[Question #1382] Moving ahead

46 months ago

41 year old male, unprotected oral and vaginal at an Asian massage parlor. She  45-50 years old. I didn't go in looking for sex but got charged up. She tried to avoid sex but gave in, she asked for a condom which neither of us had, she cleaned my penis with and alcohol I gave her brief oral and penetrated  for a brief few minutes.   I'm married and this was the first sex outside of my marriage in 16 yrs.  Next day went to a walk in medical center . Baselines where negative and I asked for PEP which I completed and was referred to an infectious disease specialist. At 4 weeks rapid oral negative, syph, gon, chalmidia, tri, negative.  Oraquick(anxiety driven) OTC at 7 weeks  negative.  I've had some strange tingling around my scrotum Dr. said looked like a little jock itch which I do get but no herpes I hit it with cortisone cream and it dried up.  She basically said if I had herpes I would know it in no uncertain terms. Went to a dermatologist and he also saw no evidence of any STI. I am so hypersensitive I think I'm losing my mind.  I went back to the walk in at 8 weeks for a full round of blood and urine testing again and expect the results back today or tomorrow. Essentially, it's unlikely that I have HIV based on the testing. I am worried about Herpes and HPV(warts.) I've been having sex with condoms with my wife for the last 2 months and avoided sex as much as possible. I told her I don't like pulling out and like finishing in the condom. She is noticing my distance and knows something’s  going on with me. I asked for Herpes testing and was told the "panel" was type specific and would tell if there is old or new infection. Based on what I've read testing doesn't seem like a good idea but I can't stop thinking about it. Based on my history how should I move forward? I’m afraid of making my wife sick yet I kind of have to try and get back to normal. Do I go back to unprotected sex with my wife? I'm I over thinking this. It's a one and done...never again. 

Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Welcome to our Forum.  I will try to help and hope that I can.  you have over reacted to the exposure you describe.  Most commercial sex workers do not have STIs (including HIV) and most exposures to infected partners do not lead to infection.  Were you my patient I would not have suggested PEP and am not sure I would feel it was ethical to recommend it following such a low risk exposure. Further, your tests now show that you were not infected and you have no signs of infection.  It is way past time for you to relax and move forward without concern.

As for herpes, had you had herpes you would have had an outbreak by now. 

Regarding HPV, most people your age have already had HPV (here in the U.S> more than 80% of adults have or have had HPV), the figure is even higher for Americans over age 40.  As already mentioned above, most exposures to infected partners, if yours was which you do not know, do not lead to infection.

It is time for you to move forward.  There is virtually no chance that you are now going to transmit and STI to your wife and it sounds as though your guilt and anxiety are having a negative effect on your relationship.  If you cannot do this on your own and it sounds like you are having trouble, then my advice is to seek out and work through this with a trained counselor.  EWH

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46 months ago
Thank you. I appreciate your response and I take stock in your recommendations. Why is my doctor putting me through the ringer. No unprotected sex for 3 months testing and heavy drugs. The pep was hell on me physically and mentally. They seem all CDC'd up. Neither of the two doctors I've been seeing levelled with me on the actual risk or gave me any useful advice.

I did get back my 8 week results. All negative both Hiv combo and Igm and Igg  herpes plus all the other tests including Hep B and C. I no longer believe I have an STI but for argument sake can you explain to me what or how conclusive the herpes testing is from a medical standpoint at 8 weeks.  It there proof in that pudding or is it BS?

I think with so much hype about people not realizing they have symptoms, it make you second guess yourself and scares people searching the net for good information. Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago

Misunderstanding of STIs is not limited to the general population. Many health care providers also have little or outdated knowledge (there is only so much that you can teach in medical school and many studies show that sexual health is among the topics which are poorly taught).  Further, by their very nature, web sites need to give general, not person-specific information.  Be confident that your tests prove that you did not get HIV.  As for HSV, it can take up to six months for a blood test to become positive.  That said, given the rather low risk nature of your single exposure and your current test results, I urge you not to worry further about HSV or other STIs and to move forward with your life.  If you feel strongly about repeat testing, PLEASE DO NOT repeat the herpes IgM test.  Even with a negative test, your odds of having a false positive test next time are far higher than your risk of getting herpes.

Take care.  EWH. 

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46 months ago
If you could clear up one more thing for me. Since week 3,  I've been experiencing mouth sores on my tongue tip and a little up the sides. Not on the lip at all.  My infectious disease doctor said it was not related random canker at 4 weeks.  At about 6 weeks I saw a Dermatologist and he didn't see anything that looked  STI related.  At 8 weeks the doctor who did that round of testing said cankers. It's actually gotten a bit worse in the last few weeks and resembles geographic tongue(from pictures i've looked up.  The sores are red with white mucus around them and have never been "open." They look worse in the morning when my mouth is slimy. My family doctor thinks it might be from GERD with acid reflux coming up at night to irritate the mouth but I did not tell her about my experience .  My question is if it were HSV or Syphilis would the antibody and RPR come back positive at 8 weeks? Would you recommend seeing and ENT or Oral Surgeon for evaluation.  I'd like to believe its unrelated but I still have doubt because I truly don't understand how these diseases present.  I will feel more comfortable when someone can tell me whats going on with my mouth or can rule out these infections. Thank you. I know your going to encourage me to relax and my chances of having an STI are slim but a little more information would be great.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
If you had sores of the sort you describe and they were due to syphilis or herpes, the blood tests would be positive at the time you tested.  From what you tell me, I agree the doctors who have told you that these lesions in no way suggest syphilis or herpes.  EWH
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45 months ago
Well at 8 week I had IGM,  IGG-1 and 2 as well syph which all came back negative. At 12 weeks 4 days(Monday) I also tested as my doctor was trying to give me peace of mind. The results of the HSV IGM came back positive 2.2 and the IGG1 ad IGG2 both came back negative. The IGG HSV2 was asctually lower than the 2 previous test at 0 weeks and 8 weeks.

Obviously I'm concerned. But from what I've read the IGM is not to be trusted but it still leaves me with anxiety and worry. The test was not a "Herpeselect."  My doctor has me going for another sampling today which is 13 weeks exactly and going to quest for an actual "Herpeselect." She said clinically I have no outbreak and the test results are contradictory? She wan't to see a real Herpesselect. 

I don't know how to feel at this point. Isn't a negative HSV2 IGG at 12 weeks like 98 percent accurate?   What picture does this paint?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Our Forum Guidelines allow up to three replies to a client’s questions.  You have received three answers and this will be my final, brief reply.  I hope my comments and the information I have provided has been helpful. 


Your experience is precisely the reason we recommend against blood tests for herpes and particularly against IgM tests.  False positive tests are common.  If your repeat IgG is still negative, this is proof that you did not get genital herpes. 


My concluding recommendation is the same as I made with our initial interaction -"It is time for you to move forward.  There is virtually no chance that you are now going to transmit and STI to your wife and it sounds as though your guilt and anxiety are having a negative effect on your relationship.  If you cannot do this on your own and it sounds like you are having trouble, then my advice is to seek out and work through this with a trained counselor.


This thread will be closed later today.  Take care.  EWH


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45 months ago
Thank you Dr. Hook.