[Question #12304] STI but which one and what to do

8 months ago

Dr Hook/Hansfield kindly answer. Terri answered before but I have new info & 2nd opinion needed.

Male - Negative STI screen

Female - HSV2 positive (unknown Site)

Nov 21 - male got kiss on cheek. Simulated sex whilst clothed.

Nov 22 - covered vag sex without skin contact. Minor vaginal secretions on condom transferred to underwear (penis was put through slit of underwear) & contact base of penis for 5 seconds after ejaculation.

Nov 23 - covered vag sex without skin contact. But slept in shorts so Minor thigh to thigh contact for a few minutes.

Nov 24 - male received covered oral but after cum the wet condom remained touching thigh for 5 minutes.

Symptoms

a) feel like nasal sore since Nov 23rd.

b) uncomfortable itching (unsure if tingling too) groin creases, scrotum, penis shaft &head, anus [front, back or side], & buttocks [back or sides] or thighs [medial]. This comes & goes, fleeting location but mostly penis, most of the time since Nov 23-24. (8 days). Penis head feels hot/tight at times but no dysuria/frequency. No visible rashes. Circumcised.

is it HSV2? could it be something else?

Male is in Middle East so afraid to check HSV2 IGM. Planned to wait for IGG but there’s contradictory info. Recent article says only 40% accurate but the tests claim to be 99% accurate.

Please when & what tests you advise & their accuracy. ChatGPT says everything is a risk.

Symptoms are real, partner HSV2 IGG is 9.

H. Hunter Handsfield, MD

8 months ago

Welcome back but it puzzles me. I don't see why you are not feeling entirely reassured about herpes from your very recent discussion with Terri. It seems clear you WAY overestimate the risks of HSV infection for the sorts of exposures you describe, as you did for HIV a year or so ago. As I recall, you are a health professional -- although I don't recall the details -- and should have better understanding of sexual transmission risks than you apparently do.

Normally Terri would have answered this question, but she asked me to weigh in; we both hope hearing the same conclusions and advice from both of us will help you accept and understand that you were at little risk and do not have herpes.

That your recent partner is known to test positive for HSV2 does not in itself mean high risk for transmission. First, undoubtedly it has happened before: depending on the country of exposure and the sexual experiences of your partners, you can safely assume that at least 20% and perhaps over half your partners would also test positive. That you happen to know about this particular partner does not significantly raise your risk. Second, you describe an entirely safe exposure with very low risk of HSV2 transmission. (Even with entirely unprotected vaginal sex with a known infected female partner, the HSV2 transmission chance is estimated at roughly once for ever 1,000 exposures.)

Your symptoms don't even hint at herpes, which does not cause itching as the only or primary symptom. Overt (visible) herpes lesions might itch for a few days, but itching alone is not a herpes symptom. Neither are the other feelings you describe in the genital area. They are typical for genitally focused anxiety: your worries are making you more aware of minor symptoms or even normal body sensations that you otherwise would ignore or not even notice. A nasal sore conceivably could be herpes, as Terri also advised, but your exposure, the fact that HSV2 rarely infects the mouth or facial area, and all other cirumstances argue strongly against herpes as the cause.

I would advise against blood tests for herpes. The tests simply are not sufficiently reliable in this circumstance. But if you decide to do it anyway, you need to wait until 3 months after the exposure, and then for sure have only IgG testing. (IgM testing is totally unreliable world wide, not just in the Middle East.)

As for other STDs, your careful safe sex -- condom protected for both vaginal and oral sex -- was excellent protection. That there may have been some skin contact with vaginal fluids, saliva etc was not risky at all. That said, all things considered, you are at greater risk for gonorrhea, chlamydia, and syphilis than you are for herpes. If you seek STD testing at all, you should have a urine test for gonorrhea and chlamydia (valid any time now) and a blood test for syphilis after 6 weeks (and maybe HIV if you would like further reassurance about that possibility). But not HSV.

Finally, I suggest you limit your online searching about STDs to professionally run or moderated sites, and avoid those run by and for persons with such health problems or at risk -- like ChatGPT, Reddit, and so on. Anybody can write anything, and statements by other anxious persons are the worst possible kind of medical or health advice.

HHH, MD

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H. Hunter Handsfield, MD

8 months ago

And another word about ChatGPT. You need to understand the limitations of AI. Whatever you find on ChatGPT most likely is an AI compilation of what people of all stripes have written online, and probably not limited to professional and scientific sources.---

8 months ago

agree sensitive/anxiety but real Sx: penis itch,burn,need to pee, even at work or on waking. Groin,scrotum,anus itch easing.

1mm pustule right buttock: burst. 2mm papule gluteal cleft. ?blood blister but wont burst. no scab.

Main issue:distal 1/3 penis burn & itch. worse if sit or walk in jeans. URGE to pee. Urine dip ok.

Valtrex on day1 ?HSV2 only nerve Sx.

So why not IgM after 2 weeks? IgG after 12 weeks

H. Hunter Handsfield, MD

8 months ago

As I said, no STD causes the genital and urinary symptoms you report. I've given you my best guess at the cause (anxiety). But we don't get into genital problems other than STDs. You'll need to see a doctor about it.

You do not have herpes and should not be taking valtrex. It will make no difference in your symptoms.

For many infections, IgM antibody appears sooner than IgG and therefore can be useful in earlier diagnosis. But it doesn't work that way in herpes and the test itself is terrible; HSV IgM results never are reliable and most positive results are false. No legitimate STD or herpes expert ever uses or advises testing for HSV IgM antibody.

You came to the forum for our professional advice. Accept it or not, I don't care -- but this isn't a debate and we will not argue about it.

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8 months ago

Thank you for your response Dr Handsfield. Sorry if i upset you, you seemed angry… of course I value your advice and that’s why I have used your services on numerous occasions and I wasn’t debating you. I would love for your conviction to be correct.

I will just use this last reply to update you and would appreciate your empathetic response.

The only additional history that came up was: 1)the female has a two month old photo of what appears to be a cold sore or pimple above the upper lip and 2) after the recent oral sex about 2 weeks ago she used her hands over the condom and then to stimulate the scrotum and groins.

It’s about 15 days now and the only persisting symptom is burning/soreness of the left side of penis shaft and Corona. At times it looks a little red but no response to antifungal or steroid creams.

Would you still be confident that this is not Herpes? I know the chances are very unlikely but have you any idea if there are other STD that can cause these symptoms; initial itching in boxer short area for a week then burning and itching of penis and now discomfort and burning of penis especially to touch of clothing.

Thanks for taking the time to respond and for your patience.

H. Hunter Handsfield, MD

8 months ago

Angry isn't quite the right word -- just frustrated when forum users completely ignore reasoned, highly professional, science-based evaluation and expert advice.

"1)the female has a two month old photo of what appears to be a cold sore or pimple above the upper lip and 2) after the recent oral sex about 2 weeks ago she used her hands over the condom and then to stimulate the scrotum and groins." These make no difference, i.e. no change in my assessment of your zero risk.

"only persisting symptom is burning/soreness of the left side of penis shaft and Corona." Herpes simply is not a possible cause of such symptoms.

"Would you still be confident that this is not Herpes?" Yes, 100%.

"have you any idea if there are other STD that can cause these symptoms"? None. No STD has ever caused these symptoms, which are not due to any infection from the sexual events described.

I've already given my scientific assessment of the probable cause of your symptoms. Here it is again: Your symptoms...are typical for genitally focused anxiety: your worries are making you more aware of minor symptoms or even normal body sensations that you otherwise would ignore or not even notice. If you remain concerned, professional counseling might be helpful. I recommend it from compassion, not criticism. In any case, please drop all concerns about herpes!

That concludes this thread. This is your second thread asking essentially the same questions about herpes, with two others about HIV -- all of which show you seriously overestimate the risks of HIV and herpes and have trouble understanding the the symptoms of both. Repeated questions on the same topics are against forum policy and may be deleted without reply and withour refund of the posting fee, so let's make this your last question about such exposures and symptoms. Thank you for your understanding. Best wishes and stay safe.

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