[Question #108] risk assessment/symptom analysis

38 months ago

I apologize in advance for this, but as I am already corresponding with Terri Warren through her clinic's online forum (and am very appreciative for her expertise) I would be extremely grateful if one of you could weigh in on my situation as well. Thank you so much.

Incident:
i’m an uncircumcized man in his early 20’s and 30 days ago I got very intoxicated and ordered a csw over. she performed fairly rough and deep protected oral sex on me for 5-7 minutes and I did not ejaculate. I felt some pain during this and upon later inspection noticed a minor abrasion near the corona of the head due to foreskin friction which happened under the condom (this has happened in the past as well). i’m fairly certain the condom remained intact. after this was done, I was so drunk I forgot to take the condom off and simply just put my penis back in my pants, only remembering to pull the condom off about 5-10 minutes later, allowing oral fluids to contact the inside of my boxers and thighs. no cleaning occurred after this, and I promptly went to sleep.

symtoms:
a week following this exposure, my scrotum turned bright red for a day and I started experiencing a burning sensation in my buttocks and thighs. this burning sensation was constant for a day bilaterally, then transitioned to just the right side for a couple days before ceasing to be constant. for the following 3.5 weeks, i've woken up with an ache/stiffness in my right lower back/hip/leg/buttock and the burning sensation returns in my right buttock/back of thigh/lower back and sometimes calf when sitting for a period of time. I also can feel the bone in my right buttock when i'm sitting. in addition, the skin on my right leg is very sensitive to heat/cold. I've been checking myself constantly for any signs of lesions/sores/marks and have found absolutely nothing. no visible/non-visible symptoms on my actual genitals whatsoever as well for the past 3.5 weeks. I'm fairly certain these symptoms all point to hsv, and as I'm fairly certain I already have hsv1, i'm wondering if these symptoms are indicative of hsv2 even though I have no lesions or sores at all. at 3 weeks past exposure I started to experience diarrhea which was ongoing for a week and a half and now i'm experiencing constipation. also had minor difficulty swallowing for a week or so as well. these symptoms i'm worried might be related to hiv. I'm in the process of waiting for blood results even though I know it's too early to test for hsv. I just can't help but think this is hsv due to the timing and the fact that no other std remotely fits my symptoms besides hsv. (right unilaterial nerve pain/burning sensation affecting lower back/hip/buttock/leg) I'm thinking fluids from the outside of the condom contacted my fresh abrasion while I slept due to my lack of cleaning and infected me. any input/insight/risk analysis you could provide would be infinitely appreciated. thank you so much.

38 months ago
more importantly than anything else, could you please weigh in on my risk for HIV? I know having the abrasion and being uncircumcised does not work in my favor. the timing and duration of the diarrhea and GI problems has me really worried
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

Welcome to the Forum.  I have reviewed your interaction with Terri on the Westover site and agree with what she has already said.  I am not doubting your symptoms or experiences but I find it most unlikely that the sensations you are describing represent HSV.  The deep muscle and bone aches you describe are not something that is described at all with herpes virus infections, nor are a mixture of constipation, diarrhea and swallowing difficulties.  I think you need to work with your doctor to look for other causes unrelated to the low risk sexual exposure you have described.

As for your HIV risk, it is virtually zero.  Most CSWs do not have HIV and even if your partner did, your exposure was condom protected and even for unprotected receipt of oral sex from an infected partner, I know of no cases in which this has lead to HIV acquisition (there are a handful of cases in which persons may  have acquired HIV from performing oral sex on an infected person but these are extraordinarily rare).  My guess is that your symptoms are unrelated to the exposure you describe in any direct way but that the anxiety you have expressed may be amplifying other symptoms.  I hope this comment is helpful to you.  EWH

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38 months ago
Thank you very much for your response. i'm actually at Quest right now waiting to get blood drawn. I know the HIV result should be conclusive at 4 weeks. my primary concern is that I suffered the abrasion during the act and took the condom off after allowing fluids to contact the inside of my boxers and thighs. I did not clean the area at all before falling asleep. when I woke up, there were still parts of my thighs that were wet (although I'm not sure if this was my own pre ejaculate from the inside of the condom. if i'd had no symptoms following this exposure I would not be concerned but now i've been experiencing these symptoms from morning till night a week after exposure so i'm seriously concerned and confused as to what is happening with me. 
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
I am confident that this and future tests related to the exposure you describe will be negative.  If there were a partners' secretions on the outside of the penis they would have been transferred to your underwear, if anything and once there would have stuck there.  Viruses and bacteria adhere firmly to fibers and are not transferred from fibers to infect people.  EWH
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38 months ago
thank you for your insight doctor. I tested for everything at 4 weeks and came back negative for everything but I had to get blood redrawn for the hiv test since the sample got hemolyzed before it got to the lab. so i'm waiting on that result next week. I know that 4 weeks is too early to test for herpes, but I was surprised I came back negative for both hsv1 and hsv2 since I thought I might have had a cold sore in the past. I know I can't effectively rule herpes out till the 4 month mark so I'll have to retest then. I was nervous when I recieved a call from quest saying the hiv blood sample had to be redrawn, but my sister who is a physician told me it happens from time to time that samples get compromised. the hiv test quest is running is an ab/ag test which i'm assuming is a 4th generation test. will a negative result at 4 weeks be conclusive in your opinion? I know the odds of this are low but if I got a coinfection of both herpes and hiv, would they still show positive at their normal window periods or would it take longer? once again, thank you so much for all your help I truly appreciate it.
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
The results of your 4th generation HIV test are definitive at 4 weeks. when your test is negative (I am confident it will be), you will know that you were not infected by the exposure you have described. 
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38 months ago
hi doctor,

just as you expected, I received my negative result today. I still have stiffness and minor pain in my right leg with a burning sensation and skin sensitivity on my right buttock and back of thigh when sitting for a certain amount of time. I was prescribed prednisone so i'm seeing how that works out. still havent ruled out herpes due to the fact that I only tested at 4 weeks but I guess i'll just have to sit tight and wait till the 12 week mark. thank you so much for your knowledge and assistance, I truly sincerely appreciate it
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Glad I can help.  I remain convinced that your herpes result will be negative as well.  I must now close this thread as we long ago surpassed our 2 response limit.  EWH
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