contracted gonorrhea via oral sex on guy, possibly HIV too?

i am a guy and performed oral sex (unprotected) on a guy. he did not *** in my mouth but i am sure there was precum. we had no anal sex of any kind. we did this for about 2 hours back and forth on each other. the guy does have a steady girlfriend but not sure how many encounters he has had with other men. his last HIV test was last summer and he tested negative.

i contracted gonorrhea from him (just got the meds yesterday). i assume that i got it from his precum in my mouth. we did rub our penises together a few times.

my questions:

1-i have read many times over that gonorrhea makes the transmission of HIV very likely if the person has it. do you think that if the guy i performed unprotected oral sex on has HIV would be able to give it to me when i performed oral sex on him, since he already gave me gonorrhea? what is the possibility and likelihood? note that i did not have any STDs at the time of exposure.

2-i saw no symptoms of STDs or HIV on his body or penis area. i know this is meaningless but i just wanted to know if gonorrhea can lie dormant in an infected man (i read the msg. boards on women).

3-is my behavior (performing unprotected oral sex on him for that much time) high or low-risk?

4-i plan on taking an HIV test during the ending 4th week after exposure. how accurate in terms of percentage do you think the results will be (given the low or high risk behavior i have engaged in)?

5-do you think, from your *personal experience* of what you have seen and encountered, that him having gonorrhea makes it very likely that he probably has HIV?

7-should i go for a PCR test after 28 days?

[H. Hunter Handsfield, M.D.]

I presume you mean you acquired gonorrhea of the throat, not urethra.  But it doesn't make much difference in my responses.  

1) Yes, gonorrhea and other STDs increase the probability of HIV transmission.  However, the risk is low by oral sex and even a doubling still leaves pretty low risk.  Some people estimate the risk of transmission by performing fellatio on an HIV infected person at 1 in 10,000.  If so, your risk might have been 1 in 5000--if he was infected, which you don't know.

2) Asymptomatic urethral (penile) gonorrhea is uncommon.  The odds are your partner had abnormal discharge.  But it could easily be missed by a looking at someone, especially if he had urinated recently or in a dark room.

3) There is no hard definition of "low" versus "high" risk.  If you have such exposures frequently with men you don't know, your at fair risk of acquring HIV someday--but nothing like the risk of a guy who has unprotected anal sex with stranger.  All men having sex with other men should choose their partners wisely (no sex with guys met in bars or baths and should always ask about and share HIV status and STD symptoms, like discharge or sores.  And of course condoms for anal sex.  Condoms can be considered for oral sex, the risk is low enough that they can be considered optional.  In summary, with oral sex your risk is very low for any particular event, but that risk of course rises with the frequency of such exposures.

4) A negative antibody test at 4 weeks will be highly reassuring (90-95% of infected people would be positive), but not as solid as waiting 6 weeks, when virtually 100% have positive results.

5) Other things being equal, persons with gonorrhea are more likely to have HIV.  But there is no way to predict reliably for any particular person.  If this is a guy you know or can contact, you owe it to yourself to call him and ask.  Most people don't lie when asked directly.

6) Your risk isn't high enough for most specialists to recommend PCR testing.  But some providers might disagree, especially if you learn your partner has HIV; or might recommend a P24 antigen test.  If your partner is positive, see a health care provider familiar with STD/HIV care and follow his or her advice.  (If you have PCR or P24 testing, it should be at 10-20 days after exposure, not 4 weeks.  The purpose is to pick up infections before the antibody test becomes positive, which usually happens by 4 weeks.)

Bottom line:  All in all, the odds you were infected during this particular event are low.  But think about your long term risks.  Would you play Russian roulette with a 5000-chamber gun?  I wouldn't.

Good luck--  HHH, MD

[worriedguy2006]

i have uretheral gonorrhea, not throat.

2-you are right. it was a dark room and i must have surely missed the penile discharge.

3-this was my first encounter with a bisexual man

5-i did ask him about his HIV status before doing anything and he said that he was perfectly clean. i am not sure if he knew if he had gonorrhea. he said he had no STDs or HIV.

[H. Hunter Handsfield, M.D.]

I have never seen a case (or heard of one) in which urethral (penile) gonorrhea was acquired from another man's urethral infection.  So if you didn't receive oral sex, I am puzzled.  But I suppose it could happen if you placed the ends of your penises directly together.  However, now I wonder about this encounter is where you acquired your gonorrhea.

Sorry, I missed your opening comment where you said you asked about his HIV status before the encounter.  As I said, most people don't lie about HIV status when asked directly, so HIV isn't likely to be an issue for you.

HHH, MD

[worriedguy2006]

i am sorry but i forgot to tell you that i did receive oral sex from him which was unprotected.

i am assuming that i got it from him. before him, i did perform oral sex unprotected on a woman about 10 days before him. i also rimmed her and put my tongue inside her ***hole till she came. she told me she was clean and i was completely sure. i don't know. maybe she did have it and was asymptomatic.

anyhow, i want to thank you for taking the time to look into my personal situation and answer my questions to the best of your medical knowledge and experience. we appreciate the work that you do.

[skerdstraght68]

There seems to be some confusion when atatching other STDs with HIV.  When you say the risk roughly doubles, wouldn't that be for someone who already "Had" the STD.  If you get herpies (herpes)/clamittia from any given incident, you obviously didn't have open soars/ inflamed urethra at the time which removes that from the equation?

[H. Hunter Handsfield, M.D.]

WG2006:  That clarifies things.  You got it from receiving oral sex.

SS68:  In theory you may be right.  However, simultaneous acquisition of STD and HIV clearly can occur--in fact, the herpes association suggest a big part of the HIV enhancement comes from simultaneous acquisition of both HSV and HIV.  But I don't think this has been studied for gonorrhea or other STDs.

HHH, MD

[skerdstraght68]

It just would seem that for an insertive person that was without herpies (herpes) previously it wouldn't really apply but thats why your a  respected doc and Im a dumb WW.

[worriedguy2006]

i didn't realize that men with gonorrhea are 2-5 times more likely to shed HIV in their semen than those without. that is an ASTRONOMICALLY higher percentage :(

[H. Hunter Handsfield, M.D.]

Other STDs do the same thing.  This is one of the main reasons HIV is so much more common in gay men and in sub-Saharan Africa (and in poverty-stricken inner cities in this country) than in heterosexual men and women in most industrialized countries, where STD are better controlled.  

Still, the likelihood of transmission remains low for any particular event.  If you assume a 1 in 1000 risk of transmission without gonorrhea for a particular exposure, then with gonorrhea the risk would be 1 in 200 to 1 in 500.  Plenty high, but still at a level that most exposures don't result in catching HIV.

HHH, MD

[kenperes]

I have always wondered why HIV was so frequently spread from woman to man in Sub-Saharan Africa.  Do other fluids (vaginal fluids) shed more HIV with coinfection as well?  Also, what is the prevailing theory on how the lack of circumcision leads to the easier spread to men from women?

Thanks, and sorry to be off topic, but I could never really understand this before.

[anotherdummy]

I have wondered the same thing but I do believe the doctor has answered this indirectly in other posts.  I believe if other disease are present and especially if lesions are present (in one or n=both parties) then it facilitates easier transmission to the blood stream.  Combine that with poor hygiene, lack of medical access and hetero anal sex (which may be the bigger factor??) lack of circumsision, and it has the makings of disaster.  Only my opinion though.

I do believe, from what I have read here, that in a high percentage of cases at least one STD or infection must be present which brings certain cells to the surface which are susceptible to hiv.  Not sure if I am correct or not.

[Alchemist42]

Ive been confused by the increased risk of concurrent STDS with regards to oral sex as well...

For example... from what ive read if you get an STD from an encounter then you are at risk of getting HIV from that encounter and need to be tested.   And ive read that the risk is 3-5 times greater.

Now lets look at Insertive Oral...  the risk of insertive oral is negligible with a theoretical risk of 0.5 per 10000.  But if you get gonorrhea from the encounter... how much does the risk go up?  

3-5 times theoretical risk is how substantial really?   If it is a substantial risk... and the risk of getting gonorrhea from oral sex is so much greater... then isnt the risk of getting HIV via insertive oral alot higher too?

Using that logic... it seems like you would need to look at the chances of getting ANY STD from an encounter as the basis for possibly getting HIV... or am i missing something.

[worriedguy2006]

it's like having "textbook" symptoms

day 18 after exposure: started to experience enlarged groin lymph node. gonorrhea still present and nearing end of treatment.

day 25 after exposure: enlarge lymph node still present. slight sore throat.

it's like the textbook version of seroconverting.

[worriedguy2006]

doc, if you are reading:

i got tested today on day 25 after exposure and got a negative result. do you think i have a good chance of staying negative? it has been near 4 weeks.

[H. Hunter Handsfield, M.D.]

I don't know how you could come to believe you're having "textbook" symptoms of HIV seroconversion.  Not even close.

Your follow-up test HIV test almost certainly will be negative.

Gonorrhea should clear up completely within a week of treatment.  If you're still having symptoms, you need to return to your provider right away for reevaluation.

HHH, MD

[worriedguy2006]

i have read that DURING experiencing ARS, a preson can still test negative till after a few weeks into the symptoms. i also read that there is general consensus that 21 days is the avg. time it takes for the body to seroconvert and show antibodies.

my question: from your experience and knowledge, how long would a person take to test positive after experiencing ARS (can that person test positive while experiencing ARS?)?

i would appreciate your view on this

[worriedguy2006]

alright doc, if you are STILL reading, here are my results:

day 35: HIV-1 Qualitative test (i think this was the DNA PCR test) came out negative. the antibody test came out negative as well.

how "conclusive" are these results would you say? i know that it did not reach the 6 weeks but i am thinking that the viral load test would have showed something