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Avatar universal

Worried about HIV risk

Hi, I'm a bisexual guy from the UK and around 11 days ago I had unprotected oral sex both giving and recieving with a guy I have never met before.  There was also fingering and kissing between both of us, the kissing was deep 'french' kissing and the fingering was done both ways.  During the oral sex he did not ejaculate in my mouth nor did he ejaculate over my body.

Around 4 days after the event I noticed a discharge from my penis, itching around my anus, swollen glands in my throat and generally feel unwell (flu like).  I went to my local GUM clinic on the 7th day and ahd a full STD screen (swabs, bloods, etc).  I was told I had NSU/NGU and was treated with azithromycin (1g one off dose).  The NGU symptoms and itching have now cleared but I still have the swollen throat glands and generally feel unwell.

I am very worried about the possibility of having caught HIV and that the swollen glands and flu-like illness are symptoms of primary HIV infection.  I would be extremely grateful if you could tell me if this is likely or whether I am over reacting.

Many thanks.
10 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.

I understand your concern:  since you acquired an STD (NGU) despite having apparently safe sex, why not HIV?  But not all STDs are the same.  NGU is quite commonly acquired by oral sex, but HIV is not.  Some (maybe most) NGU cases following oral sex probably are caused by entirely normal oral bacteria, not by traditional STD bacteria or viruses.  In contrast, when an oral partner has HIV, the risk of transmission to a penile partner by oral sex has been calculated at 1 in 20,000, which is equivalent to receiving BJs by infected men once daily for 55 years before transmission might be expected.  Many experts believe that even this is too high an estimate, that oral to penile HIV transmisison enver occurs.  Kissing and fingering are similarly low risk, with no proved cases that HIV was ever transmitted that way.

As for your symptoms, they are far more likely due to a garden vareity respiratory viral infection than to HIV.  In fact, they may have the same cause as the NGU.  About 5% of NGU cases are caused by certain types of adenovirus, which can be transmitted by oral sex and can simultaneously cause urethritis, pharyngitis, and enflamed lymph nodes in the neck, under the jaw, etc.

With almost no exceptions, UK's NHS GUM clinics are superb; the clinician(s) you saw there probably are every bit as expert as Dr. Hook and I are in HIV transmission risks, symptoms, etc.  If you remain concerned despite my reassurance, or if your sore throat and other symptoms continue, I would urge you to return to the GUM clinic.  You could even print out this thread and take it along as a framework for discussion.  But in the meantime, I would urge you to not be concerned about HIV.  That's a very unlikely scenario here.

I hope this has helped.  Happy new year--  HHH, MD
Avatar universal
Doctor,

Many thanks for your response it is very much appreciated.  I have one further question; are the odds of HIV transmission involved in giving oral sex to a man equally as low as receiving?

Man thanks once again for your time and advice.
239123 tn?1267647614
MEDICAL PROFESSIONAL
The penile to oral transmission risk has been calculated at 1 in 10,000, if the penile partner has HIV -- so extremely low, but perhaps a bit higher than in the other direction.
Avatar universal
Dr. Handsfield,

Again many thanks for your time, advice and patience.  You certainly have put things into perspective for me.

Thanks again.
239123 tn?1267647614
MEDICAL PROFESSIONAL
Glad to have helped.  Take care and stay safe.  If you do in fact have a follow-up visit at the GUM clinic, I would be interested in hearing the outcome.
Avatar universal
Hi again Dr. Handsfield,

You may think I'm over reacting here and I would be inclined to agree. However, over the past few day I have been running a slight fever (37.4 degrees C); have severe diarrhea, still have swollen throat glands; and also within the last couple of days have developed a patchy red rash on my chest.  It is now 13 days after my possible exposure and I have been in touch with the person I gave and received oral sex with and he tells me he was last tested 4 months ago and was negative for all STDs.  He has also been tested last week and like me is awaiting the results.

I realise that I may be being irrational and fitting my symptoms to primary HIV infection.  I am now extremely worried and wondered what you thought about the development of my symptoms.

Once again, many thanks for your support, advice and patience.
239123 tn?1267647614
MEDICAL PROFESSIONAL
I don't think you're being irrational at all; I understand why the symptoms worry you.  But it remains statistically unlikely that your illness is an acute HIV infection.  Some of your symptoms are compatible with it, but others are not.  Diarrhea is usually not so prominent, and most people with ARS have significant fever, generally 38+.  (37.4 really isn't abnormal.  37 is the average human temperature, not the maximum normal.)  And the information that your partner apparently is HIV negative (as of 4 months ago) also is reassuring.  I can't say for sure you don't have HIV, but the odds remain strongly in your favor and against ARS.

I still recommend you return to the GUM clinic, and look forward to hearing the results of their reevaluation.

Avatar universal
Doctor,

Further to your request to let you know about a follow up visit...

I have had a return visit to my GUM clinic and was told that tests for chlamydia, gonorrhoea, syphilis and HIV were all negative (although HIV test was undertaken 1 after my encounter) so it would appear that my GNU was caused by something other than chlamydia etc.  My partner also tested negative for the same tests.

I am considering taking a HIV duo test at 28 days just to be certain and I take it from your other posts that a I should take a negative result here to me final.  My initial paranoia and anxiety about HIV has eased considerably since getting these results.  I do still have the sore throat, swollen throat glands and diarrhoea however.

I would also like to take this opportunity to thank you once again for your support and advice during this time.
239123 tn?1267647614
MEDICAL PROFESSIONAL
The negative chlamydia test was expected, since chlamydia is rarely if ever transmitted by oral exposure and virtually all NGU acquired during oral sex is nonchlamydial.

A duo test at 4 weeks would indeed be definitive.  But my advice would be to follow the GUM clinic's advice about when to have follow-up testing and what test to use.  What did they say?

Thanks for the follow-up, and thanks for the kind words.  I'm glad to have helped.  
Avatar universal
The GUM clinic said to have a follow up at 3 months which I will be doing.  In the mean time I will be having a Duo Test at 28 days just for piece of mind, these tests are not offered by the NHS in the UK but the standard antibody tests are, along with chlamydia and gonorrhoea testing.

Many thanks again for your patience, advice, expertise.

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