[Question #1320] unprotected oral sex with a “bar girl” in South America

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91 months ago

I have contacted this board before.   I received unprotected oral sex from a "bar girl" about 9 months ago.   Since then I have received two equivocal HSV1 results.  One at 3 months and 1 at 4 months after the incident.

My only "symptom" has been ongoing general urethra tenderness (not pain).  The tenderness is felt most intensely after ejaculating.   This has been ongoing and doesn't sound like any STD, but I am not sure at this point.  I got a urologist to do a cystoscopy and he said everything looked normal even though when i squeeze the tip of my penis it feels like there may be something hard in my urethra and I feel tenderness in the tip of my penis that was never there before.

I have never had cold sores or penis symptoms so I am unsure if I am infected or not.  It was suggested that I get a Western Blot, but this has been EXTREMELY difficult.  My primary care physician didn't know what a WB was and didn't want to prescribing something unless it was the appropriate treatment.  He referred me to an infectious disease doctor.  I called the doctor's office before making an appointment and asked about having my blood drawn and sending it to University of Washington and they said that this is something that they don't do.  I then went to see a urologist and he said that I should talk to primary care physician.  He also had never heard of WB.    

Do you have any suggestions for how I should proceed?   I am in Maryland, not far from Washington, DC.

Also any other ideas regarding what the tenderness might be?

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H. Hunter Handsfield, MD
91 months ago
Apparently you have used different usernames and email addresses. If you are the Anthony I think (question 624) -- perhaps your most recent question -- Terri replied "Your contact was very brief, oral sex is really unlikely to transmit STDs, you've been treated adequately, and your testing is negative.  Now is the time to try to let this go.  It's hard, I know, especially when you are feeling some physical things that you perceive as abnormal, but the chances that you actually have something are incredibly close to zero, close enough that it's time to move on, even though you have worries, even though you have physical symptoms."

Your overreaction to a very low risk exposure, including for HSV1, has led you to far more extensive medical evaluation than was necessary or wise. You certainly should not have been tested for HSV1; nobody does that after a single exposure like yours. You also should not have had cystoscopy. (Your phrase "I got a urologist to do [it]" indicates even the urologist didn't think it was necessary.) And your symptoms don't even hint at herpes or any other STD. 

However, I would be happy to assess the meaning of your "equivocal" HSV1 blood test results if you would like to provide the numerical results for each, along with the HSV2 test results if done. The odds are that you indeed are infected with HSV1, but that like half of all adults, you've been infected for many years and it has nothing to do with the sexual exposure described above.

Regards--  HHH, MD

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90 months ago
Thank you Dr. Handsfield,

I appreciate your response and your candor.   So I didn't "get" the urologist to do the cystoscopy.   He was trying to identify what's going on with my urethral symptoms.  I am not sure if these symptoms are STD-related or not, but I do agree that this is unlikely as they don't seem to be symptoms associated with any STD, but yet all of this started after my incident so...here we are.

Also I would love to "get over it," but my wife is aware of the WB as she participated in a herpes study in college and would like me to get it so that she can feel as comfortable as possible.   She and I both understand that if it comes back positive neither one of us will know if it's oral or genital.  My wife has been amazing through this whole process so I want to make her as comfortable as possible.

As far as my history of testing:
  • 19 days after the incident I decided to get a IGG test in South America for HSV 1 and 2.   I got a 39.7 U/ml for HSV1 and a 15.6 U/ml for HSV 2. Apparently in their scale anything over 30 is positive and less than 20 is negative.  The test was a enzyme immunoassay, ELISA.
  • 2 months and 23 days after the incident I got a negative result for all STDs INCLUDING HSV1.
  • 3 months and 7 days after the incident I got a negative result for all STDs except I got an equivocal result of 1.04 for HSV1.
  • 4 months and 5 days after the incident I got a another equivocal result of .93 for HSV1.
Lapcorp doesn't indicate the numerical value for negative results only that is it less than 0.91.

Since the number is going down maybe it would be negative now?   Who knows?

The reason that I went through all the "excessive" testing is because my wife was pregnant through all of this and I didn't want to risk any exposure to the baby which can be very dangerous.
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H. Hunter Handsfield, MD
90 months ago
The tests you had for HSV1 are inherently less precise than the same sorts of tests for HSV2. I agree a Western blot would probably sort out whether you indeed are positive for HSV1. Varying numbers is common, and the apparent downward trend says nothing about whether or how long you might have been infected. But if you have HSV1, you can also be confident it has nothing to do with the oral sex event, far more likely a distant past infection orally, perhaps in childhood. Even given the slight chance you may have a genital infection, there is little or no risk to your wife:  genital HSV1 is rarely transmitted sexually to partners. There are major differences between genital herpes due to HSV1 vs HSV2, among which is that In the absence of visible outbreaks, transmission is uncommon; see the links below.


Having said all that, I understand your concern in light of your wife's pregnancy and the need to assure your wife doesn't acquire genital HSV1 in the last three months of pregnancy. (Infection earlier in pregnancy wouldn't risk the baby's health; the main risk for neonatal herpes is vaginal delivery in presence of a recently acquired genital infection.) So all you need do is assure no intercourse and no cunnilingus in the last 3 months -- and most pregnant women are perfectly happy to stop having sex during that time anyway. Also, if she alerts her obstetrician about the situation, she will know to be on the alert and be ready to take steps to assure the baby isn't infected during delivery (cesarean section if there is evidence of an active outbreak when she goes into labor).

So the bottom line of my advice is unchanged:  stop worrying so much. Do your best to separate your emotionality about a sexual decision you obviously regret from the potential infectious consequences of it. Deal with the former as you need to, but forget the latter. It's not an issue.