[Question #155] follow up question with Dr Handsfield [Question #144] Herpes and HPV concern

37 months ago
Dr Handsfield, I have purchased a new thread following our previous brief posts because I was hoping you would be able to relief my anxiety and paranoia. I have made a few changes to the original thread below:

I was tested negative for all STI before this recent encounter. I am a 22yr old male and had sex with a 29yr old asian female, we had approximately 5 unprotected oral sex (me receiving the blowjob) and 10 protected vaginal intercourse within the span of 7 days. During vaginal intercourse, the condom occasionally stretched and slipped up but my penis head was definitely covered. She squirted multiple times during the encounter. I ended the affair and am worried that I might be infected with incurable HSV1/HSV2 and HPV during this encounter. It has been 6 days and I'm paying very close to my genitals due to anxiety. My genitals itch occasionally due to pubic trimming and there seems to be 1 red bump 5cm below my belly button which I suspect is due to ingrown hair, no other symptoms. There are no visible outbreaks on the woman's lips and genitals during the whole time. I'm very paranoid and anxious atm and the GUM clinic in London only offers Herpes test if blisters are present. I do taste metallic similarly to the taste of blood while making out with her. I really hate how I get so paranoid after each new sexual encounter and googling for answers only exacerbates the situation. I only wish to trust your professional opinion. So,

1) We did make out a few times during sex, what are the chances that I'm infected with oral herpes HSV1?

2) Are the transmission of HSV1 and HSV2 

3) What are the chances that I'm infected with HPV?

4) What are the chances that I'm infected with genital herpes HSV2?

5) Are the chances of me not being infected at all good enough so that I do not need to go get tested? 
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago

Welcome to our Forum Greg.  As you were already told, clients do not get to choose whether Dr. Handsfield or I answer their questions as we do so depending on our availability.  I will try to answer your specific questions below but, as Dr. Handsfield has already warned you, my answers will not be substantially different from those you have already received.   In addition, I want to point out that you have already done the right things in using a condom during your contact with this partner and by getting evaluated in preliminary fashion for other STIs.  I should also add that when it comes to viral STIs, in that you have had three prior partners it is highly likely that you were already infected with HPV (over 85% of sexually adults have HPV) and that the chances are that you already had HSV-1 before you began the encounter you have described- over 60% of adults have HSV-1 and the majority of those with infection do not know it.  With this background let me reply to your specific questions.

1) We did make out a few times during sex, what are the chances that I'm infected with oral herpes HSV1?
See above.  Statistically it is likely that you, like most adults, already have HSV-1.  If your partner did not have a visible cold sore, it is unlikely that you acquired a new HSV-1 infection.  As Terri has already told you, there are no good statistical data on the risk of getting HSV-1 from kissing someone.

2) Are the transmission of HSV1 and HSV2 
This question is not clear.  If you were going to develop symptoms of genital herpes related to the exposure you describe, the majority of symptomatic infections are apparent within two weeks of exposure.

3) What are the chances that I'm infected with HPV?
You are a sexually active adult who has had 4 past partners.  you probably have HPV.  That should not concern you and you do not need testing.  If a sore or lesion appears, you should have it professionally evaluated.  Given your concerns, you may also want to seek the HPV vaccine to reduce your risk for acquisition of new HPV infections in the future- it is highly effective for prevention of acquisition of new HPV infections and the current vaccine protects from 9 common HPV types including those that cause most genital warts.

4) What are the chances that I'm infected with genital herpes HSV2?
You used a condom and do not have lesions at this time.  the likelihood that you acquired infection from this encounter is very low. 

5) Are the chances of me not being infected at all good enough so that I do not need to go get tested? 
You indicated in your earlier question to Terri that you had already been tested for common STIs.  if that is the case, there is no need for further testing.  If you were not tested, testing might help provide you with peace of mind.  I doubt that you were infected and would predict that if you test, the tests will be negative.

I hope these comments are helpful.  Please try not to worry or to overthink this.  EWH


---
37 months ago
Thank you Dr Hook for the reply. I would just like to add a few follow up questions to consolidate my enquiries. 

1) You strongly doubt I have acquired oral HSV1 during this encounter even though I tasted metallic , what is the most common way of being infected by HSV1 through kissing?

2) If I was indeed infected by oral HSV1, what are the symptoms? I worry that my symptoms may be asymptomatic

3) Based on what I've described, did I use the condom correctly? since the tip stretched and the condom base slipped up a few cm.

4) I was tested BEFORE this encounter and was tested negative for all STI (except HPV), my biggest fear for now is to contract HSV1/2 and HPV since condoms do not protect. In your professional opinion, on a scale of 1-10, how strongly do you believe that I did not acquire any new STI?
Edward W. Hook M.D.
Edward W. Hook M.D.
37 months ago
1) You strongly doubt I have acquired oral HSV1 during this encounter even though I tasted metallic , what is the most common way of being infected by HSV1 through kissing?
Correct.  There is no evidence to suggest that a metallic taste present during kissing is indicative of HSV or any other infection.  Direct lesion tact (I.e with a visible sore) appears to be the most common way of acquiring HSV-1.

2) If I was indeed infected by oral HSV1, what are the symptoms? I worry that my symptoms may be asymptomatic.
Cold sores are the most common symptom as Terri has already told you.

3) Based on what I've described, did I use the condom correctly? since the tip stretched and the condom base slipped up a few cm.
Yes you did.   Condoms commonly slip down during sex.  As long as the tip of your penis is covered, the condom is being used correctly.

4) I was tested BEFORE this encounter and was tested negative for all STI (except HPV), my biggest fear for now is to contract HSV1/2 and HPV since condoms do not protect. In your professional opinion, on a scale of 1-10, how strongly do you believe that I did not acquire any new STI?
Sorry, I mis-understood about your testing.  Condoms DO reduce risk for HSV and HPV although the reduction is not 100%.  In general, your risk of having acquired any STI from the encounter you describe is very low a 1 out of 10 chance at most.  We do not recommend routine testing for either HPV or HSV.  The tests do not provide useful information to asymptomatic persons (because HPV is so common in the case of HPV and because there are frequent false positives for HSV)
EWH

---
37 months ago
Thank you very much Dr Hook for your insightful reply. Finally, I would want some final clarification for future references so that I would not live in fear anymore after future sexual encounters. 

1) If I do not have cold sores 2 weeks after my last encounter, can I confidently say that I'm not infected by oral HSV1?

2) I am anxious after every new encounter because information on the internet is inconsistent and daunting. But I do have a lot of faith in you and Dr Handsfield. I do still want to have a number of flings ( 1-5 sexual intercourse per fling) before I settle down with a monogamous relationship. From what I do know, if i continue having protected sex, unprotected oral, making sure the woman (unknown STI status) doesn't have any visible symptoms on genitals/mouth area during sex, I should be able to live a worry free life without the fear of catching any new STI since the odds significantly favours me? Because I feel so foolish for wanting to get tested after every new encounter whilst some people are having sex everyday without a single worry.

3) Would you say condoms are very underrated? since the internet kept emphasising how it doesn't protect you from herpes and HPV but based on you and Dr Handsfield expertise, it provides 90% protection for every single encounter, which meant that if i use a condom correctly 100% of the time, it's very unlikely that I would be infected by herpes and HPV even though I have sex with alot of women. People who catch these infections are either having unprotected sex or constantly having sex with a long term infected partner.

4) Incase you close the thread after your reply, I just want to thank you Dr Hook for your expertise, I really appreciate the work you and Dr Handsfield do. I don't know why but I feel my world is crumbling down after every new sexual encounter since certain viruses such as herpes is INCURABLE. A few minutes of pleasure could result being infected by an incurable infection is just unfair. Any final advice for me Dr Hook?



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

Thee will be my final responses.  As you know, we permit three follow-ups. 

1.  You can be confident that you did not acquire oral HSV-1 from the encounter you have described.

2.  Nothing is 100% but the steps you outline are a great way to minimize the likelihood of infection.  The internet is NOT a reliable source of information

3.  Yes. In general, condoms are the best single preventative measure we have.

4.  Thank you for your thanks.  My only advice is to continue to do what you are doing, to occasionally (not after every exposure) get screened (tested in the absence of symptoms) have STD screening performed (every 6 months to year as you accumulate new partners) and finally, to not worry quite so much. 

Take care.  the thread will be closed now EWH

---