STD and HIV question

[turtleswim]

Dear Dr. HHH,

I'm 27 male and had 2 UNprotected oral sex with 2 Chinese female CSWs 7 weeks ago. Each oral lasted about 10 mins. One day after the exposures, urination became painful and 5 days testicles felt like they were on fire. No discharges. At week 2 and 4, I tested:  urine (included anal massage for discharge) and HIV anitbody blood. Result was inflamed urine track and prostate, negative for HIV and HSV and was given antibiotic Cycline caps for 10 days and an injection at Week 2. But the inflammatory continued, so at Week 4 was given 4 weeks of Ciprofloxacin 250 mg, Genurin tab 200 mg, and Volna-k tab 25 mg. All taken at twice a day.  

Here is concern and the symptoms up to date:

At 4 weeks, I developed sore throat and a fever that lasted 1 days reaching 38 c. The glands swelled up and hurts pretty bad to swallow but no mucus or coughs. Week 4 to 7 (now) the sore throat is still here but less painful than before. The glands are still little swelled and can be felt by hand but doesn't hurt when swallowing. The urine and prostate pain are gone and body temperature normal daily 36.5 to 37.3. Some days I feel a little tired, but this is really hard to say to be abnormal or not. Also had chills that felt goose bumps that lasted maybe 10 mins each times for 2 times but regained heat with in 10 mins. Also 2 night sweats, but gone after i turned the heater down the 3rd night. Now, I am still taking the 3 medications.

My Qs are:

1. Can the meds I'm currently on be helping the sore throat? Such that without the med, the sore throat could have been worse than now?

2. Based on the exposures description earlier, how risky were they?

3. Should antibody blood test be done again at 8 weeks and also again at 12 weeks?

4. What are other HIV symptoms that I should be watched out for?

5. What might be your educated guess on the inflamed urine track and prostate and should I continue the antibolic as directed for the whole 4 weeks?

Thank you.

[Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD]

Hello,
Here are the answers to your questions realting to the event described:

1. Can the meds I'm currently on be helping the sore throat? Such that without the med, the sore throat could have been worse than now?
I DO NOT THINK THAT THE SORE THROAT HAS ANYTHING TO DO WITH THE SEXUAL ENCOUNTER; I THINK IT IS JUST COINCIDENTAL AND IF IT IS A BACTERIAL SORE THROAT (MOST SORE THROATS ARE VIRAL), IT IS POSSIBLY BETTER BECAUSE YOU ARE ON ALL THOSE ANTIBIOTICS.  HOWEVER IF IT IS A VIRAL SORE THROAT, THE ANTIBIOTICS WOULD NOT HAVE ANY EFFECT ON THE SEVERITY OF THE SORE THROAT AT ALL.

2. Based on the exposures description earlier, how risky were they?
NO RISK FROM THE POINT OF VIEW OF HIV INFECTION. RECEIVING ORAL SEX WITHOUT A CONDOM INVOLVES MAINLY A RISK OF INFECTIONS SUCH CHLAMYDI, GONORRHOEA, NSU, HSV, SYPHILIS, ETC YOUR SYMPTOMS WERE TYPICAL OF URETHRITIS CAUSED BY ONE OF THE BACTERIA MENTIONED.  IT IS POSSIBLE THAT IT HAS BECOME CHRONIC WHICH MAKES IT MORE DIFFICULT TO TREAT, HAVING TO BE ON ANTIBIOTICS FOR A LONGER PERIOD OF TIME.

3. Should antibody blood test be done again at 8 weeks and also again at 12 weeks?
I DO NOT THINK YOU NEED ANY FURTHER TESTS FOR HIV AS YOU DID NOT PUT YOURSELF AT RISK OF IT.  

4. What are other HIV symptoms that I should be watched out for?
AFTER 6 WEEKS OF HIV INFECTION, THERE ARE NO MORE SYMPTOMS OF ACUTE HIV SERO-CONVERSION.  THEREFORE YOU SHOULD NOT BE LOOKING FOR ANYTHING.

5. What might be your educated guess on the inflamed urine track and prostate and should I continue the antibolic as directed for the whole 4 weeks?

AS MENTIONED ABOVE, YOU HAVE CHRONIC URETHRITIS AND POSSIBLY PROSTATITIS, REQUIRING ANTIBIOTICS FOR FOUR OR EVEN MANY MORE WEEKS.

Best wishes,
Dr Jose

[turtleswim]

Thank you very much for your help and I will go get tested at 3 month for the last confirmation. But until then, won't think about it much after your help.

But maybe I should consider figuring out the origin of this sore throat of mine. since it lasted 3 weeks already and it is currently flu and other virus season now.

[Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD]

Hello,
The vast majority of sore throats are of viral origin and this would not respond to oral antibiotics.  A sore throat related to HIV sero-conversion would not last as long as yours; therefore I honestly do not believe it is related to this. They last for a maximum of 10 days or so, usually less.  Night sweats can be symptoms of numerous conditions and not only of HIV sero-conversion, when they are usually associated to a fever, and not lasting longer than a week to 10 days.
Best wishes,
Dr Jose

[turtleswim]

Hi Dr. Jose

Could you expand more on the difference between bacterial sore throat and viral sore throat? and what are the type of sore throat feelings with people during HIV window period and end up HIV+?

The antibiotic had a minimum effect on my sore throat as it did act up recently. In the last few days, it hurts swallowing saliva. And during the last 3 weeks, the sore throat is present, not extremely hurtful but with enlarged glands.

Lastly, what are the night sweats people experience with HIV+? Soaking wet? or little wet? It's hard to know. I do sweat at night. Shirts get a little damp.

Thank you and this should be all the fellow up questions.