STDs Expert Forum
Unprotected Oral/Protected vaginal with escort
About This Forum:

The STD Forum 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.

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Unprotected Oral/Protected vaginal with escort

I am male, and a week ago I engaged in risky sexual behavior with multiple female escorts. I received and gave unprotected oral sex on three different occasions from high class (IE expensive, if it is possible to categorize CSWs this way) escorts. I also engaged in protected vaginal sex on two occasions. Both occasions were brief with minimal skin contact. There was also no visible sores on any escort.

I began to experience flu-like symptoms a day after the last encounter, starting with a swollen tongue,  a sore throat, enlarged lymph nodes, swollen tonsils, whiteness on tonsils, achy body, night sweats, chills, headaches and finally 2-3 big red sores with a white outline on my tongue (relatively painless).

One day after the final encounter, I also saw a small sore on my penile shaft. However, it did not hurt, scabbed up quickly and went away in less than a day.

Returning home I went to the STD clinic to sign up for testing. The nurse practitioner did not believe there was a large amount of risk and the sore was simply trauma due to the brevity of its appearance.

I went to my doctor for the intense strep symptoms. A quick strep test came back negative. However, he still wished to treat me for strep, and prescribed 1.5g of azythromycin (zithromax).

Overall I have had not penile symptoms besides the small sore and some general, soreness in the head of the penis and the testicles. There is no discharge or any other signs of sores.

Now to my questions:
1) What are my risks of STIs due to these encounters? Which tests should I seek? Would any symptoms indicate an STI?

2) Could the constitutional symptoms, or general penile discomfort be related to throat STI infection or a newly acquired HSV-2 infection or another STI?

3) If I take the azythromycin (1.5g) for strep, will it affect my STI testing in three days? I read that 2g is normal for gonorrhea and I fear taking a smaller dose could result in false negative test.

239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

I am concerned that your oral/throat infection might have been initial herpes, either HSV-1 acquired by kissing, if one of the escorts had oral herpes; or HSV-2 by cunnilingus if you were exposed to genital herpes.  The timing is right, as is the fairly severe sore throat; and tongue ulcers are not typical for steptococcal infections.

Before you overreact to the herpes possibility, I'm by no means certain about it.  Your story is not entirely typical (for example, no painful sores in and around the mouth), and there are other viruses that could cause the identical picture.  But I also don't think the possibility should be ignored.  I recommend oral testing for HSV, the sooner the better.  If you still have sore throat or persisting tongue lesions, a swab test (preferably PCR) should be done, as well as a blood test for HSV antibodies.  If the blood test is negative for either or both viruses, a second test can be done in a few weeks to check for seroconversion, i.e. development of a newly positive result -- although this step won't be necessary if a PCR test is positive in the meantime.

Those comments pretty well cover questions 2.  As for the others:

1) Condom-protected vaginal sex is generally safe, with low risk for any and all STDs.  Unprotected oral generally is quite safe, but not entirely free of STD risk -- including risk for herpes, as discussed above.  Aside from herpes, you were at low risk for gonorrhea and nongonococcal urethritis (NGU) and even less risk for chlamydia and syphilis.

3) The azithromycin will have cured chlamydia, gonorrhea, NGU, and probably syphilis. Even though the dose is not quite the recommended one for gonorrhea, there is no change gonorrhea would persist after 1.5 g azithromycin (which you probably took as a Z-pack, i.e. over a 5 day period).  Any testing for gonorrhea and chlamydia would have had to be done before taking the drug.  (Indeed, I would have assumed such testing by the STD clinic.  Not done?)  In any case, there is no point in testing now or any time in the future for gonorrhea or chlamydia; the results will be negative, and it won't be possible to know whether you were never infected or had been infected but cured by the antibiotic.

I'm sure this isn't what you were hoping to hear.  But obivously the most important issue at this time is to speak with your doctor (and/or the STD clinic) about herpes and testing for it.  I'll be interested in how all this turns out -- please return with follow-up comments.

Best wishes--  HHH, MD
7 Comments
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Avatar_m_tn
Well, you are correct, that is not exactly what I wanted to hear.

I will go to a clinic tomorrow to get tested as they are closed for the evening. The best thing I can do in the meantime is maybe provide a better description of the "mouth" sores. I noticed them last night and they have diminished greatly over the day, so I hope they are still there.

To begin, the STD clinic did not do testing, as they wanted to wait a week for "effective testing", which will be on Tuesday. When the doctor (just last night) prescribed me the z-pack, I asked if the problems could be std related and they responded highly unlikely, but then again, they did not have all the information.

The "sores" as I describe them are not exactly sores. The best description and picture I can find online that match them are "geographic tongue". Basically my entire Tongue is white, with 4 spots (ranging from the size of a dime to the size of a quarter) that are very smooth and red. They have a slightly raised white border. They are not painful and don't exactly look like 'open wounds'. I don't even know if there will be anything to swab, but I will let them know at the clinic.

As for a better description of the timeline, I began to feel the constitutional symptoms (mostly a swollen tongue if I remember correctly), a bit less than a day after the last encounter... which as much as I am embarrassed to admit, is still less than two days after the first encounter.

How long do swab test results usually take to get the results?

I have already tested positive for HSV-1 (Blood test, I get one a year and I have been positive for about 8), so is it possible for me to re-acquire that? My positive results for HSV-1 was 1.49 one month ago.
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239123_tn?1267651214
This information makes me much less concerned about herpes.  Having had HSV-1, you are immune (or at least highly resistant) to a new infection with it -- so only HSV-2 is now a consideration.  Geographic tongue accompanies almost any infection, and it seems you didn't really have overt mucosal ulcerations in your mouth.  And onset of constiutional symptoms before the sore throat etc argues against herpes.

The time to results for HSV PCR is only a day or two in the lab -- but between collection, transport to a lab, potential delay in actually running the test, and conveyance of results, a week or more may pass.  This can vary a lot between clinics and labs.

I don't understand the STD clinic's delay of testing, at least for gonorrhea and chlamydia.  While blood tests (for syphillis (syphilis), HIV, and -- if indicated -- HSV) require a few weeks to become positive, testing for gonorrhea and chlamydia is accurate within 2 days following exposure, and certainly in the presence of symptoms like sore throat.
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Avatar_m_tn
Hello again,

Thank you for that new information. It makes me feel a bit better. I still went to a different health clinic to get swabbed today however. The doctor there seemed very experienced, as I believe he has worked in the field for around 30 years. He did not believe that it had anything to do with herpes, but more about tonsillitis or maybe a strep the quicktest did not test for.

I as well do not understand the decisions by the clinic. I have been very underwhelmed by their activity in this situation. They first did not do the testing (as you have suggested they should have), but when I called them up to see if the strep antibiotics (azythormycin) would affect the test results, they assured me they would not affect the results whatsoever.  My unease about their answer is partially why I decided to post on this forum.

As mentioned, I received an oral swab today for the herpes test on the red spots/sores on my tongue. I will return and report any updates and new information as the week progresses.

Thank you for your help and advice. And here is to hoping it is not HSV-2.
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239123_tn?1267651214
Let me know the results of your oral HSV test.  I expect it to be negative, as apparently does the doctor you saw.
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Avatar_m_tn
Hello once again,

Today I received the results from both the strep test and the HSV swab test on the red mouth sores. The full strep culture came back positive for a group B strep (I dont know the differences between groups, but I have strep), and the HSV swab came back negative, as you expected.

I would just like to finish this thread with a few quick questions:

Given that I have taken azithromycin for strep (1.5g), the HSV culture is negative, and it is 10 days post encounter without any obvious HSV symptoms, is it safe to say that I should not be worried or anxious about MOST std's as several would have been cured with the azythromycin and the probability of infection on something like HSV-2 is sufficiently low?
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239123_tn?1267651214
Group B strep is generally not a pathogen, i.e. rarely causes disease.  It probably had nothing to do with your symptoms, which probably was a viral infection.

In any case, I agree you should not be worried further about herpes, or about treatable STDs -- for exacly the reasons you state.

That should wind up this thread.  Best wishes.  
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