Sore throat and rash

[Seroconcerned]

I posted a question a few weeks ago about symptoms that I experienced 1 week after performing unprotected oral on a TS escort.  I had flue like symptoms and a mild sore throat with pinkeye.  The doctor's comments put my mind at ease.  A couple of weeks later I stupidly met with another TS escort and performed protected oral and received protected anal intercourse.  And for a matter of less than 30 seconds performed unprotected oral at the end.  One day later I got swollen glands in my throat.  They weren't hard, but were very tender.  The sore throat wasn't terrible, but it was bad.  It didn't hurt when I wasn't using my throat, mostly when I swallowed.  It was a sharp pain and a feeling as if something were in my throat.  The sides of my throat under my jaw felt tight and constricting.  The saliva glands under my tongue were also sore.  A few days into the sore throat I developed a small rash on my right arm on the inside of the elbow.  Approximately a dozen small pimples, light pink to red.  They didn't itch, but scratching or squeezing caused them to get a dark center.  One week later the sore throat is mostly gone and the rash is beginning to fade.  I am terrified now, though I did not start that way.  I'm afraid that I'm now imagining symptoms as I get temporary joint pains..very transient lasting less than a minute...that may just be anxiety. I think I should get tested, but I would like to know what you think.  
1.  Could this be an STD from either of my encounters (3.5 wks from1st and 1 day from 2nd at onset)?
2.  What testing should I get performed? (I'm thinking Gonnorhea, Chlamydia, Syphilus, and HIV)
3.  Are the private tests obtained through the internet reliable?
4.  How long should I wait to get tested...it seems that there is a wide timeframe listed on various sites.
Thankyou for your patience with me.  I wish I had never gotten myself involved in this.  For others reading my post..you never know what you've got until you've lost it. Be careful!

[Edward W Hook, MD]

The symptoms you describe are not suggestive of any STD or HIV.  In addition, they came on too quickly - STD symptoms typically take several days to develop if they are going to do so.  Finally, when people acquire STDs of the throat (the only site you tell us was exposed) they tend to be asymptomatic.  As for your specific questions:

1.  See above. Unlikely.
2.  You have been exposed and are concerned.  The only medical indication for you to be tested is your exposure and the risk from that is very low.  Thus if you choose to get tested, it is much more for your reassurance than any thing else.  This being the case, you should have your throat tested for gonorrhea.  If, even though you were condom protected, you wish to be tested for genital exposures as well, tests for gonorrhea, chlamydia and nongonococcal urethritis are appropriate.  Your blood can be tested for syphilis and HIV.   The tests on your throat and genital specimens will be valid for both exposures you describe.  The blood tests only for the one about 3.5 weeks ago.  the probability that any of these tests will be positive is miniscule.
3.  Some are, some are not.  If they are positive, where do you get treated?  Personally, I am not a big fan of internet testing.  My advice -get tested somewhere near you where you can talk to the peole who are doing the tests.
4.  See 2 above.


Finally two other comments-
First, you are allowed 2 posts in a 6 moth period.  This is your second.  No more posts please until November or beyond.

Second, one definition of insanity if to keep doing the same thing again and again and expecting a different result.  Your behaviors are clearly anxiety provoking for you, costing you psychologically at the least.  You need to either change your behaviors or change the level of concern you have about them.  I would suggest the former- safe sex works.  Why put yourself at risk.  EWH

[Edward W Hook, MD]

I appreciate your efforts to share your experience with others.  This is better done on  one of Med Help's communities rather on this forum.  Please take this post and follow-ups there.   Thanks EWH

[Seroconcerned]

Just continuing the update of information in case this is useful to others.  After 4 days on Cipro, mild pain in right groin and the return of the abdominal discomfort that started a couple of days before burning with urination.  After 7 days it was clear my symptoms were returning.  Called my doctor again.  Prescribed more Cipro and referred me to a urologist.  8/1/08 urologist testing for all std, both blood panel and urethral culture.  Prescribed 100 mg doxycycline 1x/day for 7 days, suggesting that I could have a co-infection of chlamydia.

(this is where Dr. Hook's words are ringing in my ears about treatment before testing, since we are just assuming gonorrhea)

Results due back Wednesday.  Two days into the doxycycline, I feel worse if anything.  Doesn't rule out chlamydia, but I'm guessing it means Cipro resistance.

One final thought...according to everything I read, 1st line treatment is 125 mg Rocephin injection IM for gonorrhea, and 1g azithromyacin for chlamydia.  Doxycycline can be used as an alternative, but dosage is typically twice what I'm taking and usually not with Cipro.

[Edward W Hook, MD]

Treatment without testing is not a good idea becasue when it fails, you have no idea why.  Sounds like your treatment did not fail however.  there are several unusual aspects to your report which I mention below:

1.  Six-10 weeks is quite long for the onset of symptoms.  Further, it would be unusual after that long to develop both urethral and anal symptoms.
2.  Resistance does not effect all organisms, just too many.  Your imporvement is probably a sign that the treatment helped although there is really no way to tell since you were not tested before treatment.  EWH

[Seroconcerned]

I have no more posts to use, but if you could please indulge me, I'd really like to ask two follow up questions.  In mid July, 6 & 10 weeks after exposure, I developed mild burning when urinating, along with a weak stream and anorectal bleeding with a bloated feeling in lower abdomen.  I called my doctor who prescribed ciprofloxacin (without seeing me) 500 mg 2x daily for 1 week.  I started taking this and feeling immediately better, pain almost 100% gone and restored stream after 24 hours.  Since then I've seen all sorts of information about resistance of gonorrhea and ineffectiveness against chlamydia.
Q1..Is 6 - 10 weeks too long to show symptoms
Q2..Since I started to feel better immediately, assuming this is an std, does that mean I don't have to worry about resistance.  Or does resistance mean it won't be fully healed and I'll relapse.

Thanks in advance.

[Seroconcerned]

HIV test negative, June 30