[Question #182] herpes or other sti

37 months ago
On September 9 th I received unprotected oral sex from a transexual.  On the 10th we also performed unprotected oral sex on each other as well as genital rubbing and penis to analyze rubbing,  also unprotected.  On September 11th I started feeling an itch on my toe and behind my knee. This became a rash which I figured was poison ivy. This rash oozed but was only itchy and not painful.  It cleared up in about 10 days. I had no symptoms in the boxer area. 1.) Could this be herpes-2   2.) What are the risks involved with this type of sexual encounter? The penis rubbing was for only a minute or two. I did not see any visual signs of hsv on her/him. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
Could this be herpes?  Yes though unlikely.  But if it is herpes, I think it is unlikely to be from this encounter.  First, if you got new herpes from this encounter, I would expect the first symptoms to be on your genital or mouth area, not behind your knee.  While recurrences of herpes could show up on the back of the knee, the first infection is most likely to appear at the site of the virus entry into the body.  While I have seen recurrences of genital herpes behind the knee, I have seen it perhaps five times in 33 years of practice.  Unusual.  I think it is far more likely to be something unrelated to this encounter.  If you get it again, I would certainly suggest that you have it evaluated by a medical professional but again, unlikely to be herpes.  The risks from the encounter are mostly associated with the oral encounter, not the minute or two of genital to genital rubbing.  the greatest risk of the oral encounter is acquiring HSV 1 genital infection - the cold sore virus.  have you ever in your life had a cold sore?  If yes, then it is extremely unlikely you would acquire HSV 1 genitally subsequent to having cold sores on your mouth.  And if you did acquire HSV 1 genitally from the oral sex, I would certainly expect you to be symptomatic by now.  If you already have HSV 2 infection, you would not acquire HSV 1 after that.  And if you had no history of cold sores or HSV 1 infection, I would expect your genital symptoms to be rather remarkable as this would be your first ever infection with HSV 1.  So in summary, I think you're good.  If you ever get the rash again, have it checked out. 

Terri
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37 months ago
Thank you Terri. Everything I read is that herpes and poison ivy are very similar in appearance.  Is this true? I have no history of cold sores that I know of. I have never been tested. I also read that the herpes outbreak can occur anywhere on your body including the feet. Some of this information is so confusing maybe I was misled. Do you feel I would be putting any other sexual partners at risk at this time? I also felt that the 24-48 hr time period was a little quick to have oozing blisters?  Also are you saying that a first outbreak at this location is highly unlikely.  I was with the same person for over a year before this with no symptoms.  What else could have a weeping rash like this?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
Herpes and poison ivy are very similar in appearance, yes.  Have you been somewhere where you might have picked that up? 
Again, if the blisters were herpes, the circumstances are not appropriate for it to have been acquired from this partner so the timing is not important here.  Yes, a first outbreak in this locatio is very unlikely.  As you say, it could have been poison ivy.  Can you please describe the rash more fully to me?  Size, presentation?

Terri
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37 months ago
On my big toe it was a raised line almost with two bumps that where very itchy.  The puss came from the bumps. On the back of my knee it was two patches maybe the area of a golf ball but not round. One patch on both sides of my back right knee right above the bend that where raised red with oozing almost hard spots and oozing right away. Like I said it wasn't that uncomfortable just itching from time to time. There was some scabbing from my itching it a lot I believe. When the oozing stopped there was still a red raised patch for some more time that still itched. When I put steroid cream on it, it would not itch. What are the possibilities that I had never had symptoms before (or didn't notice) and it was dormant and this is where it showed itself. Also if I've never had hsv-1 cold sores and contracted it from receiving oral where would the outbreak occur? 
37 months ago
I had been in an area on my lawn that had not been mowed in sometime the night before. I have since mowed but don't see poison ivy. That us what made me curious.  I first got the itchiness while I was on a road trip the next day. I really didn't think much of the rash until I started reading online and realized how close it was to the sexual encounter. 
37 months ago
I don't recall actually seeing blisters, just feeling the oozing.  I've had poison ivy before that's what it felt like. The way I'm describing it may be off too, because like I said I wasn't to concerned at the time. 
37 months ago
My skin is very sensitive to things like that. And bug bites, and detergents. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
37 months ago
So Gregory, your subscription to this forum provides for three posts but I'm going to try to answer all of them together now but you can't post any more without renewing your subscription.  It's very unclear to me what this might have been but if you were my patient, I would ask you to get an IgG HSV 1 and 2 antibody test to rule out herpes in this situation.  I think it is far more likely that you got into something you were allergic to but I would want to know for certain that this was not herpes.  You can order this yourself online at any number of services.  Do NOT get IgM testing.  The false positive rate for the test you are going to get is about 2.8%, so very small.  And we can always sort that out with a second test. 

If you got HSV 1 from receiving oral sex, it would show up on the penis (or anus if it was analingus). 

That's all for now, if you have more questions Gregory, just renew.

Terri
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