[Question #1126] Herpes Risk.

48 months ago
Hello Doctor,

Last week-end, I made the mistake of going to an escort which I saw on the internet. She was a high priced escort (500$) and was originally from Brazil, however she had been living in Switzerland for 15 years. The whole encounter lasted around 30 minutes. We deep kissed for a long time, something like 10 minutes, and then I fingered her while she gave me oral sex without a condom. Halfway through, I noticed that her vagina smelled really bad, and this somehow led me to believe that she had an STD. I used a condom during intercourse, so there was no penetration without condom, but the oral sex was without condom. 

The next day, I texted her to ask if she had any STD's like Herpes or something and she sent me a half angry, half sad text saying that I should stop worrying about it and have a nice day. 

I am really worried Doctor please help me, my anxiety has been through the roof the past week. I barely eat and sleep. 

It's been exactly 8 days since the exposure now and I have 2-3 canker sores inside my mouth, near my wisdom tooth, and I have developed atopic eczema on my left arm and around my genitals. I have had a history of eczema since 4 years. 

I also noticed Tonsillitis in my mouth but that has been there for around 3 months but I read that Herpes can cause Tonsillitis. Should I be worried about that?

I did not notice any sores around her mouth but I dont know about the inside of it, so I am assuming that she might have had sores inside her mouth. I did not have anything in my mouth with the exception of Tonsillitis.

What is my chance of contracting Oral Herpes or Genital Herpes Doc? Should I get tested or do you think the symptoms I am experiencing are from something else?

Thank you, 

Eames

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
So I think it is unlikely that you acquired anything genitally, given your condom use - I can't say that for certain but unlikely.  Was the eczema there before you had intercourse with her?  Have you had eczema in the genital area prior to this? 
And have you had canker sores in your life prior to this encounter?  Have you ever in your life had a cold sore on your lip or in your nose?
The greatest risk here (and the risk is small) is that you might acquire HSV 1 genitally.  HSV 1 is the main cause of cold sores and it can be transmitted with or without symptoms, but if you yourself have ever had a cold sore in your lifetime, then it is extremely unlikely that you would acquire this genitally. 
When you say that you have tonsillitis, can you tell me about that - what makes you think you have tonsillitis?

Terri
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48 months ago
Hello Doctor,

Thank you for your reply.

Why can't you say that for certain? What am I at risk from even though I have used a condom?

No the eczema was not there before I had the intercourse. It started approximately 36 hours after intercourse. Yes, like I said, I have a history of Atopic eczema and I had it around my genitals before.

Yes I get canker sores from time to time.. Sometimes due to stress, sometimes due to my wisdom teeth, sometimes from nutritional deficiency when I don't eat properly. Canker sores are never caused by Herpes right Doc?

No I have never had a cold sore in my life and still haven't had one 8 days after the encounter. Do you think that is a good sign that I have not developed cold sores 8 days after encounter?

How small would you say the risk is for HSV-1 as a percentage or in numbers? Any estimate would be appreciated.

Well I looked it up on the internet when I first noticed white "stuff" building up at the back of my mouth, on my tonsils about 3 months back. Tonsillitis is what I found since I had some of the symptoms described (ex. sore throat). I read that the epstein-barr virus can cause tonsillitis. Is this true, and if so, whats the chance of me having this virus?

Do you think I should get tested Doctor?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
I can't say for certain because condoms are not 100% effective at protecting against herpes, though they likely reduce transmission by more than 50% from females to males.  Male who have herpes who use condoms are far more likely to protect their partners than the reverse.
Good there was no eczema at the time and good that you've had it before so you would recognize it as being different than a new herpes infection.
I think if you've had no symptoms 8 days out, that's a very good sign.  Most people who acquire HSV genitally who are going to have symptoms will do so within 2-10 days.  I would say your risk is less than 5% but that's a wild guess. 
Have you had the white stuff on your tonsils for three months?  Most people at some point in their lives acquire Epstein Barr - hard to know if this might be the cause of your tonsil exudate. 
I don't think testing for herpes would be helpful for you as your risk is for HSV 1 and the testing misses 30% of infection.  However, if you do decide to test, use only IgG, not IgM and if you are positive now for HSV 1 (and I mean right now),  that means you probably have had it for years and didn't now it and that you would not be vulnerable to new infection, so that might be helpful for you to know, right?

Terri
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48 months ago
Hello Doctor,

Thank you for your reply.

I am glad to hear that you think the chance of me contracting Herpes is less than 5%. I know thats a wild guess, but trust me, its real comforting to hear it from a professional.

Just another question that came to my mind, when I went to the escort, we deep kissed for at least 10 minutes. Is there a risk for Herpes 1 or 2 during deep kissing and if so, how high would you say the risk is since this is the thing I am most concerned about?

Yes indeed, I have had white stuff on my tonsils for nearly 3 months now. Do you think I should get tested for Epstein-Barr Virus? Is there even a test for that?

As for my eczema, it is probably allergic since it is the same as the ones I had before, but just to make sure, Eczema caused by Herpes (Eczema Herpeticum) is not the same as normal atopic Eczema and the "bumps" you get are filled with liquid right?

Thanks a lot for your help Doctor.

Kind Regards,

Eames
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
There is a test for Epstein Barr but not I wouldn't recommend it in this situation.  If you are concerned about this white substance, I would have a clinician evaluate it to see what it might be rather than guessing and trying to find the source on the internet - just my opinion.
The risk for kissing would be if she had HSV 1 orally but if you already have HSV 1, that is not a risk.  I don't have a percentage on that - not even a wild guess.  Again, I guess here is where testing for HSV 1 might come in handy.. 
Yes, atopic eczema is not the same as eczema herpeticum.  And yes, the bumps with EH are usually fluid filled, in my understanding.

Best
Terri

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