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STDs (Expert Forum)
Should I be concerned?
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
Should I be concerned?
by Sergiomas37, Jan 26, 2009 08:37AM
I'm a 45 year old male who has never (to my knowledge) had an STD. I've been in a reasonably monogamous relationship for 30 years or so and completely monogomous for the last five years except for the one occaison that I will describe.
Four weeks ago II had unprotected oral with a 50+ year old woman. She told me that she was sexually healthy and offered vaginal sex, but I declined because we did not have condoms. I have absolutely no symptoms of any STDs and was not the least bit concerned until recieving a phone call from her this weekend during which she accused me of giving her multiple STDs. She said that she went to an STD clinic 3 days ago (3+ weeks after our encounter) complaining of a sore throat, burning eyes and severe pelvic pain with a bad vaginal odor. She also added that since she was with me, she had protected vaginal sex with another man (didn't mention whether she had oral) and that since this sex was protected, then I must have infected her. I don't see how.
She said the doctor at the clinic said she probably had at least one and maybe three STDs. She was treated with an injected antibiotic and also received flagyl and zithromycin. He test results are due back later this week. My questions follow:
1) Annecdotally, does this sound like STDs or just a urinary infection?
2) Could I have caused this? Or more likely her slightly more recent partner?
3) Do STD clinics just presume STD infections and treat like this w/o test results?
4) If she has any infections, what is the liklihood that she could have passed them to me orally? And wouldn't I have symptoms by now if I had been infected?
5) I read the several prior threads of Dr. HHH where he opines that Chlymdia is virtually never passed orally and gonnoreaha passes orally female to make at a rate of about 1% and of those 1% nearly 99% of the men would have a discharge within a few days, which I didn't and don't now. So, should I be worried?
Four weeks ago II had unprotected oral with a 50+ year old woman. She told me that she was sexually healthy and offered vaginal sex, but I declined because we did not have condoms. I have absolutely no symptoms of any STDs and was not the least bit concerned until recieving a phone call from her this weekend during which she accused me of giving her multiple STDs. She said that she went to an STD clinic 3 days ago (3+ weeks after our encounter) complaining of a sore throat, burning eyes and severe pelvic pain with a bad vaginal odor. She also added that since she was with me, she had protected vaginal sex with another man (didn't mention whether she had oral) and that since this sex was protected, then I must have infected her. I don't see how.
She said the doctor at the clinic said she probably had at least one and maybe three STDs. She was treated with an injected antibiotic and also received flagyl and zithromycin. He test results are due back later this week. My questions follow:
1) Annecdotally, does this sound like STDs or just a urinary infection?
2) Could I have caused this? Or more likely her slightly more recent partner?
3) Do STD clinics just presume STD infections and treat like this w/o test results?
4) If she has any infections, what is the liklihood that she could have passed them to me orally? And wouldn't I have symptoms by now if I had been infected?
5) I read the several prior threads of Dr. HHH where he opines that Chlymdia is virtually never passed orally and gonnoreaha passes orally female to make at a rate of about 1% and of those 1% nearly 99% of the men would have a discharge within a few days, which I didn't and don't now. So, should I be worried?
Doctor's Answer
by H. Hunter Handsfield, M.D., Jan 26, 2009 10:31AM
, Jan 26, 2009 10:31AM
This is a somewhat complex situation. I'll try to help.
1) It's hard enough to make judgments about diagnoses from first hand description of symptoms; second hand is still more difficult. Pelvic pain and vaginal odor suggest pelvic inflammatory disease, and the treatment she was given suggests her provider suspected PID, which is commonly due to gonorrhea and chlamydia (although the specific cause of some cases remains mysterious). Sore throat and "burning eyes" don't sound like STD. But the diagnosis of PID isn't always straightforward so it's hard for me to say more.
2) It is unlikely you have gonorrhea, chlamhydia, or other traditional STD, if your sexual history is accurate -- although of course it might be possible if your wife has had other partners. But even so, chlamydia is not transmitted by oral sex at all, and gonorrhea is rarely transmitted by cunnilingus.
3) Yes, if STD is suspected -- especially in a woman with possible PID -- treatment is given without awaiting test results. Complications are too risky if treatment is delayed.
4) If she has PID due to gonorrhea, you could have acquired it orally through cunnilingus. Or if she has infection with a virus called adenovirus (discussed below), you might soon find yourself with a cold or possibly nongonococcal urethritis (NGU), which can be caused by that virus.
5) Those figures are about right. (Thanks for reviewing other discussions on the forum to help frame your own questions. Too many questioners don't do that!)
Here are some thoughts about what might be going on. First, what about herpes? If you have oral herpes due to HSV-1, as does half the population, you could have transmitted it by oral sex. You don't have to have known oral herpes for that to happen, and herpes could cause sore throat and eye inflammation (from kissing). But from your description, herpes doesn't sound like a likely explanation for most of her symptoms.
Adenovirus? As suggested above, I think this might be a fair possibility. Adenovirus is a respiratory virus, a cause of colds and even pneumonia, and also causes conjunctivitis (eye inflammation). Some strains of adenovirus infect the genitals, transmitted by oral sex; it explains a few percent of NGU cases in men. I am not aware adenovirus has ever been known to mimic PID, but I suppose it could do so, and it certainly fits with sore throat plus burning eyes. So if you had recently been infected (have you had a cold in the last couple of weeks?), this might be a possibility; or she could have transmitted it to you.
What to do now? You should be examined and tested for STDs. Since your partner thinks you are the source of her problem, that has to be taken as a possibility, however slim. Don't wait until her test results are back; do it right away. Visit the same STD clinic, which is probably the best source for expert evaluation and also the best way to assure coordination between your two work-ups. Most likely nothing will be found and the STD clinic will agree that you are not the source of her problem. But better safe than sorry, and your willingness to check it out (and probably the absence of an STD) should help your partner understand she didn't catch an STD from you.
I hope this helps. Best wishes-- HHH, MD
1) It's hard enough to make judgments about diagnoses from first hand description of symptoms; second hand is still more difficult. Pelvic pain and vaginal odor suggest pelvic inflammatory disease, and the treatment she was given suggests her provider suspected PID, which is commonly due to gonorrhea and chlamydia (although the specific cause of some cases remains mysterious). Sore throat and "burning eyes" don't sound like STD. But the diagnosis of PID isn't always straightforward so it's hard for me to say more.
2) It is unlikely you have gonorrhea, chlamhydia, or other traditional STD, if your sexual history is accurate -- although of course it might be possible if your wife has had other partners. But even so, chlamydia is not transmitted by oral sex at all, and gonorrhea is rarely transmitted by cunnilingus.
3) Yes, if STD is suspected -- especially in a woman with possible PID -- treatment is given without awaiting test results. Complications are too risky if treatment is delayed.
4) If she has PID due to gonorrhea, you could have acquired it orally through cunnilingus. Or if she has infection with a virus called adenovirus (discussed below), you might soon find yourself with a cold or possibly nongonococcal urethritis (NGU), which can be caused by that virus.
5) Those figures are about right. (Thanks for reviewing other discussions on the forum to help frame your own questions. Too many questioners don't do that!)
Here are some thoughts about what might be going on. First, what about herpes? If you have oral herpes due to HSV-1, as does half the population, you could have transmitted it by oral sex. You don't have to have known oral herpes for that to happen, and herpes could cause sore throat and eye inflammation (from kissing). But from your description, herpes doesn't sound like a likely explanation for most of her symptoms.
Adenovirus? As suggested above, I think this might be a fair possibility. Adenovirus is a respiratory virus, a cause of colds and even pneumonia, and also causes conjunctivitis (eye inflammation). Some strains of adenovirus infect the genitals, transmitted by oral sex; it explains a few percent of NGU cases in men. I am not aware adenovirus has ever been known to mimic PID, but I suppose it could do so, and it certainly fits with sore throat plus burning eyes. So if you had recently been infected (have you had a cold in the last couple of weeks?), this might be a possibility; or she could have transmitted it to you.
What to do now? You should be examined and tested for STDs. Since your partner thinks you are the source of her problem, that has to be taken as a possibility, however slim. Don't wait until her test results are back; do it right away. Visit the same STD clinic, which is probably the best source for expert evaluation and also the best way to assure coordination between your two work-ups. Most likely nothing will be found and the STD clinic will agree that you are not the source of her problem. But better safe than sorry, and your willingness to check it out (and probably the absence of an STD) should help your partner understand she didn't catch an STD from you.
I hope this helps. Best wishes-- HHH, MD
Thanks.