What are the odds this could be an STD?

[chinahand]

Hi Doc,

Yesterday you answered a question for me about HIV test accuracy.  I'm convinced that I don't have HIV and this question is not about HIV.  I also realize I can only post twice to expert forums within 6 months, so this is my final post.

I've had persistent symptoms for several weeks and remain concerned that I've acquired an STD.  I've searched hundreds of posts on Medhelp forums, but continue to be confused about my situation.  Visits to doctors and tests in China have not produced a definitive explanation.  I'm hoping you can give me a clear picture of what my STD risks might be, if any.

As you know, I had unprotected oral (giving/receiving) with a female CSW in China on 28 July.  I also had a similar oral exposure on 17 June that I did not previously mention.  Neither woman had any visible sores/chancres either on the mouth or vagina.

My symptoms are as follows:
-severe red eyes w/ slightly blurred vision since early August.  The redness is worst in the morning and gets better as the day progresses.
-low grade fever from 20 - 25 August.  Started at 37.7C and gradually abated over five days.
-cough (both productive and non-productive) since 21 August.
-very scratchy, swollen, dry throat with difficulty swallowing since 21 August.  Feels like a foreign body is stuck behind my adam's apple.
-white spot/pus on uvula that went away with prescribed Z-pak in late August, but persistent white spots in back of throat to the present.
-mild headaches; abdominal & neck pain.

I've not had any penile symptoms whatsoever (no discharge, no obvious sores/chancres, no pain while urinating).

I had several STD tests, and all came back negative, BUT the syphilis and herpes tests were too early to be reliable for the most recent exposure, and no oral gonorrhea swab was done.

What are the odds that I have oral/ocular herpes, oral gonorrhea, syphilis, or adenovirus?  Could any STD account for month-long throat problems with cough and red eyes?

[H. Hunter Handsfield, M.D.]

Oral sex rarely transmits HIV, and your negative tests show you didn't catch one.  And no STD causes the symptoms you describe.  You caught a cold, or you might have an allergy of some sort.

Syphilis blood testing is accurate after 6 weeks. It takes 12-13 weeks for herpes, but it is a ridiculous waste of money to get tested for herpes in this situation; please don't do it.  Syphilis testing is cheap, so feel free -- but syphilis also is not a possible explanation for your symptoms.

If your symptoms persist or you otherwise remain concerned, work with your health care provider to figure out the cause and possible treatment.  But you are just going to have to accept the truth and get past the obsession that you have an STD.  You do not.

No follow-up comments or discussion.  I won't have any further opinions or advice.

HHH, MD

[chinahand]

In the event anyone is interested because they have similar symptoms, I have received the results of serology tests which indicate a very high level of antistreptolysin-O.  This suggests my throat problems are the product of a strep infection, which may have spread to other parts of my body.  A throat culture (done much too late--at three weeks post-symptoms onset) was negative.  It seems that the throat bacteria were killed by the Z-Pak initially prescribed on 26 August based on my symptoms and the appearance of pus on my uvula....  Anyway, Dr. HHH was absolutely correct that my condition is not related to any STD.  Instead of fixating on STDs, I should have seen an enterologist in the first place.  Best wishes to you all.

[chinahand]

Hi Doc,
Please consider answering this one follow-up question.
I have had a sore throat with swollen, red tonsils and white spots for almost 8 weeks, and it has become worse, making swallowing more difficult and causing pain in my neck and jawline, despite penicillin injections and other treatments in response to the high antistreptolysin-o results noted in my last post.
I had an oral culture for gonorrhea last week which came back negative, but given my history, the doctor gave me 125 ml injection of ceftriaxone in my shoulder and 400 mg of cefixime orally in case the test was a false negative.
I read on this forum and elsewhere that oral gonorrhea is hard to kill.  With the antibiotics administered, what are the odds of it having killed an oral gonorrhea infection, assuming that I have it and it's one of the rare, asymptomatic cases?
Thanks for your help.

[chinahand]

Sorry, that last sentence should read "symptomatic".

[H. Hunter Handsfield, M.D.]

Oral gonorrhea rarely causes sore throat; almost all cases are asymptomatic.  Your negative test results are reliable.  You probably have a garden vareity viral infection or allergy -- or conceivably a recurrence of your possible strep infection.  If your sore throat persists, continue to work with your doctor about the cause.  But please drop STDs from your mind.  This has nothing at all to do with the sexual encounter you described above.

That's all for this thread.  I won't have any further comments.