[Question #2138] Worried about possible exposure

47 months ago
Hi doctor
I am extremely worried about an encounter 5 weeks ago. I am a 26 year old male and While on a stag party to England I got extremely drunk and ended up visiting a prostitute. I received protected oral for maybe 15 minutes. I did not ejaculate, in fact I lost my erection near the end as I was so drunk. Since my exposure I have started developing hives all over my body, started 4 days after exposure and have continued since. The started on my feet, and have moved to my arms and at weekend developed some on my backside. The only other symptom I had was peeing an awful lot the weekend after the exposure. Maybe 5 times an hour for the whole weekend but this has since ceased. I'm worried about any possible infection such as herpes, gonerhoea or even scabies. Does this sound like herpes? I'm living with my girlfriend and I'm extremely worried about affecting her. Any advice would be extremely grateful.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Welcome to the Forum.  The topic of what causes urticarial reactions (hives) and there possible relationship to recent herpes infections is an area of considerable research interest but little definitive data.  When acute urticarial occur in children, small studies have associated them with the acquisition of a number of different viral infections, most commonly other childhood viruses but occasionally with HSV-1 (the virus that causes cold sores) as well.  When this occurs however the diagnosis of herpes is usually apparent based on the presence of lesions or sores which can then be tested for the HSV.  If you do not have ongoing, obvious HSV lesions, herpes is unlikely as the cause of your hives. 

Many aspects of your situation make this sound like something other than HSV.  For instance, it sounds to me as though your urticaria ("hives") tend to appear for brief periods, then resolve only to recur.  If this is the case, such a time pattern would not be consistent with the presence of herpes since if herpes were present I would anticipate the lesions to appear and stay.  On the other hand, there are persons in home urticarial can come and go based on stress and emotions.   If there are not other sores or lesions, my advice would be to look for other causes of your urticaria. 

If you are still concerns about other STIs, I should point out that most commercial sex workers do not have STIs and oral sex only relatively rarely leads to infection.  When it does, the most common problems are either gonorrhea of non-gonococcal urethritis NGU) caused by mouth organisms introduced in to the urethra during sex.  Both of these infections would most often cause penile symptoms which it sounds as though are not present in you.

My advice regarding the urticaria would be to discuss this with your own doctor.  if there is not an obvious source for an allergic reaction, he or she may give you a try of antihistamines which can often help the symptoms even when the cause is unknown.  I hope these comments may be helpful.  If there are further questions we do permit up to two follow-up questions  EWH
 
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47 months ago
Thank you doctor for your quick reply. Just to clarify I have not had any hives on my penis. My exposure was protected oral and no lesions have appeared on my penis. 

The hives started first on my right foot got itchy for a day then just resolved into a red spot for maybe a week then disappeared. The same then occurred on my left foot. A hive appeared then on my arm but resolved within an hour or so and then just left a spot. Last weekend three or four hives appeared on my buttocks ( just above the bum crack) and spots remain. 

Would it be natural to get herpes lesions in these areas? The only started appearing after my encounter and given the fact that it was protected oral what are the likelihood of picking up something? 
Thanks again
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Thanks for the additional information.  When urticaria occur in relationship to viral infections, they may occur in areas of the body which may not be a site of infection but at a distant site other than where the infection occurs.  That said, the absence of any suspicious lesions for genital herpes make it unlikely that HSV is the cause of your urticarial.   As for timing, this may be coincidence or, as mentioned above, may reflect your emotional concerns relating to the possibility of infection, despite the very, very small probability that you were infected during the encounter that you described.  EWH 
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47 months ago
My final question doctor 
I went to see std specialist this morning and he had a look at the hives on my backside/bottom of back. He said they didn't resemble herpes and said herpes doesn't present itself as hives. I asked for him to do a blood test for herpes just in case. How reliable is this test 5 and 1/2 weeks after exposure. 

During my exam the doctor said my left tube is slightly swollen. He performed a microscopy on the penis and took a urine sample. He told me everything looked fine and expects everything to come back negative based on what he examined and my low risk exposure.

Also the doctor prescribed a weeks course of antihistamines to look the hives.

Therefore my question is how reliable is blood tests 5 1/2 weeks after exposure and why would my left trsticle tube be swollen if I had no infection or symptoms? What would cause this?
Thanking you in advance
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
At 6 weeks 60-75% of recent HSV-2 infections will be detected with a herpes IgG test.  The problem with such a test is that if you have a test, you will not know how long you have been infected (most people with herpes do not know it and if they learn about it, they do so after a blood test returns as abnormal) and the test has a substantial false positive rate.  Further, swelling of the "tubes" from your testical to your penis is not a recognized sign of HSV infection.  I really think you are worrying more than you need to about herpes or other STIs as the cause of your hives. 

As you know, this is the 3rd reply to your questions. Therefore, as per Forum Guidelines this thread will be closed later today and there will be no more replies.  If you have further, new questions you will need to start a new thread.  If the questions of related to herpes (which I DO NOT think is the problem, it would be best to direct that question to Terri Warren who also answers HSV-related questions on our site).  Take care.  EWH
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