Unprotected oral

[jrod801]

I received unprotected oral from CSW about 7 months ago. I was tested and was told by doctors I’m ok. Some symptoms have made me worried again. I’ve had a recurrent sore and very swollen throat with fever. Doctors say it’s viral. It’s happened  about 4 times during this period, each time lasting about 4 days to come and go. I’ve also had ongoing ear ringin which has made me worried again about syphilis or other STDs, given that this happened in a third world country with higher syphillis levels than the USA. I’ve had also the following symptoms: - a couple of blisters right after my “risky” encounter, which I now think they might have just been normal and I just got it confused. – a small abrasion in the shaft at about 18 weeks, it stung during the shower and resolved completely about 2 or 3 days later, it might have been caused by friction with hair after rough masturbation. I have put a lot of attention to my genitals, so I doubt I missed other symptoms.
I have the following questions:

1. Could I have syphilis that has gone undetected? I did RPR tests at 2, 8 and 10 weeks. Then VDRL at 13 weeks and RPR at 19, 23 and 26 weeks. I also had an FTA-ABS at 23 weeks and a TPPA at 26 weeks. All negative.

2. I self-prescribed 1g Zithromax at 11 weeks. Could this have had the effect of false negative test results? Could Zithromax cause the ear-ringin?

3. Are there any other STDs that could cause similar symptoms? I tested negative for HIV at 13 weeks , several urinalysis before and after the zithromax showed no WBCs in urine and a had a negative 4-week chlamydia/gonorrhea NAA urine test.

[Edward W Hook, MD]

Niether your recurring sore throat, nor your partner's rash raise concerns for me.  If your partner's lesions is painful, she should have it evaluated but I see no reason to worry about either syphilis or HSV.  Obviously I cannot see the lesion to make an accurate diagnosis but folliculitis lesions can be rather large.   EWH

[jrod801]

Dr. Hook, thank you for your answer. I know the constant anxiety over this incident seems insane, and I guess I'm not totally over the fears. I have gone from not worrying anymore about it, to worrying again after having a recurring sore throat and ear.ringing. I'm sorry to bring this touch of anxiety, but I hope you could answer one last question. I'll make sure to get help if this anxiety keeps recurring.

Your answer of course reassured me, but since I have gotten another episode of sore throat and fever and my partner has a pretty large lesion on her pelvis. I assumed it was folliculitis from shaving, but it seems now that it is sort of large, it's painful and it's been there for a week now. I understand that if I do not have syphillis I can't pass it on, but is her lesion a reason to worry and have her have a blood test?

Also, do you think having a recurrent "viral" sore throat could be the result of any other STD like maybe herpes or others, if I have no genital lesions or symptoms?

[Edward W Hook, MD]

Welcome back to our Forum.  I remember our prior interchange and have reviewed it as well.  I'm saddened that guilt or anxiety over this exposure, despite the advice of me and other professionals and much testing continues to worry you.  Straight to your questions, then a summary recommendation:

1. Could I have syphilis that has gone undetected? I did RPR tests at 2, 8 and 10 weeks. Then VDRL at 13 weeks and RPR at 19, 23 and 26 weeks. I also had an FTA-ABS at 23 weeks and a TPPA at 26 weeks. All negative.
These results represent anxiety-driven over testing.  You did not get syphilis from the exposure months ago and your tests prove it.  

2. I self-prescribed 1g Zithromax at 11 weeks. Could this have had the effect of false negative test results? Could Zithromax cause the ear-ringin?
No this would not cause a false negative syphilis test result at 11 weeks.  A single dose of azithromycin would not be expected to cause prolonged ear ringing either.  You should discuss your ear ringing with someone who can examine you, test your hearing and look into your ears – it is not related to the exposure you are concerned about.

3. Are there any other STDs that could cause similar symptoms? I tested negative for HIV at 13 weeks , several urinalysis before and after the zithromax showed no WBCs in urine and a had a negative 4-week chlamydia/gonorrhea NAA urine test. .
You do not need further testing.

My sense is that you continue to worry about your exposure months ago and have spent considerable time and money testing and looking for STDs.  Einstein said "one definition of insanity is to keep doing the same thing again and again and expect different results.".  While I do not  think you are insane, I think your concerns are not warranted.  At this time, rather than continuing to test, I suggest you discuss your concerns with a counselor or mental health professional who can help you work through this. EWH