Likelihood of HIV contraction

[liono4]

I am a straight male who recently had a sexual encounter with a female. We had sex briefly (literally about ten seconds) and I wore a condom.  In the morning, she performed oral sex.

A week later I developed soreness in my left abdomen for which I had no explanation.  Two days later, I developed a single ulcer the size of a BB and surrounding swelling on the shaft of my penis.  I take minocycline (antibiotic) for acne,  but had not taken it for about one month.  I started taking it a couple days after the sore and swelling appeared, and both subsided within 3-4 days, though I still have a slight scar from the ulcer.  

It has been almost five weeks since my encounter.  I have not had any fever or noticed any enlargement of my lymph nodes.  I did have a sore throat for a couple days last week, but that passed rather quickly and I likely would have barely noticed it if I weren't hypersensitive to such issues at this time.  Is a genital ulcer and swelling alone a common symptom of HIV?  Are my symptoms consistent with acute HIV infection?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Did you read the Disclaimer message or, as it suggests, read other threads with the same questions?  To repeat some facts that have been discussed innumerable times on the forum: your partner had HIV probably is zero or close to it, if she isn't a commercial sex worker, injection drug user, or otherwise at high risks; condoms reliably prevent HIV transmission; almost nobody catches HIV by oral sex; and no symptoms are useful clues about new HIV infection (and yours don't sound suspicious for HIV anyway).  However, if you would like to provide more detailed information about your partner, I can more accurately assess that part of the risk.  But the bottom line is that most likely you have no worries about HIV.

The genital ulcer does not suggest HIV but still might be important.  The most common overall cause is genital herpes.  You describe some atypical aspects of that disease, because catching herpes despite condom use would be unusual; most new HSV infections cause multiple penile lesions, not just one; and there are hints from your description that this sounds more like a pimple.  However, to be safe you should see a provider for clinical evaluation and testing for herpes.  When you do that, you may as well go ahead with an HIV test as well.   Almost certainly it will be negative, but you'll probably sleep better knowing that.  

Regards--   HHH, MD

[H. Hunter Handsfield, M.D.]

Sentence 2 should read "The chance your partner had HIV probably is zero...."

[liono4]

Thank you, doctor.  My partner is not a sex worker or intravenous drug user.  She is a sexually active college student at a small private Midwestern school.

With regard to my penile symptoms, the genital lesion did not look at all like a pimple; it scabbed over very quickly and itself was not raised.  However, the square inch of skin surrounding it became fairly swollen.  This does not change your analysis with respect to the possibility of HIV contraction, does it?

[H. Hunter Handsfield, M.D.]

This more detailed description of the genital lesion does not affect my opinion or advice about HIV risk, but it does increases my concern about herpes.  Please check it out.

Among women like you describe ("sexually active college student at a small private Midwestern school" -- exactly the same sort of place I attended all those years ago), I would guess not 1 in 10,000 has HIV, maybe not even 1 in 100,000.

That's all for this thread unless and until you want to come back to report your test results for herpes, HIV, or both.

[liono4]

One final question that I'm confident you won't mind answering, please.  Should I see my regular family practitioner, or my dermatologist?  Which is more likely to be able to test me on-site?

[H. Hunter Handsfield, M.D.]

Probably not a dermatologist, assuming the penile lesion has pretty much cleared up with nothing left to see.  Your family doctor or your local health department STD clinic would make sense.  Most likely neither one provides on-site blood testing for HSV and they may or may not have it availailable for HIV, but you could call ahead and ask.

[liono4]

Just wanted to report test results at 36 days.  Non-Reactive ELISA test and negative for herpes as well.  Any further advice or testing you recommend, or should I just put all worries behind me?

[H. Hunter Handsfield, M.D.]

Your worries should have been behind you from the very start. You can definitely put them there now.  There simply are no HIV worries from partnerships like you describe; and even if she were at high risk, there is no realistic chance of transmission if a condom is correctly used and remains intact.

[liono4]

Dr. Handsfield,
    Sorry to again bother you, but I still have some anxiety about my already discussed episode.  My concern now is that my symptoms were caused by syphilis.  I did not undergo syphilis testing.  Since my episode, I have taken 45 doses of 100 mg Minocycline in connection with my treatment for acne.  I have read that taking antibiotics can affect syphilis test results.  If I test for syphilis, will my minocycline medication lead to an inaccurate result?  Furthermore, would the minocycline eradicate the syphilis from my body?

[H. Hunter Handsfield, M.D.]

It is not possible to catch syphilis while taking minocycline; or if you started the antibiotic after exposure, it would have cured syphilis.  In either case, you will never have a positive test for syphilis. Don't waste any money on it.  Anyway, syphilis is currently a rare disease in the US, even among female commercial sex workers; the chance of exposure was minimal.

You may not keep returning to the forum with anxiety-driven questions that are best answered by your personal health care provider.  That's all for this thread.  Any more and I will immediatley delete the entire thread.