[Question #9166] Coincidence?

35 months ago

Hi Doctor

I did something completely which as fuelled my anxiety as I am married, especially as I am experiencing symptoms. I was very drunk, ended up in a sex bar and slept with a CSW. I don’t remember much, other than performing unprotected cunnilingus.

The next day I woke with an irritated/tingling tongue, which has progressed and I now have pain and burning sensations in my mouth and tongue, and also at the corners of my mouth.I have also been extremely anxious (about being found out and contracting an STD).

I have been suffering from breathless for a while and I have started investigations with my doctor, I began taking a combination inhaler 2 weeks ago (with steroids). had been experiencing strange sensations in my mouth before the event, in the throat and I think I recall the tongue - some before the use of the inhaler and some/changes after. I did experience hoarsness shortly after initiating the medication which I since got better.

I realize that anxiety can cause strange sensations, and also inhaled steroids can cause irritation and also thrush. I have a follow up tomorrow and looking for your advice as whether I need to mention the event or not - id prefer not to perform a barrage of tests and go on the wrong track unless needed.

I have read here that there is very little risk for performing cunnilingus, but there are many conflicting websites, explaining how easy transmitting various STDs is via this route.

Could I have caught an STD from this event, and could this be a cause form my symptoms? I have also been feeling feverish.

Is it more likely oral thrush, is that possible form the event? Or more likely coincidence (from the inhaler)?

Is there a need to discuss, or rather focus on the symptoms and follow up?

Thanks for your help

Edward W. Hook M.D.

35 months ago

Welcome to our forum. Thanks for your questions, I’ll do my best to help. Thanks as well for looking at other posts on the forum. You have learned important information including that the risk of acquiring any STI from performing cunnilingus on an infected partner is quite low. In addition, please remember that most commercial sex workers do not have STI’s to start with. Finally, for you to experience the onset of symptoms a day or two after your misstep is inconsistent with STI’s. Most STI’s occurring in the throat are asymptomatic and, on those rare occasions when they occur, symptoms do not begin until at least 3 to 4 days and often longer after the exposure.

I am delighted to hear that you have an appointment with a healthcare provider tomorrow. I would have him/her look in your mouth for any signs of thrush. Inhaled steroids of the sort you were taking can predispose people to thrush. With respect to STI‘s however I see no reason for concern and no reason for testing. As the title of your post suggests, I suspect that the symptoms you are experiencing are largely coincidental, perhaps amplified by your anxiety and guilt over your misstep.

I hope the information I’ve provided will help to resolve your anxiety. I hope this information is helpful.

If there are additional questions, please don’t hesitate to use your up to two follow ups for clarification. EWH

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35 months ago

Thanks you doctor for the reply and reassurances, unfortunately my anxiety increased and I discussed with the doctor. He said low risk but could not rule anything out so offered to test.

I got the results today and I am worried about one result, the treponema VRDL came back 2:1 with a reference of <2:1.

I called the doctors but it was late and could not find out more, I quickly emailed the doctor and got a response that everything was normal but was not able to clarify further.

Now I am really scared and shocked, my previous test was negative (before the event). Doesn’t this mean positive?!

There was another test for treponema performed which came back <0.01 (reference 0.1), the test was 6 days after exposure.

35 months ago

Apologies, I believe its 1:2 rather than 2:1

Edward W. Hook M.D.

35 months ago

Thanks for the follow up. When testing for syphilis, typically a test like the VDRL test is done, which when positive, is followed by a second unrelated treponemal test. In persons with syphilis, both tests are positive while in up to 1 in 50 people, the VDRL test is falsely positive as indicated by the 2nd test being negative. From the sound of things, you VRRL test was falsely positive. You should confirm this with your doctor.

FYI, none of your symptoms sound like syphilis and it typically takes about three weeks for syphilis blood tests to become positive. I think it’s quite unlikely that you have syphilis.

Please let me know what your doctor says tomorrow. EWH

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35 months ago

Thank you doctor, unfortunately I am still very worried and hoping you can advise.

With my anxiety I have been poking, prodding and checking neurotically, which has probably caused different sensations and irritation e.g. constantly looking for discharge by squeezing the penis, finding some and freaking out - and I know from looking through the posts that a small amount is normal and squeezing trigger it.

On Wednesday I found a very small 1-2 mm blemish/spot on my penis (about half way down the shaft), it was kind of skin coloured or a pinky brown colour. I squeezed and the surrounding area and manage to scratch the top layer of skin, I did put some cream and kept it covered, I have inspected a few times but frigtengly it is red and starts to resemble an ulcer around .5 - 1 cm.

Is this how a syphillis chancre could materialize or have I just done it to myself? I have now applied an antibiotic cream and covered with a plaster hope it will heal - would this heal it if it was syphillis, or by the fact it heals means it was not?

Thank you.

Edward W. Hook M.D.

35 months ago

Song! Picking, squeezing, and repeated self examination will only cause irritation which itself can cause discharge. In addition, a certain amount of urethral moisture which might be perceived as discharge is entirely normal.

The image that you described is likely something normal and certainly in no way sounds like a syphilitic lesion. Lesions of syphilis may begin as a red spot but within 24 hours go on to form a shallow painless ulcer. Topical creams, lotion, and even antibiotics actually have the capacity to cause irritation in and of themselves.

I remain interested in what your doctor said when you saw him/her.

As you know, we provide up to three responses to each clients question. This is my third response. Therefore I will not be providing for the responses. Please don’t worry. EWH

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35 months ago

Thank you, I will answer once I have had had my follow up appoint in 2 weeks.

I realize that it is against the rules but in case you are prepared to, it would be very hefpul to understand what is the normal timing and appearance of the chancre (there is a lot of conflicting info. on the internet).Also, would antibiotic cream resolve it?

Edward W. Hook M.D.

35 months ago

Syphilitic chancres appear, on average 21 days following exposure. Antibiotic cream will only confuse the issue and will not cure syphilis, not that there is any reason for you to think that you have it. EWH ---

35 months ago

Thank you doctor, I realise I am way over my responses but I am terrified at the moment - I will happily pay for a new question (please just let me know). I will have no opportunity to visit my doctor over the next week.

The sore on my penis is round (approx. .5cm, halfway down the shaft) ulcerated and oozing, and painful. I realise that many things would be syphillis extremely unlikely but this seems so much like a chancre, I don't ever recall having anything like this. Could I have this done this to myself and i the normal way to heal? o

- I don't remember the vaginal sex, but it must have been protected - this is not my first time, and they always careful. I also could smell the condom the next day. The fact that it is half way down the shaft, which would have covered makes it unlikely

- CSWS don't normally have STIs, and syphillis is not common in women

- it is quite soon after the event (<2 weeks)

despite all of this, I am really tressed, mainly by how this now looks. The false positive doesn't help either.

Again, I am sorry for the anxiety fuelled questions and going over my limit. I appreciate any response and as mentioned, will happily submit a new question.

Edward W. Hook M.D.

35 months ago

Final responses.

Your anxiety appears to be getting the best of you. I suspect the lesion on your penis that you have noted has been irritated and opened up because of your repeated self examination. For all of the reasons that you point out including the fact that the only contact you remember is cunnilingus, that if you had genital sex it was condom protected, and the unusual timeline of the development of this lesion all make this most unlikely to be syphilis.

Your doctor should be able to see you sooner than the middle of next week. I encourage you to call him or her on Monday and ask to be seen as quickly as possible.

Your repeated, anxiety driven questions have now been answered. I’ll have nothing more to say and will be closing this thread. Please do your best to not worry.

EWH

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