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Dr. Andrew Rynne

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Urethral infection after protected genital sex and unprotected oral sex. Could it be psoriasis?

Answered by
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Dr. Sudarshan

Dermatologist

Practicing since :2005

Answered : 1391 Questions

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Posted on Thu, 17 Jan 2013 in Psoriasis
Question: Hello Doctor, 2 months ago i had protected genital sex and unprotected oral sex, 3 weeks after that i developed urethral infection , with no blisters,sore throat,or any flu like symptoms, just itchiness and tingling pain in my urethra and pain during urination, i went to the doctor and he gave me antibiotics , 3 days later i started to develop conjunctivitis and they gave me antibiotic and antiviral eye drops, everything got well and symptoms improved in 2 weeks and now two months later i'm doing all good.

however i started to very dry skin, my skin was dry and gets more dry in winter, but this winter it seems different, i went to dermatologist and i asked them if my current symptoms has something to do with my urethral infection and the doctor said no ..
my skin is very dry, and get's itchy when i come in from the cold temperature outside (-28 degree Celsius) and get in the house tingly and itchy pain starts to come up, and relieves in a while, however sometimes at night when i'm going to sleep it doesn't relieve even after putting cream on, i also like to take long time hot shower and that increases the itchiness , there is no rash or redness, i just some scaly dark dots near my elbow and scaly, cracky dry feet.

the doctor said i have psoriasis. and she gave me something to take shower with i used it for two days and my symptoms didn't change, a friend of mine suggested me to use Olive oil before leaving the house and use it more , now after using the olive oil i feel much better and symptoms improved..

what worries me right now is that i researched from the internet and i found out that the reason for psoriasis could be due to hiv infection, that made my breath feel like stopping, because i had unprotected oral sex and i had a UTI , is it possible that after one month of possible exposure that i developed psoriasis because of that??!!
i want to make test but the doctors said you have to wait atleast 3 months to 6 months i don't know what to do.?
is it possible to develop psoriasis soon after you get infection in 1 to 2 months??
is what i have actually psoriasis, or just a dry winter skin, and if so why didn't i had this before ,i used to have dry skin but this got worse after that incidence. so i don't know i'm just worried
i made HAV HBV HCV HEV before yesterday and all came back normal
what other tests should i do???

thanks
doctor
Answered by Dr. Sudarshan 6 hours later
Hi XXXXXXX,
Thanks for writing in.
There is nothing to be worried about.
Psoriasis is a common condition and not all psoriatics are HIV positive.
HIV positive patients who are diagnosed for many years develop severe psoriasis with joint involvement.it is seen in late phase.
HIV does not present with psoriasis.
Regarding HIV testing, the best time to test would be after 3 months of exposure.Before this period if testing is to be carried out than HIV RNA PCR is the best test.
To rule out HIV you can undergo testing at 3months after the exposure.
Your symptoms do not point towards HIV infection .
If you can upload the photographs of the affected area it would be of great help in predicting the condition.
Upload the photographs and we can continue the discussion here.
Hope this helps.
I will be available for follow up .
Regards
Dr XXXXXXX
MD dermatologist HIV specialist.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 18 minutes later
thanks alot doctor for your reply.
what worries me the most is that the girl i had unprotected oral sex currently has recurrent fever, she developed symptoms after 2 weeks of the oral sex, she was diagnosed with mycoplasma bacteria and has upper respiratory infection, chest x-ray showed to me normal i thought maybe i got the mycoplasma bacteria from her oral sex.i haven't met her since then but just chat with her to see how she is doing, since she told me she has reccurent fever is almost one month and half now. she always complains from cold like symptoms and recurrent fever..
i don't have any of these symptoms....
and i forgot to mention that , at that time she had an active cold sore, which is a sign of hsv-1 . but the doctor said that my genital infection wasn't hsv-1 since i didn't have clear blisters at the tip of my penis

i uploaded the pictures you can have a look at it..
many thanks
doctor
Answered by Dr. Sudarshan 42 minutes later
Hi again XXXXXXX,
Thanks for the details and images.
The photographs sure look like treated psoriasis.
Its not HIV related rash.
Psoriasis is treatable by topical moisturizers and topical steroids.
HIV can initially present with recurrent fever,cough more than 1month,recurrent diarrhea, wt loss, swollen neck and groin glands, reddish rash over skin etc.
Even if the girl was positive for HIV it is very uncommon to transmit HIV by oral sex.
Oral saliva has antibodies against HIV virus.
It would be good for get tested for HIV anyways to rule out slightest posibility of HIV.
HIV RNA PCR at this stage will be diagnostic or it Elisa for HIV at 3 months will be appropriate.
Negative test will ensure of HIV negative status .

Hope this helps.
I will be available for follow up .
Regards
Dr XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 22 minutes later
THANK YOU, this really helped alot.
i have two final questions.

1- i have a cat in the house and i remember that she got scratched by the cat, and she got some scar, 2 to 3 days later the cat scratched me too and caused a scar on my skin, could that be a way of transmission??!!

2-i used extra safe durex condom for genital sex, is there still risk of transmission with that condom?

it will be 3 months in january 21st, i can't wait. i'm just so tired of this feeling..
i have a girl friend but i avoid her now since i got the symptoms , should i get back to my girl friend before january 21st, and forget about this or should i wait till i make the test results.??

sorry for my too many questions
thanks Dr XXXXXXX
doctor
Answered by Dr. Sudarshan 3 hours later
Hi again,
The cat cannot transmit the disease to you.
Genital sex with unbroken condom is considered safe and it cannot transfer the HIV.
If you dont want to wait till 21st you can undergo HIV RNA PCR at this point of time.It gives fairly dependable results.You can undergo this test now and get the results before going back to your girlfriend.
Hope this helps .
Dr XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 16 hours later
thanks Doctor for your reply.

i went to the Doctor today and he said i always recommend my patients to wait for 3 to 6 months for test results to be made sure after possible exposure, he said before that the test results cannot be dependable or be sure of, he said if you insist i can do the test but the results wont be assuring as it could be false negative or false positive..
i really got confused with what he said compared to what you said and i don't know what to do, should i insist to do the test???
doctor
Answered by Dr. Sudarshan 1 hour later
Hi,
As discussed previously Ideal time to test would be after 3 months.As you cannot wait that long you can get HIV RNA PCR done it is quite dependable at reports are >99% correct.
The final decision lies with you about to test now or wait for 3-6 months.
Hope this clears confusion.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 47 hours later
Hello Doctor, thanks for the information..
i went to the doctor yesterday again, and i told him that i insist on doing the test, he told me that they don't do HIV RNA PCR test at there hospital, i'm currently in China for studies.
he said that he dosen't know any where that they do this kind of test, so i said let me do the Antibody test, i have done the test both urine and blood test and the results came up negative..
he said the normal result is less than 1.000 (<1.000) and my result showed 0.211 in urine test and 0.215 in blood test, the doctor said that this result means it's negative however i'm concerned about the numbers i see 0.215 or 0.211 ( does that mean that there is some small amount and because it's just 2 months now it hasn't increased in number yet??????? because if there was nothing i think it should have been 0.000 instead of 0.211 or 0.215

my other question is that, the psoriasis and other things that i see can i now say that because i showed a negative result on the antibody test that the psoriasis is not due to HIV????

i also see some lymph node enlargement on my throat and flu like symptoms can i exlude it from be due to hiv if my results came negative?

i couldn't find RNA test in china, can this antibody results be somehow dependable it's 2 months and 5 days now...
Sorry for disturbing again doctor, i have just uploaded two more pictures, i took a picture of my mouth to show you the blisters and the possible reason of lymphnoid enlargement, there is some kind of infection in my throat, i don't know if i'm having the same infection as she had (mycoplasma bacteria) for her cold infection, it's quite painful when i drink something or eat...
if you can reach to some extent of a diagnosis with that picture i would be grateful, and if advise me if i should go to hospital or just leave it to resolve by it self...

i hope this will be my last question and sorry for taking much of your time.
i have posted the chinese report, i don't think you can read the chinese characters but i'm sure you can read the results in numbers ...
THANK YOU...
doctor
Answered by Dr. Sudarshan 6 hours later
Hi Again,
Its good to know that you have undergone the tests and they are negative.

Dont go into details of numbers.Results in decimal points definitely indicate negative results.It is not required to be 0.00 .
The test is negative meaning you dont have HIV .Psoriasis and other symptoms are not HIV related.The tests are dependable and there is nothing to be worried about.
Flu like syndrome is due to upper respiratory disease.
The photos suggest you have an pharyngitis a bacterial infection.You need an 7 day antibiotic course and you should be fine.Ussually amoxycillin or ciproflaxacin antibiotics are effective in such condition.Visit the hospital and they can provide you with medication.

Hope this eases your stressed mind.
Regards.
DrSudarshan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 2 days later
thanks dr for your helpful responses. i have final questions and close this discussion.

1-your last reply you said that i should wait for 3-6 months for the antibody tests. the test i got now was antibody test and it's after 65 days i.e 2 months, why do you think this test is dependable??? is it because there is no risk to actually worry about, or is it that 2 months can be enough for the results to be conclusive in my case??

3- i got well from the infection in the second day i posted the pictures after, and now i'm doing well from it, i didn't go to hospital neither did i use any antibiotics, should i still get the antibiotics you mentioned. and does that mean anything to be worried about.?

2-i have posted in many hiv prevention forum and all of them said that i haven't got exposed to the virus and i should stop worrying and move on with my life, however in other websites on the internet i read that oral sex has a risk specially if the girl has std infection in her mouth because that would leave cuts and lesions which can cause blood to be in mouth, i don't know who i should listen to indeed, which one can be practically true, and is there any documented cases by which t transmission took place from oral sex..?

3- i'm circumcised would that decrease the risk ?

4- these days i feel un explainable tiresome, and joint aches, and feel like i'm going to have flu or fever but nothing happens, and my hands are constantly hot when i touch them with my face, or when someone else shakes my hands they say that my hands are hotter than others, could that be symptoms

i'm going to close this discussion after this, i wanna thank you very much for your helpful answers......
doctor
Answered by Dr. Sudarshan 1 hour later
Hi Again,
To answer your questions.
1.Actual risk in your case is very low and negative test rule out the infection.
Still for 100% surety test should be repeated at 3 months.
2.If you are better now you dont need antibiotics now.
3.Risk with oral sex is minimal when compared with the vaginal or anal sex but the risk is involved.It can actually transmit HIV.
4.Cicumcision decreases the risk of HIV and other STD.
5.The symptoms are not related to HIV.You should monitor them and get your temperature measured whenever you feel hot.Objective measurement of temperature with thermometer is important than just hot feel.

Hope this helps.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 42 hours later
hello, thanks a lot
sorry i just wanna ask one last question
i'm traveling on january 18th so i want to do the test on january 15th , that's going to be a total of 86 days after the incidence that means 4 days before a complete 3 months will that make a difference, should i wait a complete 3 months ???

thank you

BYEEE
doctor
Answered by Dr. Sudarshan 3 hours later
Hi XXXXXXX,
86 days or 90 days does not make a big difference .Actual period is 3 months or 12 weeks or 84 days.So 86 days is good enough .There is no need to wait for complete 3 months.
Hope this helps.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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