[Question #1808] HIV / STD confirmation questions

81 months ago
Hi Doctor,

About 7 months ago I visited a strip club (end of July, 2016). I had a private dance in which there was bare genital to genital contact (no penetration). At about 2 weeks I noticed a small lesion on my genitals, but had forgotten about it until around week 12 at which my GP prescribed me Acyclovir - tablet and ointment. I used both for about a week before the lesion had cleared up. 3-4 weeks after that I decided to get tested for everything and did a 10 panel STD test. To be clear the tests were taken exactly 110 days after the incident in the strip club.

I came back negative on all fronts except for HSV-1. The type of HIV test included in this panel was the 4th gen ag/ab duo test. 

At about 6 months I developed a cough. At 7 months now, I have other symptoms include red dots on tip of tongue and sensitive skin on chest and back of shoulders. I say sensitive because the skin looks normal, but becomes read very easily during workouts and when rubbed or pressed on.

My questions are:

1) I have read that my exposure was no/low risk for HIV. Does the fact that I caught herpes increase those risks?
2) Is my one 4th generation duo test at 110 days conclusive? Do I need to take another test to confirm these results? Would Acyclovir alter the results?
3) Is there any possibility I have HIV or any other STD? Or is the 10 panel test at 110 days confirmatory? 
4)  Would you warrant (outside of herpes) I can be unworried and have unprotected sex with my girlfriend?
H. Hunter Handsfield, MD
81 months ago
Welcome to the forum. Thanks for your question.. Thanks as well for researching your question (either on this forum or elsewhere) before asking it.

My first comment is that you do not necessarily have genital herpes; and if you do, not necessarily from the strip club event described. Two weeks is late for onset of new herpes, and a single lesion also is uncommon for the initial infeciton. Exactly where was it on your genitals (penis? scrotum? other?). Also, the wording suggests the lesion might have been present (more or less unchanged?) for 10 weeks before being examined by your GP. Or do you mean it went away and then reappeared? A continuous lesion that long is extremely unlikely to be herpes, although a recurrent one is more consistent. Also, what was the nature of these lesions? Herpes would start as a red bump, within 1-2 days become blister-like with clear fluid, then maybe pimple like (with pus), then an open sore, then scab and healing -- all over a period of 1-14 days. Any other appeance or pattern is atypical for herpes.

Also, in the US 30-60% of adults (depending on race, geography, and other factors) have positive blood tests for HSV1, usually from childhood infections and usually without symptoms. So your positive blood test doesn't necessarily have anything to do with your strip club adventure or the genital lesion. However, if you previously have had a negative HSV1 test, that would increase the likelihood of a new infection sometimes between that test and the recent one.

To your specific questions:

1) There was no appreciable risk of HIV from this exposure, even if you acquired herpes at the time. In any case, how high the risk of HIV was at the time is irrelevant, because...

2) ...your HIV test is conclusive and proves you were not infected. There are no illnesses or drugs (including acyclovir) that alter the reliability of the 4th generation HIV blood tests, which are 100% conclusive 4 weeks or more after exposure, and once posiitve remain positive for life.

3) Given the combination of low risk of the exposure plus negative test results at almost 4 months, you can be 100% confident you did not acquire any of the infections included in that test panel.

4) There is no STD related reason not to continue unprotected sex with your regular partner. And perhaps not on account of herpes either, as discussed above. Finally, even if you have genital herpes, your partner probably is at little risk. Unlike genital HSV2, HSV1 recurs infrequently and has little asymptomatic shedding, i.e. little potential for transmission between outbreaks. Nobody wants GH, but if it happens, HSV1 definitely is the preferred type.

Returning to the herpes issue, I would advise remaining off acyloclovir or other anti-herpes drugs. If and when a new lesion appears, see a doctor ASAP (within 1-2 days) so the lesion itself can be tested for HSV, preferably by a polymerase chain reaction (PCR) test. Also, in the event you ever develop a typical oral herpes outbreak (cold sore, fever blister) that would tend to confirm your positive HSV1 blood test is from a distant past oral infection, and unrelated to the strip club exposure or your penile lesion.

In the meantime, I may have more comments if you would like to fill in some of the missing information about the genital lesion.

Best wishes--  HHH, MD

81 months ago
Hi Doctor Handsfield,

Let me first say that I really appreciate your detailed explanation of all of my concerns and questions. All of that information is extremely helpful and clear. 

To be clear, the lesion was on the shaft of the penis. I remember seeing the lesion sometime in the first week, but at the time it was just a small red mark so I thought it may have been a scratch or a minor irritation. At around week 2 it became inflamed and more like an open sore type lesion. When it was like this it caused a stinging or burning type pain. Then it would heal and become slightly scab like.  Also, it wasn't there for the entirety of the 10 weeks. It would become inflamed rarely during workouts and also during protected sex with my girlfriend. We were living apart at the time as I was temporarily out of state for work. It was after a weekend of her visiting at that 10 week mark that I realized that it was continuing to come back and I needed to get it checked out. To me, it looked like one lesion, but my GP said that he thought it was herpes due to the fact that he could see a bunch of small sores making up what looked like the one sore.

I had never tested for HSV-1 before that and don't know if I had it prior. I also have never had cold sore or fever blisters in the past. I read that chicken pox virus is often mistaken by blood test for HSV-1, not sure if its relevant, but I have never had chicken pox.

I only took Acyclovir for about a week and haven't taken it since. I have not had another outbreak since and actually got a pretty bad cold just before Christmas (I heard outbreaks typically occur when you are sick or stressed). 

I really appreciate your explanation of everything. I had become fairly stressed recently after I started to search the internet and ran into a bunch of sites leading to  HIV. After that I just started to get into my own head.  I am glad to hear that HIV is not a concern and that my 10 panel test was conclusive for all other STIs as well.

I appreciate any further comments in regards to my herpes issue.

H. Hunter Handsfield, MD
81 months ago
Thanks for the more detailed description. I would summarize the overall picture as consistent with genital herpes but not typical. That said, I cannot judge your GP's description: true that multiple lesions would support herpes. However, another fator is that you only mention genital-genital contact with the stripper, not oral sex. As just discussed, if you have genital HSV1, the risk of transmission to your gf will be low:  and for exactly the same reason, genital contact with the stripper carried little risk of HSV1. It's possible, especially if she happened to have an active herpes oubreak at the time. But in my 40+ years in the STD business, I have never seen a patient with genital HSV1 that appeared to be acquired by genital exposure; every case appeared to be from oral sex.

The positive test has nothing to do with chickenpox (infection with varicella zoster virus, VZV). Some non-knowledgeable physicians and labs sometimes attribute apparent false positive HSV antibody test to past VSV, but it simply isn't true.

And something I didn't mention above is that if this indeed is herpes, I would be more suspicious you caught it from your regular partner, especially if oral sex is among your usual sexual practices. Statistically, receiving oral sex from a regular partner, even though not know to have oral herpes, is a far more likely source of genital infection than is a single genital exposure with a new partner.

Recurrent oral herpes indeed is often triggered by other infections, which of course is where "cold sore" and "fever blister" come from. However, there is no good evidence that these things trigger recurrent genital outbreaks of either HSV1 or HSV2. It might happen, but has not been scientifically studied or reported. (But stress for sure doesn't do it. Despite claims by many people with recurrent herpes, oral or genital, research has been done and found no reliable relationship with stress, anxiety, or other psychological determinants.)

In addition to my advice above about lesion testing if it reappears, you might consider discussing this with your regular partner. You can do so in good failth without mentioning the strip club event. Tell her you may have developed genital HSV1; although not yet confirmed, it could either be your first recognized outbreak of a longstanding infection from some past partner; or that it's from her, your gf. She could then have a blood test for HSV1 antibody. The result, positive or negative, will confirm either of these origins, without implying a new sexual partnership on either your part or hers. (Of course such a discussion might lead to revealing other partners, by either or both of you. As you know, even committed couples who are temporarily separated sometimes have outside hook-ups, so maybe none of this would shock or surprise her. But you know her and your relationship, and I don't.)

In any case, for sure you can put HIV to rest. Regardless of risk at the time of exposure, your blood test is conclusive.

81 months ago
Once again, thank you for providing such a detailed response. It is so helpful and clears a lot of things up for me!

I certainly did not have any sort of oral sexual contact in the exposure described at the strip club. It was a 2 minute private dance that I unfortunately let the woman take a little too far by creating bare genital to genital contact.

 My GP stated exactly what you did though. He said it was unlikely caused by the exposure at the strip club (however he made it clear that it was still possible) and more likely came from my current partner or a past partner. He said that if it is HSV-1 (which he believed it to be due to my lack of other symptoms that he mentioned sometimes come along with HSV-2) than it was more than likely caused by an oral sexual exposure from current or past partner.

I had mentioned the recurrent sores after sex with my partner and so as soon as the doctor said it is probably herpes, I informed her. She understood that it could be from a past partner or even from herself as she isn't sure if she has the HSV-1 virus. She was very understanding and supportive when I told her, which was helpful in wrapping my head around it and being at peace with it when my GP first diagnosed it (it first came as a bit of a shock as I have had a low number of sexual partners in my lifetime and have always been pretty smart about using protection). 

My biggest fear was definitely other STIs (especially HIV) so I am happy that I can put that to rest. Thank you for all the feedback and information, you have definitely provided me some clarity and peace of mind. I have been battling with some anxiety with this for the past few weeks, but wasn't sure if it was worth the time and money to get tested again.

Thanks Doctor Handsfield!
H. Hunter Handsfield, MD
81 months ago
Thanks for the follow up information. You are doubly fortunate in having both an understanding and seemingly level headed (and caring) partner, and a GP who seems to understand genital herpes better than many do. Many (most?) general physicians are unaware of the clinical differences between HSV1 and 2 and many also have incomplete understanding of transmission risks and diagnosis.

Anyway, glad to hear all is well in regard to herpes. And certainly there is no need for any further testing for other STDs.

That completes the two follow-up comments and replies included with each question, and so concludes this thread. Best wishes and stay safe!