[Question #2358] Please help!

45 months ago
Heres my situation please help:

4/19 and 4/22 received protected oral from 2 asian escort in vegas.  My concern is they both licked/sucked my scrotum.  I could not see oral mouth sores but might have looked like dry lips.
4/30 noticed 1 pimple on bottom of scrotum.  This pimple was in hair follicle with long pubic hair.  I squeezed it and some clear/blood liquid came out.  Pimple wasnt really sore but was a little sensitive when found.
5/9 visited dermatologist and he gave me some acne cream (adapalene and benzoyl peroxide) to put on. I was worried it was std but he said no just a pimple.
From 5/11 to 5/19 after applying cream scrotum area where pimple found was clammy, sticky, itchy, and entire scrotum had icy/hot sensation (stress of hsv 1 kicked in).  Could be from acne cream?
5/19 call dermo again about my symptoms.  He calls in doxycycline 100 mg for 10 days and finish on 5/29.  
5/26 i go back to dermatologist panicking so he takes swab for herpes test.  
5/30 herpes swab test normal.  Pimple sore just about healed, now feels like small scar tissue lump under skin.  Probably not accurate because waited too long?
6/6 (about 6 weeks) i went back and got tested for syphillis, hiv, hep c, and hsv 1 and 2.  All negative
To present still experiencing sweating in groin area.  When in cold AC room standing my scrotum and anus area sweat a lot.  Also sometimes have slight cool sensations of testicles.  Notice testicles are cold when in hot area.

Questions:
Do i need to get follow up test since hsv was little over 6 weeks (read online testing is 12 or 16 weeks) from exposure?
Can you give me opinion on what i might have? 
Are my ongoing symptoms hsv? 

This stress is killing me and affecting my daily life.  Worried about giving wife std, telling wife, and losing marriage. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum. Thanks for your confidence in our services.

My first reaction is to congratulate you on having entirely safe exposures. Oral sex is safe sex, even without a condom. It's not totally risk free, but with far lower risks than vaginal or anal sex -- low risk for all STDs and virtually zero risk for some. And it sounds like most of the exposure was condom protected anyway. The part you are most concerned about is safest of all:  to the extent oral sex is a risk, it is generally because of exposure of the penis head and meatus (penile opening). Contact with skin of the scrotum is no different than kissing anywhere on the body, no risk at all. That your partner might have had dry lips makes no difference in risk. And none of the sympotms you describe sound suspicious for any STD. It would appear you talked your dermatologist into tests and treatments that really were not necessary. Had you been in my clinic, we would not have tested your for herpes, treated you with doxycycline, or done most of the tests you had. I don't mean to sound insensitive, but you have seriously overreacted to a zero risk situation.

To your specific questions:

1) You did not need HSV testing to begin with and do not need to waste more money on yet another test.

2) We cannot diagnose anything from afar. Clearly your symptoms are not suggestive of any STD. I would guess simply pimples, as your dermatologist said, plus various trivial or normal body sensations that you wouldn't have noticed except for your anxiety over some sexual decisions you regret.

From an STD protection standpoint, you should be continuing unprotected sex with your wife. If you have been holding off all this time, get started again now. There is no medical need to say anything to her about your sexual exposures or your symptoms.

I hope this information has been helpful. Best wishes and stay safe.

HHH, MD
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45 months ago
Thank you Dr. HH for your reply.  Just follow up questions and comments that you can kindly comment on.

I know you dont like what if questions but is a hsv 1 mouth sore visible all the time?  I didnt see any sores but could it have been right inside lip or on the tongue where i couldnt see?  If there was a present sore that i couldnt see do you still think i had no risk? 

My negative HSV 1 test also surprised me.  All this time i thought i already had HSV1 because i have these sores inside my cheek with clear liquid blisters every so often that i pop they fill up again and eventually go away.  My kids have sores clearly outside their lips when their resistance is low and we share drinks and food all the time.  They definitely look like cold sores that scab with puss.  I would assume they got hsv1 from me or wife.

My scrotum feeling sticky from sweating, cool/hot sensations, excessive sweating, cold testicles when in hot area convinced me that i have probably have hsv1 since this would involve the nerves which is what hsv uses?  Forgot to mention sometime i feel like groin and arm pit lymph nodes are tender.  Could that acne cream i used cause these symptoms or damaged my scrotum nerves?  The clammy feeling at location applied cream and scrotum burning sensation really scared me.  I also went to medhelp forum that you were involved in the past and found large threads where people have the same symptoms as me for years but blood test negative for months.  Living with these symptoms is very uncomfortable and stressful.

When looking over the other questions and answers  on this form i came upon this thread #2352 "HSV1 Positive".  Some symptoms are similar to mine and he is hsv1 positive.  Today this thread almost  convinced that my life is over.

So with all the above does your answer of no risk still remain?  I should go on with unprotected sex with wife with no worries and no further testing?  What if the symptoms continue what should i do.  I just dont want to hurt my wife.  I hope all my symptoms are stress related.  I just never had these symptoms before.  These past few weeks have been very difficult with crying nights and hoping this was all a bad dream. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
No, oral herpes sores recur an average of once or twice a year, but the virus can be presetn at any time; and many people with oral infections never have visible outbreaks. Oral herpes is often transmitted in the absence of visible sores. In other words, inspecting a partner for oral sores has absolutely no value in prevention.

Oral herpes outbreaks (cold sores) are outside the mouth, usually on the lips. Sores like yours, inside the mouth, are not cold sores and usually not due to herpes. You have had canker sores. But it sounds like your kids might have oral herpes. Up to 30% of people with HSV1 have negative blood tests, so you still might have the virus -- but it's not the cause of your canker sores. (And by the way, if you DO have HSV1 despite your negative blood test, you cannot catch it again. You're immune to new infections with it.)

No acne creams will damage nerves. I already gave you my best guess about your symptoms:  not herpes and very likely influenced by your anxieties about all this.

That you have symptoms similar to someone with documented herpes is irrelevant. I've had headaches, but that doesn't mean that when I read about somebody with headaches from meningitis that I have meningitis as well. Anyway, you have seriously misread that other thread. The whole point of that discussion (and two other threads by the same hyper-anxious user) is that his symptoms are NOT due to herpes. Just like you!

So these comments definitely do not change my opinions or advice. That you haven't had such symptoms before says nothing about their cause. Herpes simply NEVER causes symptoms like yours.

You came here for reassurance. I'm doing my best, based on the best science and my 40 years of experience. Do your best to believe it, suck it up, and move on with your life.

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45 months ago
Thanks again for your reply.  I will try to move on with the advice you provided.  But it will be difficult with the ongoing symptoms.

I feel like i am the unlucky one and got something from getting my scrotum sucked/licked.  I thought what i did was safe.  Regret of my life.

Yesterday i experienced dull pains in both testicles like they are being pushed up my scrotum sack causing stomach pain.  Also my scrotum was red shinny/glossy like the shinny slim a slug leaves behind on the sidewalk.

Symptoms to date:
1 pimple in hair follicle with long pubic hair
Burning of scrotum
Cold testicles when hot
Slight itching on sides of scrotum
Clammy area where pimple was after applying acne cream
Excessive sweating resulting in sticky scrotum by thigh, even in cold environment
Dull pain in testicles causing lower stomach pain
Red and shinny glossy scrotum
Dull pain in lymph nodes

What really scares me is the amount of people on other forums posting similar symptoms.  And  a lot of them after a sexual encounter.  It seems a few people found they were hsv1 positive only after getting a swab after immediate outbreak.  If no swab most of the blood test are negative.

It seems my only hope is if my wife already has oral hsv-1.  Im the worrier type so this stress will end up killing me.

Dr. HHH if someone had genital hsv-1 and location was at initial pimple near bottom of scrotum would outbreaks and shedding occur at that location only?  Or anywhere in genital area?  During sex if the location of initial pimple does not get in contact with skin or vagina would that prevent transmission of hsv-1?  Is my negative syphillis results conclusive?

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Herpes doesn't cause the symptoms you describe. Neither does any other STD. I already commented on the unreliability of symptoms posted by people who claim they have herpes causing the same symptoms. Re-read my reply above.

Here is how herpes outbreaks work:  1) They start with itching irritation in a particular spot and within 1-2 days red bumps then blisters develop. 2) Within another 3-5 days they turn into open sores that then develop scabs. 3) They heal entirely within 7-10 days. 4) After the sores heal, there are no symptoms. 5) Such outbreaks occur no more often than once a month. 6) Herpes never causes more or less continuous symptoms.

And since the contact was with the skin of the scrotum, herpes obviously could not have caused the pimple in your pubic area.

Really, this for sure isn't herpes. And even if it were, genital herpes due to HSV1 (the mostly oral HSV type) causes few recurrent outbreaks and is rarely transmitted to sex partners, because asymptomatci viral shedding is uncommon. So even if you have it -- and I remain certain you do not -- it really should be such a big deal. HSV1 is a very different deal than genital HSV2.

Finally, yes about syphilis. That would be even rarer than herpes in this situation (most syphilis in the US is in gay men, with rare cases from female sex workers); and doxycycline would have prevented it for sure; and your blood test proves you don't have it.

So do your best to stop worrying. All is well. I'm confident most of your symptoms are the result of your anxieties magnifying trivial symptoms or normal body sensations that you otherwise wouldn't notice. Don't confuse your axieties over a sexual decision you regret with the medical consequences of that decision. They aren't the same. Deal with the first as you need to. But you can forget the latter.

That concludes the two follow-up comments and replies included with each question and so concludes this thread. If you remain concerned, the first thing to do is carefully re-read all my comments in this thread. Please do not be tempted to post another question about all this. Our replies and advice won't change!

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