HIV risk/testing need - Unprotected oral, protected vaginal, have STI symptoms

[Macklevon]

Thanks in advance for answering my question, doctor.

Last Thursday, I had unprotected insertive oral sex and protected vaginal sex with a female of unknown STD/HIV status. I do know she has had multiple partners in recent years. The condom did not break (as far as I can tell) or slip during intercourse, and I used it before there was any contact with her genitals. The following day, I noticed some discomfort in my penis/urethra. This discomfort has grown worse in the last week. It does not burn when I urinate, and there is no discharge. I experience more discomfort following/between urination, and an urge to go more often. It is not sharp pain, but rather dull. A doctor performed urinalysis and informed me that they did not see anything under the scope so there was nothing to culture. The strip didn't show anything either. I was given a course of Cipro. After two days of the antibiotic, I'm still experiencing the discomfort. I'm still waiting for results from the gonorrhea/chlamydia PCR test.

What is my risk of HIV from this event? I noticed she produced a lot of saliva, but did not notice any blood. Is HIV testing necessary/encouraged after this event? If so, when should I test? Are there any other tests I should have?

Thanks

[Edward W Hook, MD]

You may have NGU.  NGU is best diagnosed with a swab specimen taken from the penis at least an hour after last urination. On occasion microscopic evaluation of urine collected just as a person begins to urinate can serve the same purpose but the swab is the preferred  approach.  With either method, one is not looking for bacteria but for white blood cells which are a sign of inflammation.  It is the signs of inflammation, manifest as increased numbers of white blood cells, which are the basis for the diagnosis of NGU.   Much NGU is caused by bacteria of which the association with chlamydia is most certain.  Other micro organisms cause it less often (trichomonas, some ureaplasmas, Mycoplasma genitalium, oral bacteria  introduced into the urethra during receipt of oral sex, etc) but are not typically tested for and despite optimal microbiological evaluation, in about 30% or more of cases there is no clear cause.  We also DO know that there are non-STD causes of urethritis (NGU) as well.  In most men NGU responds well to recommended treatment with doxycycline or azithromycin irrespective of cause.  

If you have NGU, you and your exposed partners should be treated and abstain form sex until the symptoms ressolve.  EWH

[Macklevon]

Thank you Doctor. The test results did indeed come back negative for gonorrhea and chlamydia. However, I'm still suffering from urethritis. Are there other STI's that would cause this that would not show up under microscopy or urine dip? Should I avoid sexual contact?

I will do my best to avoid worrying further about the HIV risk. Thank you for your comments.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be glad to comment.  Let me first comment on the issue of risk.  Despite the fact that your partner had other partners, the likelihood that she had HIV in particular or, even other STIs is rather low.  Less than 1 in a thousand and perhaps closer to 1 in 10,000 U.S. women have HIV and most women do not have STIs .  You then reduced your risk of infection further by using a condom for vaginal sex to essentially zero risk for HIV. Similarly, there has never been a case of HIV proven to have been acquired from receipt of unprotected oral sex from an infected partner.  

The symptoms you describe do not suggest HIV and their onset occurred long before we would expect the symptoms of recently acquired (typically at 2-6 weeks after exposure).

I see no need for HIV testing related to the exposure you describe and if your lab tests are negative (I anticipate that they will be), I would urge you not to worry or test further.

I hope this assessment is helpful to you.  EWH