[Question #12513] following question- #12479

7 months ago

I am M[20]. On January 1, 2025, I engaged in unprotected oral sex with a male partner whose health status I did not know. My previous oral encounter was on October 23, 2024, with full STD tests on December 2, 2024, which were negative except for HSV-1/2 (childhood history). I also tested for HIV antigen and syphilis yesterday—both negative.It’s been 9 days since the encounter, and I’ve developed herpes on my lips and redness on my penis shaft near the glans (no discharge, pain, or significant discomfort). I also feel occasional itching, likely anxiety-related, as I’ve been researching HIV risks from oral sex with ejaculation (partner’s HIV-negative claim via app status is unverified).I plan an HIV PCR test on January 13 (Day 13 post-exposure) and follow-ups with HIV+p24 antigen tests on January 16, January 30, and a full STD panel on February 7. 1.Can a PCR test at Day 13 be conclusive if asymptomatic?2.How soon can syphilis be detected? Would symptoms speed up positivity in tests?

H. Hunter Handsfield, MD

7 months ago

Welcome back to the forum. Your question apparently is about the same exposure you asked about 6 days ago, answered by Dr. Hook.

The new aspect is your apparent herpes outbreak. Do you know for sure that's what you have? Were you previously diagnosed with oral herpes? In any case, "redness" of your penis without pain or discomfort cannot be herpes or any other STD, and probably has nothing to do with the oral sex event. And as Dr. Hook said, your risk of HIV was so low that you do not need testing for it and I would advise saving your money on a PCR test. But at least that negative result will be conclusive; you definitely will not need the additional tests later in the month. Finally, beware of the "full STD panel" of tests offered by many labs. Given the nature of your exposure, the only testing you should consider in addition to your HIV tests are urine for gonorrhea/chlamydia, a throat swab for chlamydia, and a syphilis blood test. There is no point in doing the syphilis test earlier than 6 weeks after exposure -- but your symptoms do not suggest syphilis anyway.

If "herpes on my lips" is a new problem and you are diagnosing yourself, of course you need to get care immediately to confirm the diagnosis and be tested to know whether it's HSV1 or HSV2.

Let me know if anything isn't clear.

HHH, MD

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7 months ago

Thank you for your response. I apologize if my questions seem odd; I’m just stressed and worried, knowing this situation is my responsibility.Yes, this relates to my earlier question about providing oral sex to a man who ejaculated in my mouth. Do you really believe the risk of transmission is as low as mentioned? I had no sores or issues in my mouth at the time.Regarding herpes, I believe this might be it. I had outbreaks in childhood, and past tests showed S_HSV 1/2 IgG at 30 COI, so positive, which makes sense.

I’m curious if an HIV PCR test 13 days post-exposure is reliable. I’ve read it’s accurate only with symptoms, which I don’t have.Lastly, is testing for gonorrhea and chlamydia necessary if I have no symptoms, like a sore throat, painful urination, or discharge?Thank you for your understanding, and I appreciate your insights!

H. Hunter Handsfield, MD

7 months ago

Yes, I agree exactly with Dr. Hook's risk assessment.

Can you say more about "Regarding herpes, I believe this might be it"? What symptoms are you having now? Also, the HSV lab report you describe means you have HSV1 or HSV2, but doesn't tell which one. Did you have any other test, or another part of the report, to distinguish the two virus types? (Even if having an oral herpes outbreak now, if it wasn't resent at the time of exposure, it did not chance your risk of HIV.)

The HIV PCR tests are conclusive any time 1 days or more after exposure. You misunderstood something you heard or read: PCR test reliability and timing are no different with or without symptoms.

The risk of gonorrhea is low after any single exposure, and the chance of chlamydia almost zero. Testing is optional. Absence of sore throat or other symptoms doesn't mean anything one way or the other: almost all oral gonorrhea is asymptomatic, and chlamydia always is. If you remain nervous about it, feel free to arrange for a throat swab test; you can expect a negative result. You might have a urine test as well.

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7 months ago

Thank you very much, Doctor, for your response.

I wasn’t aware of that information about gonorrhea and chlamydia—I thought these infections usually come with symptoms. Given this, I will arrange for testing.The HSV lab result I mentioned is from December, and I don’t have an updated one yet. I’m scheduled for testing next week. My current concern is a bump that appeared on the upper-right corner of my lip. At first, it looked like a pimple, but I believe it wasn’t. I can’t confirm if it was herpes since I’m not medically trained, but a few hours later, another bump appeared on the lower-left part of my face, not on the lips. It itched a little but didn’t form a scab. I started applying an anti-herpes ointment immediately.Importantly, these sores were not present at the time I performed oral sex—they only started appearing yesterday.

H. Hunter Handsfield, MD

7 months ago

Almost all urethral (penile) gonorrhea and most chlamydia do cause symptoms. Oral infection almost never does.

Most herpes outbreaks appear in a cluster of lesions near one another; the first pimple-like lip lesion sounds like herpes but maybe not the second one. The typical sequence is red bump that becomes a blister which then turns into a sore that soon scabs over. Total time from start until the scab falls off typically is 10-12 days. Unfortunately, the anti-herpes ointments make little or no difference in healing time. However, if your repeat blood test confirms HSV1, you can safely assume you've had an HSV1 outbreak. In that case, ask your doctor for a prescription for valacyclovir (Valtrex®). Two doses (2 grams each) 12 hr apart may abort the outbreak if started early enough, or at least will reduce healing time to 3-5 days.

And don't worry about this changing the risk of the sexual exposure you described. But in the future, you should protect your partners by avoiding kissing or performing oral sex during an outbreak, until completely healed.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope you found it useful. Best wishes and stay safe.

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