I have quite a few questions linked to the same exposure. 

22nd: unprotected oral sex with sex worker in Hong Kong.

27th: STD test at a local clinic, everything came back negative except for 3 strains of HPV (51/54/55) found with the DNA genotyping test. On the same day I might have injured my urethral opening too with the cotton swab, so I have a red spot that doesn’t look like blister nor chancre on my penis that is not going away till now (i.e., since 27 December)

31st: was given Doxycycline 100mg twice x 7 days, and a gentamacin cream, but the red spot is just not going away.

Today (06/01, 15 days post exposure), I have another blood test for hiv hsv and syphilis and I am extremely anxious now waiting for the report to come back, and I have few questions:

1. 6/11 is causing 90% of warts, may I know if it’s possible for a human body to fight off HPV before warts develop? How likely are the strains 51/54/55 will cause warts?

2. I know oral sex carries little risk and over all the posts here I’ve seen, you have explicitly said test is probably not even needed, but I’m just too anxious, may I know my current doxycycline treatment may lead to false negative / false positive result? I’m having a cold with nasal congestion and green phlegm too, will it affect the test?

3. Assuming that my red spot is not STD related but just a friction burn or irritation, and assuming that the cotton swab is clean (given its clinical use), why is it not going away, how long normally should it take and what kind of treatment you would recommend? (I won’t buy meds myself I’m just trying to find out what is the possible treatment as everytime I visit a doctor I need to pay).

Interesting that you were tested for HPV in this context. HPV testing is rarely done in males and I would not have advised it in this situation. In any case, the positive results have nothing to do with your recent exposure. HPV is rarely transmitted by oral sex; and no HPV infection can be detected sooner than a few weeks after exposure. You've had those HPV strains for some time. Neither HPV nor any other STD causes a "red spot" of the penile skin or anywhere else. My best guess is that it isn't new, that you're now just noticing (perhaps influenced by anxiety) a small aberration in the skin, a little hemangioma, or something else -- but entirely benign and not related to the sexual exposure last month. For the reasons you state yourself, you are at no significant risk of HIV, and very low risk for all STDs.

I also don't fully understand the timing of your tests. Fifteen days is much too soon to detect recently acquired HSV, syphilis, or HIV with the standard tests. If it includes an HIV RNA PCR test, however, that negative result will be conclusive. And having had the doxycycline (unnecessarily, in my opinion) there will be no point in future syphilis testing. And I see no reason for future HSV testing.

1. The HPV types you have are unlikely to cause warts, cancer, or anything else. If you ever develop a visible wart or a non-healing penile sore, see a doctor. Otherwise this test result will have no impact on your health, and unlikely to be a problem for future sex partners either.

2. Given the nature of this exposure, I would not have advised doxycycline treatment. But it does NOT cause false negative test results for bacterial STIs. If your test results are negative, it will mean for sure you do not have gonorrhea, chlamydia, or syphilis. You can never know whether you were never infected, or infected and cured -- but most likely you never were infected, since the risk was so low. Your cold will have no effect on any tests you have had or might have in the future.

3. As noted above, I am confident the red spot is no STD and probably has nothing to do with the sexual exposure described. It doesn't sound worrisome at all. But if it persists or you remain concerned, discuss with your current doctors or see a dermatologist.

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

HHH, MD

Nobody needs testing for HPV just because a partner has a positive test. She needs nothing more than to follow standard Pap smear guidelines. An HIV test probably will be done with her next Pap smear, whenever that is. In any case, obviously she has been repeatedly exposed to the HPV strains you have, probably infected, but it probably doesn't matter. She could have been the source of your infections, but you'll never know and it doesn't matter. HPV should mostly be ignored except if visible warts are present or found by Pap smear. And yes, your test was irrelevant. That's why I said "I would not have advised it in this situation" in my initial reply. It's normal and expected for anyone to test positive, which is one reason testing is not advised except in particular situations.

I'm inclined to doubt the "red spot" is from the swab. I agree that if that was the cause, it would have disappeared by now. For sure it isn't herpes or syphilis; from your description, neither is remotely possible, and it's also too soon for either of them.

The doxycycline dose required for prevention of syphilis is a lot lower than needed for cure of established infection. A single dose of doxycycline would have aborted syphilis if you were exposed.

Doxy-PEP:  probably 100% effective. There are reasons related to study design the the 80% effectiveness is an under estimate.

HPV:  The DNA of the virus may persist forever, but usually the infection remains inactive. Sometimes it may be gone for good, but the science on this isn't entirely clear. Either way, the virus usually isn't anything to worry about. Everybody has it and the large majority of us have no health problems from it.

Thanks for the thanks. That concludes this thread. HNY to you as well.