[Question #12447] Herpes 2 and HIV Question

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7 months ago

I had a protected encounter with a sex worker approximately 8 days ago. When I got home, I noticed a small amount of bleeding around the rim of my penis. A couple of days later, I began experiencing a burning, itching, and tickling sensation around my genitals. I got tested for HIV and STIs two days ago, and all results came back negative. However, since yesterday, I've been feeling a burning sensation in the lower scrotum area, although I don't see any lesions there or on my genitals.

My questions are:

  1. Should I be concerned about HIV transmission from the bleeding, given that I wore a condom?
  2. Should I be concerned about HSV-2 (herpes) due to the burning sensation? 
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H. Hunter Handsfield, MD
7 months ago
Welcome to the forum. Nurse practitioner Terri Warren usually answers herpes-related questions but she is temporarily unavailable. I'm happy to address these concerns.

You describe a very low risk sexual exposure, with no realistic chance of any STD, and certainly not herpes or HIV. Although overt herpes lesions (blisters, sores, etc) can burn or itch, and can be preceding by a tingling sensation, herpes does not cause such symptoms as the first or only symptoms. Two days also is too soon -- the symptoms of a new HSV infection typically start 3-5 days (and sometimes up to a couple weeks) after exposure. And two days is way too soon for HIV, which also does not cause such symptoms. And having had condom protected vaginal sex also made you very low risk for either of these infections (and really zero risk for HIV).

The blood you saw undoubtedly means your partner was menstruating; you would have a visible injury if the blood were your own. Menstruation does not raise the risk of HIV any more than it would be otherwise, because the amount of HIV in blood is no higher than in vaginal fluids. And contact with either vaginal secretions or blood on intact skin (of the penis or anywhere else) does not transmit HIV. 

Those comments cover both your questions, but to be explicit:  no, you should not be concerned about having either HIV or HSV2. Your symptoms are typical for anxiety -- i.e. your worries magnifying trivial symptoms or even normal body sensations that otherwise would not be bothersome or maybe you wouldn't even have noticed.

I don't advise any testing.  However, you are free to be tested for HIV the negative results would add to my reassurance that all is well. But for sure no testing for HSV:  the available blood tests are not always accurate, and there is a much greater chance of a false test results than the likelihood you acquired herpes.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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7 months ago

Thank you, Dr. Handsfield. I have two follow-up questions:

  1. I want to clarify that the CSW wasn’t menstruating. There was a small amount of my own blood on the rim of my penis, most likely due to the handjob. Given that the other activities involved protection, I should be fine, correct?

  2. What is the likelihood of acquiring HSV-2 on the scrotum, considering herpes is transmitted through skin-to-skin contact and that area isn’t covered by a condom?

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H. Hunter Handsfield, MD
7 months ago
1. I don't understand how the handjob could have caused bleeding. Or how you could have blood on the penis but no apparent cut, sore, etc. But even if somehow that happened, it doesn't change my risk assessment.

2. HSV generally must be massaged into exposed tissues for infection to take hold. Simple skin-to-skin contact is not sufficient. I doubt your scrotum was repeatedly rubbed. (This is why initial sexually acquired herpes lesions almost always occur on the penis itself, the vaginal opening and labia minor in women, or the anus following receptive anal sex:  the areas that receive friction during sex.) In my 50 years in the STD business, I don't recall ever seeing a patient with initial herpes involving the scrotum.
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