[Question #8660] Unknown Oral Infection

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41 months ago
Hello, thank you in advance for your response!

 I gave fellatio on New Years Eve, and following that, I had viral pink eye (confirmed by optometrist), a red throat, slightly swollen tonsils, pain on one side of the throat, and a cough. I went to urgent care on Jan 24, and I received an STI panel (HSV 1/2, gonorrhea, chlamydia, syphilis, HIV 1/2 (4th gen ag/ab)), and a strep throat test, and they all came back non-reactive/negative. 

Most of my symptoms previously resolved, but recently, I have still had a red throat (with more discoloration) and slightly swollen tonsils, but with lots of phlegm (white and yellow), minor earaches/headaches, minor muscle aches and neck soreness in the nape area, what I think is oral thrush, and some skin lesions, including warts on my face. 

I've been really anxious about what is going on with me, and I'm not sure if I'm worrying too much because I keep posting on Reddit and scouring symptoms online. I've been trying to see my PCP, but I've been having issues since I am a new patient at this office. For now, I've scheduled a dermatologist appointment to take a look at my skin, and a Planned Parenthood appointment to get re-tested for STIs but this time with an oral swab for gonorrhea/chlamydia.

My best guess as to what I'm dealing with is oral HPV or oral gonorrhea/chlamydia.

So I guess my questions/concerns are:
1) Based on the context above, what sort of infection am I dealing with do you guess? If oral HPV, do I just wait until it goes away?
2) My doctor's office said they will contact me once my new patient forms have been processed, should I just wait until they do so, or should I let them know I'm dealing with something?
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H. Hunter Handsfield, MD
41 months ago
Welcome to the forum. Thanks for your confidence in our services.

You don't describe the timing, i.e. the interval from performing fellatio and onset of your symptoms. Assuming only a few days or less, it is highly likely you acquired an adenovirus infection. Adenoviruses most commonly cause upper respiratory infection; they are frequent causes of common colds. Many strains have a predilection for conjunctivitis (pink eye) in addition to pharyngitis (throat/tonsil infection). Bronchitis or pneumonia are fairly common as well, and would fit with your cough.

Like other viral upper respiratory infections (URI), adenoviruses are spread primarily through non-intimate contact with respiratory secretions or by kissing, but over the past couple of decades several studies have shown them to occasionally infect the urethra by oral sex, with resulting nongonococcal urethritis (NGU). But obviously they can be transmitted in the other direction as well, i.e. penis to oral. Or if you also kissed your partner, perhaps that was the source rather than performing fellatio. STI experts and infectious diseases physicians have come to understand all this, but many other health care providers are unaware of genital adenovirus and the role of sex in transmitting some infections. So it isn't surprising that your optometrist didn't think of this possibility. 

In case you're interested in learning more, here are two medical literature citations, one reporting that adenoviruses explained around 5% of NGU cases in Melbourne, Australia and the other an editorial I wrote to accompany that article. You can find more if you google "adenovirus" and either "urethritis" or "sexual transmission".

https://pubmed.ncbi.nlm.nih.gov/16388479/
https://pubmed.ncbi.nlm.nih.gov/16388480/

You don't mention whether the urgent care clinic did a throat swab to check for oral gonorrhea. However, that was unlikely:  the large majority of oral gonorrhea cases are entirely asymptomatic; and when it does cause symptoms, they do not include nasal congestion or cough. Chlamydia also is not known to cause any of the symptoms you had. HPV infections are asymptomatic until and unless they cause warts or pre-cancerous growths (e.g. of the cervix), typically several months later. They have never been known to cause symptoms like yours. Given all the other negative tests, I am confident you have no other STI from your New Years Eve adventures!

Adenoviral infections are cleared entirely by the immune system, and I doubt you minor-sounding continuing symptoms are due to ongoing infection of any kind. You may be having some residual effect of the initial infection, but if so you can expect them to clear entirely as time passes.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD


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41 months ago
Thank you so much for your thorough response Dr. Handsfield, it has definitely alleviated a lot of my anxiety regarding this while I wait for my appointments. My urgent doctor initially thought I had an adenovirus infection as well. In case this changes your opinion on anything, I'll address some of the points that I accidentally omitted. 

1) Timeline: From what I can remember, I got pink eye within a day or two after my encounter, and it lasted for about two weeks. All of my initial ENT issues (red throat, lightly swollen tonsils, pain on one side of the throat, and a cough) started about a week after my pink eye went away, and the pain on one side of the throat and cough resolved the following week. The second round of symptoms I had (red throat (with more discoloration), slightly swollen tonsils, lots of phlegm (white and yellow), minor earaches/headaches, minor muscle aches and neck soreness in the nape area, what I think is oral thrush, and some skin lesions, including warts on my face) began in mid February and continued intermittently until now. 
2)Urgent Care: They did not take an oral swab when I went.

I have some follow up questions as well:
1) I guess I'm mainly concerned about my continued phlegm output. I am currently producing an above average amount of white and yellow phlegm, and I end up with a lot of it stuck on my tongue (which is why I thought it might be thrush). Is this normal following an adenovirus infection? Or is this something I should inquire further when I finally get an appointment with my PCP?
2) I'm also concerned about the pace at which the warts are spreading. I noticed that I had warts prior to this encounter, but I I have never had them to this scale before. I read online that warts spreading is linked to a weakened immune system. Is this something that I should have looked into more as well (besides my upcoming dermatology appoint)?
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H. Hunter Handsfield, MD
41 months ago
So the conjunctivitis aspects fits with adenovirus, and your oral sex partner probably was the source; at least that timing is right. I have to suspect you then just caught a cold from someone else:  your other symptoms came on too late to be the same infection, and are much more consistent with a garden variety respiratory infection. And these symptoms do not fit with any STI. These symptoms also could be COVID:  were you tested for it? Or influenza?

1) Mucus or phlegm (called sputum when it comes from the lower respiratory tract) is not a symptom of any STI. It also does not occur with acute HIV infection, for which you were at little or no risk anyway. And none of this suggests thrush (which in itself is NOT evidence of HIV, although it has that reputation).

2) I missed your mention of facial warts. Sorry, my fault! The main thing here is to see a dermatologist, as you are planning:  keep that appointment!  -- to confirm the diagnosis and its potential causes. Advanced immune deficiency indeed can explain rapid growth of warts or their appearance in atypical locations, and it is rational to worry about HIV as the cause. However, that remains very unlikely: it's very rare to have that much immune deficiency only 2.5 months after infection, especially with your negative HIV test 3+ weeks after the fellatio event.

So I'm really not concerned by your respiratory symptoms, phlegm, etc, but can't say much more about the warts. I'd enjoy hearing the outcome of your dermatology visit.
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41 months ago
Hi Dr. Handsfield, just wanted to let you know how my dermatology appointment went. I saw a NP, and she took a look at my face and just told that I am experiencing some acne, despite having done Accutane during high school. She prescribed me a new face wash along with tretinoin. So I did not have any warts!

I have one last string of questions since I think this is the last follow up I can do. My throat is pretty discolored still, and I am pretty sure there is a lump in my right cheek that is not present on the other side. Can this be due to adenovirus as well? I will definitely still try and see my PCP regardless as I have not had a check up in a while, but I just wanted to get your opinion on this. For additional context, I have had several oral sex partners in the past. So I guess, I'm still wondering if this could be an oral HPV infection or the beginnings of an oral cancer.

And again, thank you so much for your responses, I had been experiencing a lot of anxiety due to this, but you've definitely helped me calm down while I am waiting for appointments.
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H. Hunter Handsfield, MD
41 months ago
Adenovirus symptoms don't last this long; even if they did, this virus doesn't cause acne or other skin bumps. Check back with the dermatologist:  most likely the lump is a cyst, likely related to your acne (or perhaps a result of your past acne treated with accutane). Neither HPV nor oral cancer behaves at all like this.

I'm glad to have helped -- I hope this final reply also helps reduce your anxiety. You clearly have no health problem related to the sexual exposure you have described. Believe it!
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