Some time has passed since my previous question (#11236). For a short summary, I received unprotected oral sex from a CSW and was primarily concerned with oral gonorrhea, HSV2, and HPV as a result of receiving oral sex from a female CSW (I am male).

The exposure was on 4/20/24 and I decided to get tested on 6/14/24. I took a 10-panel STD test (blood and urine). Negative for all except HSV-1 (which I have had since childhood).

My questions/concerns for following up are below:

1. Are my test results conclusive? I think I tested in the proper window for all other STDs, but not sure if I tested too early for HSV2.

2. My main reason for following up — I’ve been noticing red spots on one shin, my chest, and recently one red spot appeared on the head of my penis. The red spots on my shin and chest look like either acne or heat rash (or a combination of both). I was surprised to see a red spot show up randomly on my penis. I can’t tell with certainty if there’s a raised bump or not (sometimes it feels smooth and sometimes I can feel a bump depending on how I touch the spot). Currently, it’s just a single spot but I will monitor if it gets worse. Are these just dermatologic or could this be HPV? My understanding is that HPV is rare in the mouth and transmission, if infected, from female to male through fellatio would be extremely low.

Thank you for taking the time to address my follow up questions and for all that you do to help people.

My first response is to request clarification of the exposure. Did you perform oral sex on your CSW partner, or only her on you? If that latter, you are at no risk of either HPV or oral gonorrhea. You cannot catch an oral infection by exposure of your penis. And HSV2 is not a risk from oral sex, because oral HSV2 is rare and very unlikely in your partner.

1. Assuming your 10 test panel included urine for gonorrhea/chlamydia (and if your penis was exposed), those results are conclusive. The standard blood tests all are conclusive, except that the test was too soon to detect all HSV2 infections. That requires testing at 12 weeks or more.

2. No STD causes the sorts of red spots you describe, either on your penis or anywhere else. HPV does not appear as red spots, and for sure could not show up anywhere that was not in contact with your partner's genital area. The large majority of skin conditions of the penis or genital area are not STDs. (I have a book titled Genital Dermatology Atlas, 300 pages of photos and brief descriptions. All STDs are covered in just 15 of those 300 pages.)

You can rely on your test results -- but feel free to clarify the exposure, as suggested in my opening comments.

HHH, MD

Thank you for your reply!

To clarify details of the exposure: my female CSW partner performed unprotected oral sex on me only. I did not perform oral sex on her. We attempted protected vaginal sex, but I could not maintain an erection and my penis (with a condom on) did not enter the inside of her vagina. I cannot remember if there was brief unprotected genital rubbing.

Yes, the 10-panel STD test included a urine test for chlamydia and gonorrhea. Thank you for clarification on oral gonorrhea! I meant to communicate I was concerned about contracting gonorrhea on my penis as a result of receiving oral sex.

The STD test mentioned that an IgG test is used and advertises 97-99% accuracy after 6 weeks, which is why I tested at 8 weeks instead of 12 weeks.

With the above details clarifying the exposure, I understand tests for HIV, chlamydia, and gonorrhea are conclusive. Should I retest for HSV2 if oral HSV2 is rare and is not really a risk? Is HPV still no risk?

Presumably your comments about IgG refer to the HSV2 test? If so, that's just plain wrong:  around 70-80% of newly infected people have positive results by then; maximum sensitivity (~98%) is at 12+ weeks. (Up to 2-3% never have positive results.)

Oral sex virtually never risks HSV2, and the chance is lower still in absence of typical symptoms. Definitely don't waste money on another test. Yes, the HIV, chlamydia and gonorrhea results were conclusive. There was no chance you could have caught any of the others in most labs' usual STI test panels.