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gonorrhea and hiv (HIV AND GONORRHEA)
Apr 22, 2008

Hi Dr Robert

First of all, i would like to congratulate you and this site for this wonderful work. Second, i'd like to say that i am sorry for my poor english. I am from Brazil and i am not very fluent, but i will try hard.

I'm worried because i had oral sex (insertive) with a profissional sex worker and without protection. The point is that i know that she passed gonorrhea to me. This is letting me completely paranoid. I would like to know the implications of this fact over the probabilities of being infected by hiv.

Thank you very much.

PS - please, let me know how to contribute with the site.

Response from Dr. Frascino

Hi Brazil-Guy,

Your concerns are largely unwarranted. Gonorrhea can be transmitted via oral sex quite easily and efficiently. HIV, by comparison, cannot. In fact it's quite difficult to transmit HIV via oral sex, particularly via the receptive partner to the insertive partner.

It is true that if your partner was coinfected with both HIV and gonorrhea, the risk of HIV transmission increases somewhat, but still remains overall "low." I'll repost some information (in the form of entertaining questions) from the archives below that deals with HIV and gonorrhea. I would recommend you get a single HIV-antibody test at the three-month mark. The odds remain all in your favor that you did not contract HIV from this oral sexperience.

By the way, your English is far more fluent than Dubya's! (But then again I suppose that's setting the bar extremely low now isn't it?!)

Thanks for your donation to The Robert James Frascino AIDS Foundation. Donation information can be found on the foundation's Web site at www.concertedeffort.org. In return I'm sending you my good-luck karma that your definitive three-month HIV test will be negative. (I strongly suspect it indeed will be negative.)

Good luck.

Dr. Bob

diagnosed with Ghonorrhea Feb 14, 2007

Today my doctor told me i have Ghonorrehea , gave me 6 tablets of antibiotic and asked me to take it 6 tabs alltogether. i believe i got infected from my gf coz i never doit with else than her. she did HIV 1 and 2 P24 antigen and EIA , and she tested negative 1 month back so did i . the CDC links Ghonorrhea with HIV infection, do u believe she is HIV positive and it seems negative in the test since i got Ghonorrhea? and how both are linked . pls Dr. Frascino i need ur help coz am depressed and afraid that she is HIV positive and not shown in the test . promise u a donation of 200 Canadian Dollars. pls help ..

Response from Dr. Frascino

Hello,

Gonorrhea and HIV are two completely different diseases caused by two completely different germs. The correlation between HIV and gonorrhea is that the presence of gonorrhea increases the risk of contracting or transmitting HIV. This is because the increased number of white blood cells at the site of STD infections, like gonorrhea, make it easier to transmit or acquire HIV. I must also point out that it is much much easier to contract or transmit gonorrhea than HIV (thankfully!). Also even if both diseases are present concurrently, that doesn't automatically mean both will be transmitted or acquired.

The mere fact that you and/or your girlfriend have gonorrhea does not automatically mean you have HIV! That you both tested negative for HIV-1, HIV-2 and p24 one month ago is very encouraging.

What you and your girlfriend need to do now is get treated for gonorrhea and then repeat your HIV test three months from the last time you had unprotected sex. Use condoms for sex during this period for protection. You and your girlfriend will also need to have a discussion about STDs and how one or both of you became infected with gonorrhea. If indeed you only have sex with her, it's probably safe to assume she contracted gonorrhea from someone else. Ultimately it is a good idea to always and routinely use latex condoms in the future, girlfriend or not, to provide extra protection against unwanted pregnancy and STDs.

Thank you for your donation (www.concertedeffort.org). In return, I'm sending my best good-luck/good-health karma to both you and your girlfriend that your definitive three-month HIV tests remain negative.

Good luck.

Dr. Bob

Scared and confused puppy Sep 11, 2004

Dr.Frascino, I can't tell you how I'm getting so pessimistic towards sex. I am a gay man in my twenties. Been negative since starting HIV testing and I always been carefull using condom for anal sex which I do rarely. Now, after a long dry spell I meet this guy, have a great time but to my surprise after a few days I am diagnosed with gonnorhea...and one that was resistant to quinolone by the way. What is scaring me is thinking that this is nothing, my DOC tells me to get tested in a few weeks because I am 5 times more likely to get HIV from the gonorrhea infection if the guy is positive. What the F***!! What else can I do to avoid infection. Abstinence? sucking and kissing with a condom?priesthood?...What kills me too is by the time one finds out of std infection, it's too late to consider PEP, right? I am very depressed and scared! :( Please tell me something good 1.Is it true that I am at higher risk of getting HIV with the gonorrhea and what are the odds? 2.What's your take on preventing this, what's left? 3.Do you agree I should be tested in a couple of weeks?

Response from Dr. Frascino

Hi Scared and confused puppy,

OK, let's looks at your options first:

1. Abstinence/celibacy? Hmmmm, theoretically yes, that would work, but is it workable? Generally most of us find that not to be a viable option, as it can lead to a sense of deprivation, frustration, and, ultimately, acting out. (The Catholic Priest scandals are a good example.)

2. Sucking and kissing with a condom? Hmmmm . . . again, that would work, and indeed some folks do "plastic wrap all meat products for safety," so to speak, but others find a diet that consists only of nibbling on latex to be too restrictive and not worth the effort. Kissing with a condom? Gosh, I'm not sure that's such a good idea. You'd have to crazy glue it to your lips, and then when you spoke, it would inflate and get bigger and bigger until KABAM, it bursts and you fly around the room backwards as it deflates.

3. Priesthood??? Hmmmm . . . well, some dudes might find wearing a dress, not having to explain why you are not married, and living in an all-male dorm called a "rectory" appealing, but see response to #1 for the downside.

OK, so that leaves us with safer-sex methods. If you want all the details, check out the HIV InSite Knowledgeable Base Chapter on Safer Sex Methods (http://hivinsite.ucsf.edu/InSite?page=kb-07-02-02). Basically, the take-home messages for oral sex are:

1. There are different levels of risk, depending on the STD and the type of oral sex.

2. Having an STD can increase your chances of getting infected with HIV.

3. STDs that cause sores and blisters (syphilis, herpes, etc.) are easy to get from all types of oral sex getting or giving.

4. Gonorrhea, chlamydia, and NGU infections are possible from sucking and getting sucked.

5. It's easier to pass STDs when sores, blisters or discharge ("the drip") are present.

6. Available scientific data suggests that while some STDs are quite easy to contract from oral sex, like gonorrhea and herpes, others, like HIV, are not easy to get form any kind of oral sex.

7. Yes, there are some documented cases of getting HIV from sucking ("giving head"). Bleeding gums, gum disease, and sores in the mouth can make it easier to get infected with HIV through oral sex.

8. There have been no well documented cases of getting HIV from getting sucked.

Now, what about what your doc told you concerning gonorrhea and HIV transmission? I think there may be a misunderstanding here. Perhaps he was referring to your potential HIV exposure. There is some data indicating that dudes with one STD have an increased likelihood of having other STDs concurrently. But if we talk about actual STD transmission rather than exposure, the story is that having gonorrhea can increase your risk of getting HIV. This occurs because white blood cells at the site of a gonorrhea infection may make it easier for HIV to enter the body. But the reverse does not seem to be true: It does not appear that HIV infection affects transmission (or symptoms or treatment) of gonorrhea. So the bottom line is that a person who has active gonorrhea has an increased risk of acquiring HIV compared to someone who doesn't have gonorrhea.

Next, you ask about getting tested "in a couple weeks?" That, of course, is up to you. The important point here is to realize that a negative HIV test result would not be considered definitive until at least three months.

Finally, you ask that I tell you something good. Hmmmmm . . . OK . . . .

1. Your risk of acquiring HIV from oral sex remains very low.

2. Thank goodness you are not a priest. That would make explaining even having "the drip" very difficult.

3. Puppies are the most lovable creatues on the earth.

I hope your "pessimistic" view towards sex evolves into a more enlightened, informed, and positive (in the best sense of the word) view. Most of us, except for the entire Bush Administration, believe sex is not a luxury that you can easily do without!

Good luck.

Dr. Bob

So scared I am losing it Jul 20, 2006

Im a 25 year old, After a sexual encounter with another man I found out I had gonorrhea now I am freaking out over HIV. The situation was, he preformed oral on me and put himself into me without condom for 5-10 seconds... then pulled out and I helped him to cum 3 minutes later. How did I get gonorrhea? and am I at risk now for HIV?

So scared.

Response from Dr. Frascino

Hello So Scared,

How did you get gonorrhea??? Dude, your buddy "performed oral on me" and "put himself into me without a condom" and yet you wonder how you got gonorrhea? Well it certainly wasn't from playing Parcheesi! Unprotected sex always, always, always places you at risk for STDs (sexually transmitted diseases), including gonorrhea and HIV! Some STDs are much easier to contract and/or transmit orally than others: gonorrhea is, for instance, transmitted orally quite readily, but HIV much less so.

Are you at risk for HIV??? Hopefully you now know the answer to this question! Yes! You are! Why? Because you had unprotected sex. However, your risk of acquiring HIV from oral sex is minimal. The risk of acquiring it form unprotected receptive anal is higher. Luckily your unprotected receptive anal sex was very brief and did not include ejaculation. These facts would mitigate your risk significantly, but certainly not completely eliminate the risk.

I have to wonder how, at age 25 and being sexually active, you still do not have even a rudimentary knowledge of how sexually transmitted diseases, including HIV, are transmitted!!?! I can only assume you are a victim of an abstinence-only sex education curriculum! It's time to wake up and get informed. I strongly suggest you spend some time reviewing the information on this site and related links pertaining to STDs, paying particular attention to how they are transmitted and how to protect yourself from infection. You can study this information while waiting to take your HIV test. You must wait at least until the three-month mark to take an HIV test, as tests taken prior to three months are not considered to be definitive.

Stop being "so scared" and become "so informed," so that you'll know how to enjoy sex without placing yourself at undue risk.

Good luck.

Dr. Bob

Quit answering crap and answer a real Question - Lymph Nodes Dec 31, 2003

I see you answer question after question from people who and an exposure a bazillion years ago and have tested negative ever since but still think their positive. Then you answer just as many from people who were in the same bathroom with / walked past / on the phone with / etc. someone with HIV and they think their positive. How about a real question; definite exposure to at least one STD and some noted signs of HIV. Take a shot at a real one this time In late April I had unprotected sex with a professional. About five weeks later my urine started to burn a little. I broke down at the seven week mark and got tested for Clamydia, Gonorrhea, Syphilis, & HIV. I popped positive on Gonorrhea. The doctor gave me antibiotics, which took care of the problem. (I believe the HIV test was an ELISA. I had the test in Japan and everything was written in Japanese.) Around Thanksgiving I started to feel some pain (on a scale of 1 to 10 about a 1) in my left submandibular gland, or the collocated lymph node. Between Thanksgiving and two days ago there was a slight increase in pain but nothing major. In the morning I would feel nothing, but by evening it was about a pain level of 2. Three days ago I went flying in an un-pressurized aircraft. (My third time flying since Thanksgiving.) As we climbed to 6500 feet I felt my parotid gland, or the collocated lymph node, begin to swell in the climb as barometric pressure decreased. It was probably about a level 3 to 4 of pain. When we came down the swelling subsided but not completely. The next morning (two days ago) when I awoke there was swelling in both the region of my submandibular and parotid gland. I took some Nyquil (day-time formula) and most of the swelling in my parotid area went down and some in my submandibular area. Yesterday and today my submandibular areas, both sides, are swollen enough that is can now be seen if you look closely. The parotid area is not really visible but when I touch it, it is a little swollen. (For the record, I had mumps as an infant.) My chin and upper jaw feel as though they have a headache. Touching either area in my chin or neck tingles a little, but causes no discomfort. I have a mild headache, but again nothing severe. My mouth is slightly dryer that normal, but not much of difference from usual. I get an occasional shooting pain in my groan that feels like someone is putting a needle in one of my testicles (not always the same one). The soonest appointment I could get with an ENT was 8 January. I have scheduled another HIV test but was unable to get in until the 29th of December. Right now the worst part is the not knowing. Every minute Im awake Im wondering if Im positive or not. Knowing either way would be easer than this. So, in your expert opinion should I start resolving myself to a life of medication and a 20-year live expectancy or am I likely suffering from something else?

Thanks DD

Response from Dr. Frascino

Hello DD,

You want me to "quit answering crap," and answer your "real question?" Would you like to apologize for that inappropriate and rude remark now or later? I suppose I could skip your question entirely, or wait for your apology to the readers/questioners of this forum, but that would be unkind. And I really do try to be a nice guy, even to those with bad manners.

Now your "real question" involves having unprotected sex with a pro and then getting gonorrhea. Wow, now there's a real unusual situation. Thanks for sharing. So then antibiotics "took care of the problem." OK, good. Next, you have some minimal discomfort (1 on a scale of 1 to 10) in your "left submandibular gland or the collocated lymph node?" What the heck is a collocated lymph node? So then you climb to 6500 feet in an un-pressurized aircraft and feel your parotid or collocated lymph node begin to swell. This question is so "real" and fascinating that I'm sure our readers are on the edge of their chairs waiting to hear what happens next. Ah yes, Nyquil Daytime Formula to the rescue and things improve. So now you have "neck tingles," "slightly dryer" mouth, and an occasional shooting pain in your "groan!" (Your what?) As if someone is putting a needle in one of your testicles! Oh my! By the way, how would you know what that feels like? And no wonder you are "groan"-ing. Ouch! So with this information, you want to know if I think you should "resolve yourself to a life of medication and a 20-year expectancy . . . . "

Do you know how many folks are scratching their heads at this moment wondering why I even bother to answer your rather crappy question? Those are the exact folks who will be waiting for your apology, by the way.

OK, here's your somewhat obvious response. Unprotected sex places you at risk for STD's, including HIV. Some STD's are quite easy to contract gonorrhea, for example and others are much less so HIV for example. Since you developed symptoms following a potential exposure, common STD screening is warranted. Your tests revealed gonorrhea. HIV screening is not considered definitive until three months or more following the exposure. Your exposure was in April; consequently, if you're concerned about HIV, you should obtain an HIV test. Your seven-week test is encouraging but not definitive. I'm glad you have another HIV test already scheduled. Your symptoms are not suggestive of HIV-ARS. So I'd predict you are indeed "suffering from something else." Now about that apology

Dr. Bob



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