Oral Sex But Different

[solcann]

Day 0: Received multiple unprotected bj’s over a 12 hour period in India from multiple CSW’s.  Also took 4 tablets of generic Viagra during this time period.  After the episode, I noticed a lot of swelling (no pain) of the foreskin (am uncircumcised), which eventually subsided over a few days.

Day 1: Took 2 grams Zithro and 600 mg Cefixime (repeated this on days 2 and 3 as well)

Day 5: Started getting semi loose stools once daily for the next 4-5 days

Day 7: Woke up because I felt hot (not sweating).  Did not have a thermometer, so not sure if there was fever.  This has happened at different times every night since (it is day 17 now).

Day 8: Got what seemed to be a small ulcer on the inside of my lower lip which went away after a few days.

Day 9: Woke up with a stiff neck which pained more when I turned to one side that lasted one day.

Day 11: Very itchy skin on shins and top of feet and malaise on and off for a few days now


Questions:

1.  Looks like I have pushed the threshold for oral sex given the trauma/swelling, duration, etc.  Does this change the odds of being infected with HIV?  Do I need to test?  Would you?

2.  I do remember seeing white particles on my penis from the mouth of one of the CSWs.  If this was thrush and she had HIV, would this add any risk?

3.  I am concerned about the oral ulceration and timing of all the symptoms coming together.  In your opinion, does this seem like ARS?

4.  Isn’t it odd for a stiff neck to resolve completely in 24 hours?

5.  Would mouth ulcers associated with ARS be multiple or single?  How do ulcers present in ARS?

6.  What does the waking up because I am feeling hot mean?  Is it a night sweat, hot flash, or indicative of fever?

7.  How long before the antibiotics cleared up all bacterial STD's?  I deep kissed my partner and got a handjob 5 days later.  She touched her privates right after (washed hands very lightly with soap).  Any chance of infecting her?

Thanks!

[Edward W Hook, MD]

No, this does not change my assessment in any way.  I am confident that your symptoms are due to something other than ARS. EWH

[solcann]

Dear Dr. Hook,

Thank you for your comments and advice.  

Just a quick follow up question:

One of the CSW's had given a bj to an aquaintance a few minutes before with ejaculation in the mouth and then proceeded to give me a bj.  If there was some fluid still in her mouth, could this change your assesment?  Apart from that, the only other potential risk was if she touched herself before touching me...

Its just that the last few days (2 weeks afterwards), have been having muscle/joint pain/stiffness, nausea, diarrhea, malaise, and low grade fever (is 99.5 low grade fever?), which I suppose sounds more like ARS in terms of symptoms and timing then the symptoms I actually had earlier.

Thanks again for your advice and help.

[Edward W Hook, MD]

Welcome to the Forum  I'll go straight to your questions after a brief comment.  As we've said multiple times before, there is no risk for HIV from receipt of oral sex, even multiple times.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.

Further, your GI symptoms were most likely due to the azithromycin.  Now to your questions:

1.  See above, no risk.
2.  No change in my assessment.
3.  No, this is not suggestive of ARS
4. No, not at all.  This is typical for stress, fatigue, anxiety an muscle strain related disorders,
5.  They are part of the sore throat and are not a typical part of ARS.
6.  This too is nonspecific and could be due to any number of things.  Your symptoms are not suggestive of ARS.
7.  Your partner is not at risk.  The antibiotics would have their effect immediately and should be more accurately thought of as preventing infection than curing it.

Bottom line, no risk for HIV, no need for concern, no need for testing.  EWH