[Question #1008] Need Reassurance and Help

52 months ago
To whom it may concern,

I had an encounter with a CSW ( escort ) a little over 3 months ago. I have undergone all testing recommended by my doctors ( HIV syphilis, gonorrhea, and chlymidia ) at their appropriate window periods for what they said was conclusive. All of these tests have been negative, on top of that I have taken multiple of them to be sure. Just to add, all these tests were done after the 10th week as well as at the 3rd month mark. From what I understand, based off of talking to multiple people and from reading here, all these tests are accurate and conclusive.

I need some help calming my worry concerning HSV in the genitals as well as HPV. I have read plenty of posts here and have gotten a decent undertamding but I'd like to get some answers to my own questions. I have not seen any watery blisters or sores and I have not had any wart like growths in my penis and sack. I know based off of reading from the CDCs page about HSV that the average incubation period is about 2 weeks. Is this the period in which symptoms for HSV appear? I have also read to avoid testing unless symptoms do occur. Would you recommend this?

Without having any watery blisters or sores that are painful at 3 months, can we assume I'm not infected?

What does it feel like before having an outbreak?

What are the chances of being infected with genital HSV from a single protected oral and vaginal encounter with a CSW?

What should I be on the look out for?

I have a bump on the leg in between my sack and thigh, it doesn't hurt or itch much but does have some redness and a little dry skin. Is this something to worry about?

Thanks in advance.

52 months ago
I would also like to add that I am a 20 year old male and the CSW I was with said she was 25.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Welcome to the forum and thanks for your question, which came in just a couple of minutes before I logged on. Most users should not expect nearly real-time replies!

There are no data on the numerical risk of acquiring either HPV or HSV after a single exposure of this sort. However, it's surely low. I would jduge probably well under 1 chance in a thousand for HSV, although higher for HPV. However, since nearly all sexually active people acquire HPV at one time or another (with equal frequency in people with few vs many lifetime sex partners), often several infections, this event does not raise your risk of HPV materially higher than it already was or will be. And should you someday have an HPV related problem (or if a future sex partner does, such as an abnormal pap smear), it will never be traceable to any particular exposure. It is generally not possible to accurately judge when and from whom any particular HPV infection was acquired.

I would also point out that most escorts -- by which I mean expensive female sex workers by appointment, in contrast to brother workers, bar pick-ups, etc -- are carefuly about STD/HIV risk and typically at fairly low risk. Among other things, they tend to use condoms consistently (although perhaps not your partner, since you don't mention condoms); usually have relatively low risk partners, such as married men or others who do not have frequent casual sexual exposures; and get tested frequently. I would also guess that those with known genital herpes are likely to use suppressive treatment to protect partners, and also are likely to be aware of the HPV vaccine and to have been immunized. There are no data on this, but these notions would fit with most of what we know about such persons' sexual behavior patterns. If so, you are quite well protected against these infections. And even if not, the transmission risk remains low for any single exposure.

Finally, I assume your apparently comprehensive STD testing included a blood test for HSV2, right? If so and still negative at 10 weeks after exposure, the negative result is around 90% reliable, although it can take up to 4 months for truly conclusive results.

To your specific questions:

1) Absence of symptoms does not conclusively rule out new herpes, but the combination of no symptoms plus negative testing at 10 weeks is probably is around 95% conclusive. If you had acquired HSV with symptoms, they would have begun within 10 days and usually within 3-5 days.

2) Usually there is no "prodrome" (symptoms before an actual outbreak) for initial herpes. That's an issue only for recurrent herpes. If you had been infected, your first symptom would have been the outbreak sores themselves.

3) Chance of infection?  See above.

4) Genital sores, blisters, etc; or warts (which look like warts, no better way to describe them). Genital warts typically show up 3-6 months after exposure, but it can take a year.

5) A bump in that location almost certainly is neither herpes nor a genital wart. Both infections take hold primarily at places where the virus is "massaged" into the exposed tissues, i.e. the areas that receive friction during sex. Accordingly, initial herpes or warts generally appears on the penis (or vaginal opening and labia in women, or anus) and are uncommon at sites like the scrotum, groin, thighs, etc.

So all things considered, it is unlikely you acquired either infection. I really don't think you need be worried about this.

I hope this has been helpful, but let me know if anything isn't clear. Best wishes and stay safe--   HHH, MD

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52 months ago
Thanks for answering Doctor. 

In response to some of the things you mentioned, the escort I was with seemed like she used protection often if not all the time. I'm basing this off of my encounter as she placed the condom on me before any oral or vaginal took place. This encounter was protected at all times, I didn't take the time to ask about any STDs and I didn't take the time to look for any signs of herpes. I did not perform oral on her as well.

As far as testing goes, I did not test for HSV as I was told by my doctors not unless I have an outbreak. They also mentioned that my risk was low and some said it was very unlikely that I would be infected. 

I forgot to mention that I took the HPV vaccine (Gardisal 4) in 2012. I know it doesn't cover all strains but it covers the 2 that cause 90% of warts. Does this drop my chances for warts dramatically?

I had a sharp pain in my pubic hair area above my penis 2 days ago that lasted around 15 seconds. I haven't felt this since. Could this be anything to worry about?

I have had some small red marks in my pubic hair area as well that have been there for a few days maybe. They don't itch or hurt and don't seem like blisters? Is this normal?

Should I avoid testing for herpes in case of there being a false positive?

I'm I likely to have an outbreak this far out? Should I continue to check for signs?

52 months ago
I would just like to add that I have been very scared/anxious/depressed because of this encounter. I know that I can't test for HPV and I've been told not to test for HSV because it could set me up for trouble. 

I wish to stop my worries, but I'm not able to. I keep checking myself constantly and this fear is always on my mind. I try to stay off the internet but my mind gets the best of me.

When can I stop worrying? Can I stop checking myself so often? 

Are symptoms of HSV continueous? ( occasional pains, itches, bumps aren't HSV signs right?)

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
The answers to your follow-up questions are pretty obvious from my original reply.

I also would not have recommended HSV testing; I agree with your doctor. I mentioned follow-up testing only because you went ahead and got tested anyway, in which case a final test at 4 months would make sense for reassurance. You could still do that if you want, but there is absolutely nothing in your story that makes me worried you caught herpes. False positive resutls are extremely rare for HSV testing; that's not a consideration. HSV symptoms are never continuous, and you are correct that "occasional pains, itches, bumps" do not suggest herpes.

Gardasil-4 indeed will reduce your already low risk of genital warts by another 90%.

No STD causes pubic pain or "red marks" like you describe. You're examining yourself too closely and noticing minor issues or perhaps normal skin. Stop all self examination.

The level of concern you describe is clearly beyond reason given the circumstances. I'm pretty sure that hearing more reassurance from me isn't going to help. You're going to need professional counseling, which I suggest out of compassion, not criticism. Ask your primary care doctor for a referral; you won't regret it. In the meantime, try to separate your shame, guilt, and anxiety over a sexual decision you regret from the infection consequences of that decision. They aren't the same.

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52 months ago
Thanks again for the answers Doctor.

I think there is a little bit of a misunderstanding regarding my testing. The tests I have taken are for HIV, syphilis, gonorrhea, and chlymidia only. I have NOT taken a single test for HSV at all as recommended by my doctors. 
I think there was also some misunderstanding as far as my encounter goes, I think you may have thought my encounter was not protected but it was. At all times I had a condom on that was placed on me by the escort.

Does it change your opinion in regards to me not having HSV since I have NOT tested for it?

What I meant as "continuous" symptoms for Genital HSV was in terms of pain when a lesion is present. Is the pain associated with a gential lesion for HSV continuous until the lesion heals or does it come and go?

So just to recap and close this thread, I shouldn't be worried because it is very unlikely that I am infected correct? 

I will take your recommendation and see a couselor, I just wish to get closure to this.

One last request from you sir, is there anything more you can tell me or point me to that will help me feel more reassured faster?  I know that mentally recovering will be difficult so I would like to have something that can make me believe that I'm not infected in case I feel doubt ( which I hope I don't). I know counseling will help but I'd like to have as much help as possible. 
Thank you so very much! You are an amazing individual. You have really helped me calm down.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
There is a typo above. I realized that misunderstanding in my last reply:  I should have written "I mentioned follow-up testing only because I THOUGHT you went ahead and got tested anyway". I went on to write "You could still do that if you want..."; "that" referred to having a test at 4 months, even though you had not had any previous tests. I continue to believe it is unnecessary, but it is an option you are free to consider. I apologize for the poor wording and resulting misunderstanding.

Herpes lesions typically are continuously painful for the first few days, until healing begins.

Your "recap" is correct.

I have no other advice that I have not already given above. Re-read my previous replies with care, concentrating on every word. I can do nothing more than that. In any case, I'm glad this discussion has helped you calm down. Thank you for your kind comments.

That completes the two follow-up comments and replies included with each new question, and so ends this thread. Do your best to move on; and I hope you follow through with counseling. Best wishes.

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