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Sexually Transmitted Diseases/Question about STDs and HIV transmission likelihood

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Question
Hello Mr. Behar,


     I wanted to ask you a couple questions regarding testing for STIs and HIV. I have e-mailed you in the past about testing and now that i have done testing, i just wanted to know some more. As such, I'm 21 years old, male, and my exposure was oral/deep throat. I have never done anal or vaginal intercourse and i don't plan on it. Aside from that little speech, i went and got tested for STIs as you suggested previously as wanted to know a couple of things:
1) The sexual health nurse that i saw did an thorough examination of my genitals to see if any Herpes lesions were visible. After that, she said they were not characteristics of herpes lesions or genital warts. To them, it was normal variations such a fordyce spots, inflamed follicles, and sebaceous glands. Every now and than i feel itchy and random pinchy feelings and was wondering if what the nurse examined is accurate that there was no concern of herpes? (I know i didn't provide a picture but i was wondering if it is normal to get these random twitches/itchy feelings down under the genitals?)

2) I completed a urine and swab test of the urethra to test for chlamydia and gonorrhea but did not do a throat swab. The urine and urethral swab test came back negative as well. Should i go back and get a throat swab for possible chlamydia infection of throat. I do feel like something is there but i don't have any exudate in the back of my throat and it doesn't hurt to eat or swallow but i feel like something is in the back of my throat that i cannot get out simply by hacking? Could it be that the deep throat i did on the guy irritate my throat? or i  may have an infection and needed to get it diagnosed? Also, should my results be conclusive (for urine and urethral swab/genitals) if my exposure was three weeks ago or should i go for a repeat test again?

3) I know you have been through this before in saying the oral is low risk activity and no reported documents have shown oral as a high risk exposure like others, although the chances still exist... but should it warrant an HIV test? I didn't know the status of my partner (he claims to be clean -.-) and it worries me a little. I do know that no fluid was exchange. I have done HIV testing before and it came back negative... but this time him not so sure. Is it possible to do testing after 1 month and then pursue a repeat in two months at the three month mark to have conclusive results?

Thank you for your feed back in advance,

     Alex

Answer
Hello Alex,
Random twitchy and itchy feelings are absolutely normal in the genital area. A throat swab for gonorrhea and chlamydia would be helpful, IF YOU HAVE ORAL SEX WITH ANOTHER PENIS. Your mouth to your partner's vagina rarely transmits gonorrhea or chlamydia, as you  need deep throat penetration to infect the back of the throat. The irritation in your throat may be due to allergies causing drainage to the back of the throat from sinuses, or acid reflux of acid up from the stomach to the back of the throat. The urine test for your penis should be rechecked every 3, 6, or 12 months depending on the frequency of unprotected sex with ANY partner(s). Periodic HIV testing is good to have, even though oral sex is considered a low risk activity, but as I may have said before, "low risk does not mean zero risk."

Good luck!
--mark  

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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