6 weeks ago I had unprotected oral and protected anal sex with a man. I topped both. 

2 weeks following I met an escort who performed unprotected oral on me only.

Following this a week after I had an unprotected bj from a woman and we had protected vaginal and anal sex. 

2 days after the last encounter I experienced pain urinating. I got tested the next day for chlamydia, gonorrhoea, syphilis and hiv. All came back negative. I then re tested for microplasma and hsv. I also started valaciclovir while awaiting the results. The results showed hsv 1. In my urethra only. 

It’s been 15 or 16 days since showing symptoms of hsv1. The pain has gone however I’m feeling very tired and my lymph nodes below my ears are swollen. I’m not sure if this is still from the genital hsv. Or could I have possibly picked up HIV as well? I assumed I was being safe with covered sex and uncovered oral. However I still picked up hsv so possibly hiv as well? As I’m still feeling run down?

Thank you 

Going straight to your main question, there is no realistic chance you acquired HIV from any of these encounters. Certainly none of your symptoms fit with HIV, and your negative HIV test exonerates the exposure 6 weeks ago. And even though you likely acquired a urethral HSV1 infection from the unprotected oral exposure 2 weeks ago, there has never been a proved case of HIV transmitted oral to penis, and the condom was excellent protection for vaginal and anal penetration. In addition, it is statistically unlikely your female partner has HIV. That said, for reassurance you could have a conclusive HIV RNA PCR test, valid any time 11 days of more after exposure; and perhaps a confirmatory AgAb (4th generation) test in a couple more weeks.

Your HSV1 infection is unusual in that initial urethral infection usually is accompanied by external penile herpetic lesions. In addition, your description suggests less severe symptoms than many men experience with urethral herpes. On the other hand, the valacyclovir probably is helping, i.e. reducing symptom severity. In theory, it is theoretically possible you had a previous genital HSV1 infection without symptoms and now are having a urethral recurrence. I stress theoretical -- very probably it's a new infection. However, if you would like to confirm that, you could have an HSV blood test now and again in a few weeks. If it converts from negative for HSV1 to positive, it would confirm you have a newly acquired infection. If you are able to contact your escort partner, you might find she has a history of oral herpes, although she didn't need to have an active outbreak to transmit the virus.

As for your fatigue, "run down", and other symptoms, almost certainly they are not due to herpes. They also are not typical for HIV -- but as noted above, you'll probably want to be tested for it. The negative result would confirm you don't have it and that HIV isn't a possible cause of your symptoms.

I'll ask Terri Warren -- who handles most herpes related forum questions -- to take a look at this discussion and see if she has anything to add. In the meantime, I hope these comments are helpful; let me know if anything isn't clear.

HHH, MD

I thought I would run out of characters in the initial question so I left some details out.

I actually did contact the escort while waiting for the results for hsv asking if she had any history of being infected. She told me that it was aids and that I deserved it etc. she was extremely unprofessional and unhelpful. I think she probably has some mental health issues. I don’t believe she has hiv but who really knows. I also contacted the other woman and she said she hasn’t had hsv. 

I guess the fact that the escort said it’s aids has me concerned although as you say hiv doesn’t transmit orally or certainly no proven cases.

I’m not too concerned with the hsv. Although it’s far from ideal. I have watched your video on hsv and are comforted knowing it’s type 1 and hopefully won’t have too many outbreaks.

I'm glad you're feeling OK about the herpes situation -- and thank you for the kind comments about my ASHA video on herpes. As discussed there, genital herpes due to HSV1 usually has low recurrence rates and many have no recurrent outbreaks at all. Still, in the future you should be alert to recurrence of urethral pain or discharge, or to external genital blisters, sores, etc. 

When you say that you were diagnosed with urethral HSV 1, I'm a little confused.  How was this type specific location determined?  Some people are now using a urine test to detect HSV.  Is that how this was determined, through a urine test?  Some people also do urethral swabs for HSV?  Because a blood antibody test would not tell you where this infection is.  As Dr. Handsfield mentioned, you could do an IgG test to help determine if this is a new infection or not, but a negative could be a false negative as the IgG test for HSV 1 misses 30% of HSV 1 infections compared to the gold standard western blot.  

I'll be interested in how the test determined that the HSV 1 location was urethral

Terri

Andy, I interpreted your comments as meaning an HSV PCR (or culture) was done from your urethra (or maybe urine?). But I agree with the implication of Terri's comments:  if it was a blood test, it doesn't necessarily mean you had an active urethral HSV1 infection. We both look forward to your clarification! Also maybe a comment about the doctor or clinic where you were evaluated? Seemingly quite knowledgeable about STDs!

Yes it was a uretheral swab that was taken. I had it done at a local sti clinic and spoke with a doctor there about it. She also took a urine test to check for microplasma genitalia as well. It came back negative.

She did say that hsv can be sometimes confined to the urethra. There weren’t any other sores visible and the pain was closer towards the head of my penis. It was quite painful urinating before taking anti viral medication and was still painful (but less so) while taking it. It probably took 10 days from first showing symptoms until the pain subsided. 

In regards to the hiv worry. I will get a 4th gen test a month after my last exposure. I’m obviously expecting it to be negative from your comments here but really just for my own piece of mind. 

Thanks again 

FYI, around 2-5% of nongonococcal urethritis (NGU) is due to HSV1 following fellatio, and a clue to herpes is having the most prominent pain near the tip of the penis -- sometimes with swelling and redness of the meatus (urethral opening, sometimes called meatitis). So your description fits quite well.---
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