[Question #166] final assessment

97 months ago
Hi. This is my second post in this forum and I believe I have already received excellent advice from Dr. Hook. (subject was risk assessment/symptom question 108) I am also currently in correspondence with Nurse Warren, and the following is the link to the thread I started on her forum: 


since I've already corresponded with two experts, I'd really appreciate it if Dr. Handsfield could provide some input to my situation. I apologize as I know this is poor etiquette, and I will gladly wait until Dr. Handsfield is available to respond. (my anxiety is just fairly high at this point and I'd love to have the expertise of all the experts applied to my situation)

I started feeling symptoms 6 days after my exposure (which is written out in full both in this and terri's forum) and they are a tightness/ache in my right lower back/hip/buttock/leg that is experienced from morning till night. this leg feels slightly (but noticeably) weaker and stiffer in comparison to the other. in addition, I experience an icyhot burn on the back of my right buttock/thigh when sitting for a certain period of time. generalized slight lower back pain as well (I sit all day for work and drive a long distance) and skin sensitivity on my right leg to heat and cold. random muscle twitching in right leg and foot as well when sitting still. I also experience random stinging pains on the back of my right thigh when sitting but this is most likely psychosomatic and only lasts for a couple seconds at a time. I had a sight burning sensation when urinating for the first couple of weeks but that went away and was followed by constipation for the next couple weeks. I tested negative for all STIs including HIV 4 weeks post exposure. my exposure was 9 weeks ago and these symptoms have persisted for 8 weeks. I have had no noticeable lesions or sores on my genitals/genital area. I tested negative for hsv1 and 2 at 4 weeks and tested negative again for hsv1 and 2 at 7.5 weeks post exposure. my questions are as follows:

Do you think my exposure put me at a meaningful risk for contracting herpes?

Are my persistent symptoms indicative of a herpes infection?

Are my test results encouraging at all?

Thank you so much for your response, doctor. Your time and advice truly means a lot to me.
H. Hunter Handsfield, MD
97 months ago
Welcome back. Your request notwithstanding, it is by chance that I am responding and not Dr. Hook. Other users should not assume we respond to requests for one of us or the other. The reason we do not honor such requests is that there is never any material difference between Dr. Hook's replies and mine. We have been close colleagues and personal friends for three decades. Our styles differ, but not the essence of our scientific/medical expertise, opinions, and advice.

Based on that, it won't surprise you that after reviewing your previous discussion with Dr. Hook, I agree entirely with his replies.

Herpes doesn't cause the symptoms you report. You cannot read lists of herpes symptoms and conclude, if you have some of them, that you might be infected. It is not those individual symptoms that really matter, but the pattern and combinations of them. For example, herpes lesions may itch, and therefore genital itching is often listed as a symptom. But that doesn't mean that genital itching along suggests herpes. It almost never does, unless there are other symptoms as well. And there may be localized tingling or other sensations in the area where a recurrent outbreaks is about to appear (the prodrome), but not more widely; and pretty much only with recurrent herpes, not the initial infection. Not one of the symptoms you mention raises any particular suspicion of herpes, which does not cause the various itches, burning, stinging, etc that you describe -- especially in so many locations. Further, herpes symptoms do not persist for weeks on end. HSV related symptoms always come and go, typically lasting 1-2 weeks, no more often than once every 4-6 weeks, and between those times there are no symptoms at all. So all by itself, your 8 week duration means herpes is not the cause. Finally, although it can take 12+ weeks for HSV blood tests to become positive, they are almost always positive within 2-4 weeks of onset of herpes symptoms. Therefore, your negative resutls at 7.5 weeks are strong evidence that HSV isn't the cause of any of them.

In addition, the exposure as described in your previous thread (#108) was low risk. The average transmission risk from a single oral sex exposure to a woman of unknown HSV status is probably no higher than 1 in a thousand for HSV1 and zero, for all practical purposes, for HSV2.

Accordingly, based on the exposure and your symptoms, I would have recommended against HSV testing. But now that you have started down that path, you probably should finish -- not because it is medically necessary or that there is any chance you were infected, but only because it will probably drive you crazy to not have as definitive a test result as possible. So go ahead with a final HSV blood test at 16 weeks. You can expect it to remain negative. 

Those comments address your three suspecific questions. But to be explicit so there is no misunderstanding: the answers, sequentially, are no, no, and yes.

I hope this has been helpful. Best wishes and stay safe--  HHH, MD

97 months ago
Thank you so much for your timely response Dr. Handsfield. What concerns me is that these symptoms started a week after my exposure and are unilaterally focused on the right side of my body - lower right back ache, stiffness/ache in my right hip/buttock/leg and a icyhot burning sensation when sitting on my right buttock and back of my right thigh. skin sensitivity to heat/cold localized to my right leg as well. In regards to my exposure, it was condom protected oral sex. however, as I am uncircumcised, an abrasion occurred near the head of my penis due to friction from the act. this abrasion was under the condom; however, I forgot to immediately remove the condom and simply put my penis back in my pants, allowing fluids from the outside of the condom to contact my boxers and thighs. I eventually pulled the condom off and went to sleep. My fear is that the fluids from the outside of the condom remained on the insides of my boxers and thighs and entered via the fresh abrasion I suffered, therefore infecting me. My symptoms are noticeable from the time i wake up - mainly the right leg weakness/stiffness, and continue throughout the day, causing the burning during sitting and random muscle twitches. I have not had any type of lesion or sore whatsoever. 

Does this information change your thoughts on my situation?

Do you know anything else that could possibly be causing my symptoms?

Should I relax and stop thinking herpes is the cause of what I'm feeling? My anxiety since exposure has been off the charts.

Once again, thank you so much for your expertise and time. I truly appreciate it.
H. Hunter Handsfield, MD
97 months ago
"Does this information change your thoughts on my situation?" Nope, definitely not. With rare exceptions, herpes isn't transmitted by simple contact of secretions with intact skin. The virus must be massaged into susceptible tissues, which is why the lesions of primary herpes are almost always concentrate at the sites of maximum friction during sex: penis, vaginal opening, labia minora, etc.

"Do you know anything else that could possibly be causing my symptoms?" I believe your symptoms are mostly, if not entirely, due to anxiety over the sexual exposure, which you obviously regret.

"Should I relax and stop thinking herpes is the cause of what I'm feeling?" To the extent you can, that is exactly what you should do. And swear off any searching of the internet about herpes, symptoms, and transmission. If you find you still cannot let it go, in view of the repeated, reasoned, science based reassurance you have had from me, Dr. Hook, Terri, and probably your own doctors -- and especially after you get your final negative test result -- then professional counseling would be a logical step. I suggest it from compassion, not criticism.

Thanks for the thanks. Take care.
97 months ago
Hi Doctor, once again, thank you for the response. You made the statement that contact with infected fluids doesn't cause infection when exposed to intact skin, however in my situation, saliva could have made contact with the abrasion i suffered near the head of my penis during the act. I did not clean the area at all before falling asleep, and this is what worries me, as infectious saliva left from the outside of the condom on my thighs and boxer shorts could have seeped into the wound. As a final question, does saliva transmit HSV or is direct contact with a lesion necessary to spread infection?
H. Hunter Handsfield, MD
97 months ago
This also does not change my opinions or advice. Saliva is an unlikely vehicle for transmission. It is time for you to ignore any more "what if", "yes but", or "could it happen" thoughts. Trust me on this: There is nothing else you will think of that will change the fact that you don't have any STD from the exposure you are concerned about, and nothig you will think of that would change that fact or our opinions. My suggestion now, as we close this thread, is to re-read all the replies you have had, on all threads here and on the Westover Heights forum, and concentrate on them. Believe every word. 

That ends this thread. Please do not start a new thread on this forum about this exposure or your concerns related to it. It would be deleted without reply (and without refund of the posting fee). Finally, re-read my comment above about counseling. Best wishes to you.