After your negative got/chl test results, you won't need any more tests of any kind. However, if you feel you need conclusive lab test results despite absence of risk, you'll need to have an HIV antigen-antibody (AgAb) blood test and a syphilis blood test 6 weeks after the exposure.

Leaving STIs aside, your partner needs to be on the alert for sore throat and possible strep throat. That's a far higher risk for her than any STI, and more dangerous than most STIs as well.

Really, don't worry about this. All will be well! I hope you find these comments as reassuring as I intend. Let me know if anything isn't clear.

HHH, MD

To clarify, though I think you read correctly, the cunnilingus was not protected. I understand from former responses in this forum that the risk of gonorrhea/chlamydia is very low from cunnilingus. Ideally my test results will confirm that shortly. The doctor from urgent care who prescribed amoxicillin told me got/chl were fairly probable, which has me very anxious. 

I am very concerned regarding discharge and have seen some clear, scant discharge in very low amounts from my penis, though these instances have been 10-20 minutes after urination (my suspicion is… urine). My ejaculate also seems conspicuously stringy (almost strand like) and thick.  I have worn dark boxer shorts to sleep in the past few nights but haven’t noticed any stains. Would the stains be yellow or off color? Would the discharge be clear? Am I just losing my dang mind because of guilt?

I was a bit confused by your comment on the HIV test. The HIV RNA test was done 15 days post exposure, could you clarify on whether this is a long enough period to be meaningful? My understanding is this test would catch 90-95% of positive individuals by the 15 day mark.

Last question, is amoxicillin effective against chlamydia? I have seen mixed results. Would the amoxicillin impact the got/chl test results (I started the amoxicillin 3 days before testing; 500mg 3x daily)?

Thanks for your response, it does bring me some peace. I appreciate your help and expertise immensely.

But this doesn't change things very much. There has never been a proved case of HIV transmission by cunnilingus; and HIV is rare in women like the partner you describe -- probably something like one chance in a thousand. The only time frame you mentioned above is 7 days, so I thought that was the time of your HIV RNA test after exposure. Fifteen days will pick up more infections than 7 days, around 90%, so that result should in fact be pretty reassuring.

As for possible urethral discharge, it seems you are indeed just noticing a bit of urine, and you are correct about abnormal discharge being thick and almost always cloudy or yellow (pus). But if you are confident you have abnormal discharge, you'll need to be professionally examined. If you have a urethral infection, it isn't from the exposure described -- it would have to be from some prior exposure. Which in turn would mean your regular partner is the source of your infection. You're a much better judge of that possibility than I can be. However, I will point out the obvious:  when one member of a couple finds need for outside sexual experiences, often the other has also done so. Don't get me wrong:  by far the most likely scenario is that nothing at all is wrong except your anxiety and your guilt over a sexual decision you apparently regret.

You cannot possibly have chlamydia from the events described, gonorrhea also is exceedingly unlikely, and those tests will be negative. So your amoxicillin question is irrelevant. However, it is unlikely to have any effect on the reliability of your test results. Even when antibiotics cure these infections, the standard tests remain positive for several days (even up to 3 weeks).

Each question includes a maximum of two follow-up questions and replies, so you have one coming. I would suggest holding off on further discussion until you can report your gonorrhea and chlamydia test results. As I have said, you definitely can expect negative results, regardless of what you understood the urgent care doctor to say.

That concludes this thread. Best wishes and stay safe.