scary situation in mexico

[concernedinnyc]

hi.  i have a question about two STD issues.

I was in Puerta Vallarta Mexico and has sex with a local there.  Here is what we did:
1.  He sucked me off.
2.  He came.
3.  10 or 15 minutes later we started up again and he started to rub his **** against my anus
3.   he inserted the head of his **** and i quickly pushed him out.
4.  i did not suck him or do analingus or anything else.  just jacked off.
5.  before we started i asked if he was poz or neg and he told me neg and last tested 3 months ago

seems ok, but here is the concern.
1.  36 hours later i got penile gonorrhea
2.  also, i was constipated and had been having some blood perhaps from a hemroid those days before this.

my concern:
1.  gonorrhea:  my doc gave me a one powder pack of azythromiacin and one pill of ciprofloxacin (500 mg).  i took these 24 hours ago and still have some dripping.  is this normal or do i have a different strain and should i have different antibiotics?
2.  HIV:  I thought i was being pretty careful, but now knowing he had gonorrhea of the throat and learning that HIV is more widespread in mexico, i am concerned i have been exposed.  i am past the window for PEP.  do u think there is a concern here?  The concern is new or older semen getting into my bloodstream, even though there was no '*******' and he poked his head in me for 1 second.  
3.  I am considering a DNA PCR test today.

deeply concerned.
thanks

[H. Hunter Handsfield, M.D.]

Acquiring gonorrhea implies a somewhat higher risk than otherwise of getting HIV as well.  However, the data on STDs as transmission risk factors are limited to gential and anal exposure; there is no evidence that the presence of STD enhances HIV transmission through oral sex.  If it does, the increased risk is minimal.  Even if you double the risk of an exposure with near-zero risk, the chance of transmission remains near zero.  Add to that the probability that your partner doesn't have HIV (most people don't lie outright) and your risk of HIV from this event is vanishingly small.  As for your very brief receptive anal exposure, that sounds too brief and inconsequential to worry about; and the fact that your partner had oral gonorrhea doesn't necessarily imply he had a urethral infection.

On to your questions:

1) That treatment should be fine for gonorrhea.  It takes a few days for symptoms to clear up entirely.  Get rechecked if you still have discharge after a week.

2) See above.  3) I recommend against PCR testing.  The HIV PCR tests have a risk of false positive results.  That chance is low, but it is far higher than the chance you acquired HIV.  Thus, if you have a positive result, it probably will simply cause horrible anxiety for a couple of weeks without meaning you are infected.  If you decide to get HIV tested at all, I suggest a standard antibody test 6 weeks after the event.

Good luck-- HHH, MD

[concernedinnyc]

thanks.  this is very helpful.  very helpful and i decided not to PCR and to just test in 6 weeks, but it sounds like the chances are slim that i have been exposed or contracted hiv.  sound right?

also, my gonorrhea symptoms came on in aboyt 26 hours.  does that sound too fast?  if so it could have beem a friend the week before but i would be SHOCKED at that.  thoughts?

lasty, is it true that it takes an onoculum of hiv to overwhelm and infect?  i just thought if his precum got into a blood stream....wham, but i am hearing it is much harder than that and i wondered why?

thanks again.

[H. Hunter Handsfield, M.D.]

As I already said, the chance you acquired HIV is zero or close to it.

You're right, your gonorrhea symptoms were sooner than expected; 26 hours might be possible, but is unusual.  Shocked or not, your friend from the week before needs to be tested for gonorrhea, and preferably for HIV as well.

The biological reasons for why HIV is so inefficiently transmitted are very complex.  Of course, if infected precum "got into your blood stream", the risk of infection would be high.  But the epidemiological statistics prove that if that happens, it is extremely rare.

HHH, MD