[Question #8408] STD

45 months ago

Never thought I would be back here again but here I am. I’ll get right to the point.

Had oral sex with a guy me providing with ejaculation on 10/28. No other sex to date.

On 11/5 had blood drawn for a routine physical on 11/11 all number within limits.

Two days later [11/13 had a dry throat, so I went and had an STD screening. HIV rapid test negative throat culture and urine and syphilis to date have not been reported [don’t know why so long]. Two days latter on 11/15 I developed white spots in my throat and on my uvula. I went to urgent care and explained my events and my worry that I had oral Gonorrhea. The great Doc. Without hesitation ordered me a single dose of Azithromycin [ZITHROMAX] and ceftriaxone [ROCEPHIN]. Two-days latter the spot were gone and it is now 5 day my throat feel fine.

I am aware of the window period and realize my tests were only 18 days out from the event why they order a syphilis test that early I don’t know. Anyway, my timeline seems long for Gonorrhea to show up but in your opinion did I follow the correct procedure? If all the tests come back Neg. which I doubt at least I have good results on some passed events with the tests.

I will retest in a few weeks should I also test for Gonorrhea to make sure it was cured if indeed it was Gonorrhea?

I am also worried about passing it on to family. No sex involved simply a peck good morning and a peck good night.

Thanks

H. Hunter Handsfield, MD

45 months ago

Welcome back to the forum.

Almost certainly you have no STI from the event described. Fellatio (oral-penile contact) is safe sex for the penile partner, with low risk for all STIs and essentially zero for some. And penile exposure is not a possible source for an infection causing sore throat or oral/throat ulcers. Gonorrhea or herpes are the only STIs likely to cause these symptoms, but contrary to popular belief (including misunderstanding by many health professionals), most oral gonorrhea is entirely asymptomatic. And in any case, there is no possibility of either of these if you didn't perform oral sex on your partner. I would not have recommended STI treatment (ceftriaxone and azithromycin) in this situation. (Kissing could have risked oral herpes, however: did you kiss you your partner?)

So by far the most likely explanation for your symptoms is a garden variety upper respiratory viral infection, or perhaps strep throat. You don't mention rapid strep testing, which most urgent care physicians would have done in this situation. But there is no possibility of oral gonorrhea if you only received oral sex and didn't perform oral on your partner.

I really see no need for additional testing of any kind, especially in light of treatment with azithromycin and ceftriaxone: not only would they have cured gonorrhea if somehow you had it, they also would abort an incipient case of syphilis if you were exposed, so there is no point in syphilis testing going forward. As for HIV, there has never been a proved case of transmission oral to penis. You're not likely to be the first confirmed case in the world! But if you would like conclusive testing, you could have an HIV AgAb ("combo", 4th generation) blood test 6 weeks after the event.

As we have discussed previously, no STIs ever are transmitted to household members other than sexually, and that includes social kissing. No family members would be at risk even if you had an STI.

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

HHH, MD

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45 months ago

Doc. I am so sorry for the mistake I made in my post. I was the recipient during oral not the provider!! I know this will change your advice again my sincere apology

H. Hunter Handsfield, MD

45 months ago

I knew that. My reply was based on your penis in her mouth, not the other way around. In other words, your mouth was not exposed.---
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45 months ago

Doc. I’ll be blunt my event was male to male and I was the one sucking the penis I hope that clears it up.

Also, I just got my test results all Neg. which makes me happy but also sad. I though it was Gonorrhea and was treated for it but now I am worried it could have been Herpes for there was a 10 second French kiss involved. Anyway, I feel the infections’ reaction to the antibiotics was classic for a bacterial infection. The two white spots on my uvula cleared in a day and half after treatment also the white streaks in the back of the throat cleared in a few days and now the red patches on the roof have cleared at 6 days so my throat is normal now. My only symptoms were a dry throat and these white [I guess spots] on my uvula and very mild sore throat all gone after I took the pills and shot

I hope it is not Herpes any thought with this new information?

Thanks so much

H. Hunter Handsfield, MD

45 months ago

OK -- I guess I misunderstood the exposure after all. Thanks for setting me straight once and for all-- sorry!

The quick response to the antibiotics argues strongly against herpes -- i.e. I agree exactly with your statement about the response as "classic for a bacterial infection". If a new infection with HSV orally causes symptoms at all, the symptoms would have started sooner (typically within 5 days of exposure), and once underway would continue for at least a week or two. The timing also argues against gonorrhea: as already noted, most oral gonorrhea is asymptomatic, but when symptoms do occur, typically they start within 5 days. So I stand by my previous assessment that you had an upper respiratory viral infection (which was about to spontaneously improve) or strep throat; and that whatever the cause, it is entirely unrelated to the sexual exposure nearly 4 weeks ago.

Sorry again for the previous mistake about your exposure. I would advise an HIV AgAb (4th generation) blood test in a couple of weeks (6 wk or more after the event), but nothing more than that -- and you can expect a negative result.

I'll leave the thread open for one more exchange.

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45 months ago

Thanks, Doc, for the extra question. The timeline is as follows:

1-Event was on 10/28

2- The first indication of throat discomfort was on 11/13 but did not bother me so mild felt dry.

3- Took STI tests on 11/15 with no throat problems.

4- On 11/17 first noticed the white spots on uvula went to Urgent care Dr. gave me the pills and a shot

5- On 11/19 Uvula cleared up

6- By 11/22 all is back to normal.

7- today 11/23 got all the STI results back all NEG. Syphilis, Gonorrhea, Chlamydia. And as I said HIV rapid test week before was NEG.

In addition on 11/5 I had a blood draw for a Phy. And all the numbers were within limits on the CBC

I hope the timeline and other info still leads to a good outcome for me.

Thanks for all you do.

H. Hunter Handsfield, MD

45 months ago

This information doesn't change my assessment or advice. All is well and you can move on without worry. I would still recommend an HIV test as suggested above. Almost certainly it will be negative, but it's a standard recommendation in anyone at potential STI risk; and serious enough that "better safe than sorry" is a rational approach.

That concludes this thread. I hope the discussion has been helpful.

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