Worried by symptoms

[worried13579]

Dear Doctors,

Three weeks ago I received unprotected oral sex from a masseuse in Hungary, for less than 5 minutes.  The oral aspect was unexpected, and I have been worrying about it ever since.  The establishment has a good reputation for cleanliness, I have no reason to suspect that the girl was infected, and everything that I've read here tells me that the risks are low.  However, I'm still very worried.

Within hours, I could feel a mild sensation in my urethra - not painful or burning, but sometimes making feel like I needed to urinate.  This sensation has come and gone over the last three weeks, peaking after about a week and has now pretty much disappeared.  I went to see a doctor about 1.5 weeks after the visit who told me to stop worrying and that an infection could not have taken hold so quickly.

I was mostly reassured for a few days, but for the last week or so, I've been feeling light-headed almost all the time and occasionally slightly nauseous.  I'm fairly certain that most of these symptoms are down to anxiety (certainly they get worse when I think about all the things that are scaring me), but that doesn't help.  I've also got the general jittery feeling of being on edge, which I associate with nerves.  The severity of these symptoms seem to come and go as I worry more or less about the situation.

Lastly, and most worryingly for me, I've noticed that I seem to have enlarged lymph nodes in my neck.

I've made another appointment to see a doctor at the end of the week, but in the mean time I'm worrying myself sick and so any advice would be greatly appreciated.

Thank you.

[worried13579]

Thank you, Doctor.  Your swift replies have been really appreciated.

[Edward W Hook, MD]

Even with piles present, anal fingering, like other forms of masturbation has no risk for HIV.  You have nothing to worry about.  EWH

[worried13579]

Thank you for your reassurances, Dr Hook.

Two swabs were taken when I first saw my doctor.  Results were expected within 2 weeks, so if anything shows up, I would expect to hear about that soon.

I hope you will allow me one follow up question.  My fears were very much fixated on the oral sex, but I also received some anal fingering.  I do suffer from mild piles, was there much risk from this activity?  Her finger was uncovered - I didn't see any cuts, but I can't say for sure.

Thank you again.

[Edward W Hook, MD]

Welcome to the Forum.  I'll be pleased to comment.  You are correct, oral sex is not particularly worrisome.  Since this is the HIV Forum I will comment first on your HIV risk from this exposure, which is non-existent.  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.   We typically do not even suggest testing for HIV following receipt of oral sex.  

As for other STDs, oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   The symptoms you describe are suggestive of urethritis (penile infection).   To evaluate this, you should have a swab test taken from your penis at a time when you have not urinated for at least an hour and have it tested under the microscope for the presence of white blood cells.  In some  instances health care providers prefer to use a specimen of urine collected just at the beginning of urination for these tests but this is not quite as good a test as the swab test.  If you have NGU, it is easily treated.  On the other hand, if your tests are negative, I would nto worry further.  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  

I hope these suggestions are helpful.  EWH