[Question #12175] HSV 2 / Syphilis Testing Concern

9 months ago

Male in 30s. 9/13 receptive anal & oral with someone online. Condom only used during anal. He rubbed penis without condom around my anus before insertion.

9/26 HIV1 RNA: neg

10/1 mod pain around anus for 3 weeks after stomach bug (looked like hemorrhoids & fissure). Mild leg aches for 2 weeks. Anus remains mildly sore

10/8 Chlamydia, gonorrhea, trich, HIV 4 gen, HepC, HSV2, Syphilis: all neg

10/12 to now mod pain around sit bone on left. Didn’t notice skin abnormalities. Area has a stinging feel. Still have possible anal fissure on right side of anus

10/15 Chlamydia, gonorrhea, HepABC, HSV2, HIV 4 gen, Syphilis: all neg

10/22 3 Site chlamydia and gonorrhea: all negative

10/28 Hep C, HSV2, Syphilis: awaiting results

Most worried about anal fissure & stinging feeling around sit bone being related to STD.

1. How confident can I be in my Syphilis & HSV 2 tests?
2. STDcheck (10/15 tests) claim HSV2 97-99% accuracy 4-6 weeks post exposure. Can I trust that?
3. What additional testing do you recommend?

Edward W. Hook M.D.

9 months ago

Welcome to our Forum. Thanks for your questions and your implied confidence in our service. I'll be glad to comment. The encounter you describe was close to no risk. Condom protected sex is safe sex, few STIs (and never HIV) are acquired from receipt of oral sex and your have tested at times when your results are reliable and conclusive or close to it. You have over tested for gonorrhea and chlamydia, having repeatedly proven you were not infected. Your HIV tests are close to conclusive- at 4 weeks after the encounter over 98% of persons who have acquired HIV will have positive tests and your 1./28 tests, taken more than 6 weeks after the encounter will be entirely conclusive as will your hepatitis C results. As far as herpes is concerned, if you were going to experience a herpes outbreak, you would have done so within 10 days of your exposure- blood tests, which we do not recommend because of high false positive and false negative rates can take 4-6 months to become positive..

The anal discomfort and leg aches do not suggest an STI. With regard to your specific questions:

1. How confident can I be in my Syphilis & HSV 2 tests?

Your syphilis results are reliable- you did not get syphilis. The people selling the HSV blood tests have more faith in their product than we or most experts do. That said, your risk for syphilis and HIV, as for other STIs is close to zero.

2. STDcheck (10/15 tests) claim HSV2 97-99% accuracy 4-6 weeks post exposure. Can I trust that?

See my comments above. Neither we not the CDC recommend blood tests for herpes. The HSV antibody tests however can take up to 6 month to become positive. Your risk for HSV from this encounter is close to zero even without testing.

3. What additional testing do you recommend?

I see no need for additional testing. My advice is to take a deep breath and try to relax. I am confident you did not acquire an STI of any sort from the encounter you describe and recommend that you move forward without concern.

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9 months ago

Thank you for the quick reply, Dr. Hook. I appreciate you answering my questions and offering me some help calming my nerves.

I have two follow up questions:

1. Was there much risk of HSV 2 transmission from rubbing penises together (maybe 5 minutes) and he rubbing his penis on my butt/anus? Those are the two actions that have me nervous.

2. How common is it for herpes to present as an anal fissure? Should I be worried that could be a herpes outbreak?

Thank you!

Edward W. Hook M.D.

9 months ago

1. Virtually no risk.

2. Rectal herpes and anal fissures are very different illnesses.

I think you are continuing to worry needlessly. EWH

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