Caught something, could HIV be next?

[ConcernedGuy81]

Hi doc, have a situation that maybe you can give me some insight on.

Bi guy here who had an encounter about two weeks ago with another guy. We engaged in unprotected oral and anal sex (top here). After everything was over he handed me a towel to wipe off with and I noticed some brown (presumably fecal matter) in the lube as well as streaks of blood. I immediately went to the bathroom and washed my penis with soapy water and after getting home drenched it in rubbing alcohol (I know, bad idea)

About two days later I developed a pain in my urethra that would come and go. Two days after that I noticed I had a slight discharge although it never did hurt when I urinated. Went to the clinic two days after that and got put on Zithro, which cleared up the symptoms (plus 2.5g of Amoxicillin I took before that out of panic).

Now I'm worried that I might've caught HIV as well. He reassured me he was negative on everything as he has other health issues (diabetes and high blood pressure) that require he get a physical every 6 weeks or so which he said include a full STD check up. He seemed overly concerned about my status as well, asked me three different times if I was clean as well as the last time I got tested (which was back in November). I know some people will say that a person who tells you they are negative is most likely telling the truth but it's obvious that I caught something off of him, he could've been lying about his HIV status as well...

I go back to the doc sometime next week to figure out what the culture results for my discharge was, although he and I both assume it was Chlamydia. And I know I'll have to wait a bit longer before I can test conclusively negative for HIV. Do you have any insight as to how much my risk was at catching this on top of the STD if he was indeed poz?

Thanks in advance.

[H. Hunter Handsfield, M.D.]

I reviewed your dialog in the community forum.  You had pretty valid advice and you agree you need testing.  I won't repeat the condom lecture.  However, unlike the respondents in the community, I do congratulate you for pursuing the equally important safe sex strategy for men who have sex with men, asking and sharing HIV status.  That your partner believes he doesn't have HIV isn't proof, but it is reassuring.  If he was unevasive and seemingly honest, probably he wasn't lying.  But lying isn't the only problem; he could have been newly infected since is last test.  If he keeps letting new men top him without condoms, it's only a matter of time before he has it.

Insertive anal sex is a good way to get gonorrhea, and also non-STD bacterial urethral infection due to fecal bacteria like E. coli.  The short incubation period suggests one of those problems; chlamydia doesn't cause symptoms sooner than 7-10 days.  Your treatment probably was adequate.  If your doc collected urine for standard bacterial culture, you might learn something; if only tested for gonorrhea and chlamydia you might never know exactly what you had.

Getting any urethral infection probably increases the risk of HIV if your partner was infected.  But still the odds are in your favor.  Let's do a quick calculation:  Chance your partner had HIV despite his reassurance, let's say 1% (1 in 100).  Chance you were infected if he had it, given the fact that he would have had early infection (with high viral load) plus your urethritis, probably 1% and conceivably as high as 10%.  Those figures put the risk you caught HIV somewhere between 1 in 1,000 and 1 in 10,000 (0.01 x 0.1 = 0.001; 0.01 x 0.01 = 0.0001).

In other words, the statistics say you probably dodged the bullet.  But do get tested.  And get into the condom habit.

Regards--  HHH, MD

[ConcernedGuy81]

Thanks for the reply. As for the condom habit, I have a pretty good one outside of this last encounter. First time in about a year that I've gone without and have suffered the concequences of such actions.

As for the NGU, I remember them doing a urine test but they didn't alert me to anything out of the ordinary. If I'm not mistaken they told me there didn't see anything abnormal. The MA even questioned me as to what I felt was my issue as the symptoms I had described to her didn't seem consistant with a typical case of Gonorrhea or Chlamydia I'm guessing. But from other threads on here that I've read, the ammount of Zythro they put me on (2000mg, but I only took 1500mg as my insurance didn't cover all eight pills) is considered overkill so I'm sure it eradicated it.

As for the guy in question, we have been keeping in touch and I've alerted him to my NGU. He again reassured me that he is neg and asked me to let him know the results of my culture are. He went to his physican today to get himself tested and will be letting me know his results as well. It does give me a bit of comfort that he is being responsible by informing me as well as keeping in touch, but to be on the safe side I will be getting a test done in the next few weeks so that I may put this to bed once and for all and move on with my life. With condoms fully intact :)

Thanks again Dr.

[H. Hunter Handsfield, M.D.]

My comment about chlamydia also applies to NGU; symptoms after 2 days is too soon.  (Except for "NGU" due to fecal bacteria, which behaves more like a bacterial UTI.)  Of course, you could have chlamydia or NGU from some earlier sexual encounter.  But not this one.

[ConcernedGuy81]

Well a couple of days ago I talked with the guy in question. He told me that his doc ran tests on him for bacterial infections and came back clean although he requested to have him run more extensive tests in order to cancel out all possibilities.

As for myself, I figured I was getting better, the discharge went away and the pain was close to zero. Over the weekend though, I noticed a bit of a stain in my boxers after waking up and upon milking my urethra had a small amount of cloudy discharge. Again I panicked, started taking some left over amoxicillin. After a day of that still woke up with a stain in my boxers but upon milking, the discharge was clear and very minuscule. Noticed my urine was a tad cloudy that night as well. Not sure if that had to do with the amoxcillin though. As of today, didn't notice any discharge or cloudy urine, still no pain or discomfort with urination, although the penis pain has come back sporadically. How much I'm thinking about it determines how bad it is. It could be all in my head, although I know the discharge wasn't.

I'm sure whatever it is I've got didn't get cleared up with the zithromax and amoxicillin I previously took. I'm going back to the doc today to see if there's anything else he can put me on to clear this up for good. Hopefully he'll also have my culture results seeing as how it's been almost two weeks now. I'll also be going in for a rapid test next week at the 4 week period. I know it won't be conclusive but it'll at least give me a little piece of mind as to what to expect. Any idea though as to why this infection hasn't gone away? Does this sound typical of a UTI or any STD if I've taken the antibiotics and haven't had any sex since then?

[H. Hunter Handsfield, M.D.]

Sometimes it takes symptoms 1-2 weeks to go away even though the infection is cured.  Or perhaps you had a non-STD bacterial UTI (from normal rectal bacteria) that is resistant to the antibiotics you received.  It was a mistake to re-treat yourself with amoxicillin, which could screw up further testing.  Don't take any more antibiotic until you are reevaluated.  If not yet done, you should ask your doc to do a standard urine culture for UTI bacteria.  Otherwise, follow your doctor's advice.  In the meantime, this isn't particularly worrisome.  Probably no STD and HIV still isn't a concern.