[Question #2012] Scared of incurable STDs (herpes, warts, molluscum, HIV)

48 months ago

I am a homosexual man. Throughout the years were numerous encounters with others in bathhouses and with gay male escorts. Protected anal and me being bottom all the time. Orally I gave blowjobs without condoms; 1-2 time(s) I received blowjobs without condoms but I pushed away guys after less than one minute or two because of fears of herpes and warts. Hand-to-genital mutual touching and contacts or maybe genital-to-genital contacts (less often) happened - may involve exchange of fluids though I tried to be as careful as I could be. Sometimes I involved in annilingus and I was a giver (mostly to the escorts). I am positive HSV-1 (proven by PCR test once) as I got mouth sores on lips since I was a kid. No known past history of confirmed vesicles/herpes involving my pubic and penile area to my knowledge up to this point - not sure about my anus though. I caught molluscum contagiosum (specialist doctor said I got it by the look of it, though the size of one molluscum was roughly the size of the rubber end of a pencil) in 2013/2014 - no relapse after cryo. I was vaccinated with Gardasil 4 (2015ish definitely after molluscum) despite my age (over 26). So far no history of genital warts up to this point - questionable if said 2013's molluscum would have been actually warts. Previous blood tests were HIV negative, HSV 2 negative, Syphillis negative.

 

Incident Saturday 15-Apr-2017 afternoon: I discovered one 1-2mm lesion (the count was one) suspicious of blister on the right edge of dorsal side of my penis during shower - water running from above down to pubic area made an odd sensation (no pain; not itching; alerting enough for me to examine hence discovery). I did not think it was acne or pustule. Out of the shower I did not feel any odd sensation nor any pain nor any discomfort. No other symptoms showed up. Date of last exposure with the guys in bathhouses and escorts was pretty much April before 14th, but I did not do any anal (either top or bottom) in April 2017 and I did not receive any blowjobs. Much of the exposures were via hands, in addition to one watersport (the guy pissed on me) event.

 

Questions as developments progressed:

(1) I had to wait until Easter Monday 17-Apr-2017 when one specialist doctor (different from the one aforementioned - trained in dermatology and venereology) opened shop. He told me the surface of the lesion was intact and it did not look like blister (2-day lapse by the time he examined it - a big doubt if the questionable 1-2mm blister lesion (the count was one) would be healed when examination). He added the lesion did not show any disruption of the skin surface which was hallmark of herpes as he said. I asked if shower during the time (15-Apr and 16-Apr) would have washed off the blister/lesion, but he did not find any - he countered that with his experience he would have told me if he were to find any such thing. He suggested Foban cream on the skin lesion for 2 days in observation mode. Is the one lesion on Sat 15-Apr-2017 herpes? How to differentiate between herpes and other non-STD bump-like lesions? Could herpes exist as only one vesicle/blister (or at most two blisters)? Could shower wash off the blister so that all the evidence got washed away and cannot be readily sampled and examined by the specialist? There was a 2-day lapse from the onset to the consultation. Also, is disruption of the skin surface (I take it in the context of erosion in the context of dermatology) any hallmark of herpes? Or a necessary condition for the diagnosis to be established?

 

(2) I insisted on the HSV PCR test - but the lab was closed due to holiday 17-Apr-2017 here. The specialist could have taken the swab sample and could have stored it in the practice's fridge (domestic fridge) only to get it shipped off when the lab was open on 18-Apr. Specialist advised to test on 18-Apr because the test would then be based on the 'fresher' swab. I agreed to test on 18-Apr. Q: If the swab sample had been collected and put into the fridge (a domestic-ish fridge) for one day before being shipped off for PCR, any impact on the test results? For how much max time would the swab be stored in a domestic fridge? Please see if you can advise at what temperature the swab should be stored in the fridge in order to maintain the 'integrity' of the swab well enough for testing (and thus reliable result)?

 

(3)  So on 17-Apr-2017 after seeing specialist I went home, took one shower and lied on the bed to wait for the test. I observed there was one-or-two black spot over the skin lesion before the test. I went for the PCR test on 18-Apr-2017; there was not much left of the lesion – like almost healed; no blister seen; no erosion of skin surface seen; no scab observed; only a slightly raised surface. Specialist needed to prick the skin lesion by needle and swabbed the blood off from it for the test, because there was no observable blister to be popped by needle. Q: Does this one-day lapse make a difference in terms of PCR test result? Was there enough sample collected (sample now being blood oozing from the prick) for the PCR test? In your opinion, do you think that this PCR test was performed via swab testing positive an area that was symptomatic? Would the PCR test result be reliable?

 

(4) Overall I am very scared about getting HSV-2. From the forum you guys mentioned that positive HSV-1 serology would minimize symptoms (or severity) of HSV-2? And also you guys said that positive HSV-1 PCR test on my lips would make getting HSV-1 on my genitals (and here I also infer anal) being new location very unlikely? Could the duration of the possible HSV-2 genital and/or HSV-1 genital outbreak be as short as say 3-4 days and be lacking obvious symptoms (as described by pictures drawn from Google search)?

 

(5) How about watersports (I got pissed on)? I always think the piss from anyone with good kidney or liver function is sterile? Not much chance of getting any STDs (maybe except chlamydia or gonorrhea or non-gonococcal urethritis – I am not sure about these 3)? Please shed light.

 

I apologise for writing too much on this. But I am really scared – I am already an anxious guy. Please please please and many thanks.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Before I start answering your question, I would like to note that there is a word limit on our posts - I think you likely copied and pasted this and it's too many words - next time, please just type into this area - it will stop you when you have too many words.

Is the one lesion on Sat 15-Apr-2017 herpes? How to differentiate between herpes and other non-STD bump-like lesions? Could herpes exist as only one vesicle/blister (or at most two blisters)? Could shower wash off the blister so that all the evidence got washed away and cannot be readily sampled and examined by the specialist? There was a 2-day lapse from the onset to the consultation. Also, is disruption of the skin surface (I take it in the context of erosion in the context of dermatology) any hallmark of herpes? Or a necessary condition for the diagnosis to be established?

I have no idea if this might be herpes - herpes could exist as a single blister or two, yes, but  shower wouldn't wash off the evidence, no, it might take the top off the lesion but I think an ulcer beneath would remain until your appointment.  It is not necessary for skin disruption to have a diagnosis - we have blood tests that can diagnose without lesions - but it is a hallmark of herpes, yes, and I think the fact that an experienced clinician didn't think it was herpes is essential.

If the swab sample had been collected and put into the fridge (a domestic-ish fridge) for one day before being shipped off for PCR, any impact on the test results?

No,no impact - it is very stable for many days or weeks

 For how much max time would the swab be stored in a domestic fridge? Please see if you can advise at what temperature the swab should be stored in the fridge in order to maintain the 'integrity' of the swab well enough for testing (and thus reliable result)?

We have stored study sample PCR swabs in the refrigerator for a month without any loss of virus.  I think we kept the fridge at 4-8 degrees but that's been a while so that may be incorrect - you could look it up.

Does this one-day lapse make a difference in terms of PCR test result?

Maybe a little, but likely not much.  It is always best to swab a lesion as early in a possible outbreak as it can be done.

 Was there enough sample collected (sample now being blood oozing from the prick) for the PCR test? In your opinion, do you think that this PCR test was performed via swab testing positive an area that was symptomatic? Would the PCR test result be reliable?

I think the result would be reliable yes, but it seems unlikely it would be herpes if he had to prick the skin and got blood vs. swabbing an ulcer or a real water blister.  Now if the lesion was older than you think, the more time from the start of the outbreak, the less accurate the swab test - even PCR

From the forum you guys mentioned that positive HSV-1 serology would minimize symptoms (or severity) of HSV-2? And also you guys said that positive HSV-1 PCR test on my lips would make getting HSV-1 on my genitals (and here I also infer anal) being new location very unlikely? Could the duration of the possible HSV-2 genital and/or HSV-1 genital outbreak be as short as say 3-4 days and be lacking obvious symptoms (as described by pictures drawn from Google search)?

Yes, your having HSV 1 orally provides almost complete protection against getting it genitally.  an HSV 2 outbreak could be very short, yes, but not usually if it is your first infection.

How about watersports (I got pissed on)? I always think the piss from anyone with good kidney or liver function is sterile? Not much chance of getting any STDs (maybe except chlamydia or gonorrhea or non-gonococcal urethritis – I am not sure about these 3)? Please shed light.

Yes, urine is virtually sterile unless something has a urinary tract infection.  I doubt that you would get any of those three STI's even if he had it because you aren't saying that the urine went directly into your urethra, right?

Terri
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48 months ago
Hi,

PCR and HSV-2 antibody blood serology tests came back negative results.

How long would a herpes ulcer be healed? Could the whole episode from symptoms (ie prodrome feeling, blisters) to ulcers to healing be in 2-3 days?

You mentioned herpes being unlikely the result - did you think because HSV is usually not present in blood? My doctor told me the HSV travels from the nerve directly to the skin, so the virus is most likely to be found in the ulcer or fluids from the blisters. So, HSV, the virus, either type 1 or 2, is unlikely to be found in blood? How about if any virus in semen, pre-cum or bodily fluids (like urine, sweat, discharge)?

So the herpes transmission route is skin or mucosa, with the presence of lesions (like blisters and ulcers) or without (asymptomatic viral shredding), 'massaging' each other, so that the virus could land 'on' the skin or mucosa of another person, and travel to the nerve? This also applies to genital warts and molluscum too?

As for watersports, you meant to say that the most likely for the transmission to occur would be the urine directly going into the urethra? How about if the urine from the infected person lands on the glans and the area under the retracted foreskin?

I am planning to do the HSV-2 antibody blood test at one month and three month points to confirm further.

Thanks.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
48 months ago
Glad to hear your testing has been negative. 
It is unlikely that a herpes lesion, from prodrome to healing, would take only 2-3 days
Herpes is not normally present in blood, no.  Possibly with first infection, but even then, really unlikely.  That's why antibody test are done from blood, not a test looking for virus.  Virus is found in lesions, rarely in semen, urine or discharge and not in sweat.
Remember that most skin is too thick for virus to penetrate without an opening, except the think genital tissue or anus or mouth.  Wart virus and molluscum don't need an entry point into the body likes herpes does, no.
I don't believe there is a risk of transmitting herpes if urine from an infected person lands on the glans penis or the area under the foreskin - not enough virus, if any!

Terri
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