[Question #2636] Risk assesment

42 months ago
Dear Doctors,

I got very drunk about 2 weeks ago and came home with a CSW here in San Francisco. We had a protected blowjob and there were very brief , like under like 1 minute of genital apposition where she was on top of me. I never penetrated (although the crazy what if's my mind has been wandering in, do open possibility of  slight dipping perhaps given my level on drunkenness). I filled the condom with water next day to make sure it wasn't broken. I wore it throughout all the acts and it remained intact. Anyhow, having perused all your prior questions here and on medhelp, HIV risks for both acts are virtually nil.

What else should i be worried about? I have been checkin my genitals for herpes, but since i have fordyce's spots and pearly penile papules my genital skin is bumpy in general. Would it be possible to mistake a herpetic lesion for either or I'd really know if i had it? I was once misdiagnosed with HSV2 on a blood test and needed to plonk $240 for a Western Blot to clear it up (you'd think I'd learnt my lessons :( ). Wouldn't want to go down that rabbit hole again.

- SF Idiot
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Welcome to our Forum.  I'll be pleased to comment.  This was a very low risk encounter and one that I would not worry about.  You wore a condom throughout the encounter and that effectively eliminates meaningful risk for STIs transmitted through penetrative sexual contact.  As for herpes (or syphilis), the risk for such infections is likewise  very, very low and not something I would worry for.  The fact that you are now nearly two weeks out without any visible lesions pretty much eliminates the likelihood that you acquired herpes and syphilis is both rare and unlikely.  My advice is to do your best not to worry and if you do not develop a new, obvious sore or lesion in the next week or two I would not worry.  I see little to be gained from a medical perspective from testing of any sort although you may wish to do so for your peace of mind.  If you do test, I would recommend against testing for herpes- your experience with a falsely positive blood test is precisely the reason that we recommend against blood testing for HSV in most instances such as yours.

I hope this perspective is helpful.  Please feel free to follow-up if there are additional questions or any of what I have said is unclear.  You are permitted up to two follow-up questions in the next 30 days.  EWH.  
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42 months ago
Thanks a lot Doctor! Your response is very reassuring. Given that this behaviour is entirely out of the norm for me, anxiety and guilt have gotten the better of my rational side and have at times been working out what if scenarios in my mind. Anyhow, my follow up question was about how to identify STI lesions for someone like me with cosmetic fordyce's bumps over my scrotum and penile shaft and PPP lining my glans. While I haven't noticed anything out of the ordinary down there, do people have lesions typically that may be mistaken for a cosmetic condition or are the blisters particularly unique?

Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
The lesions of genital herpes are typically quite different from those of Fordyce lesions or pearly penile papules, both of which are typically asymptomatic.  Most people who acquire HSV are aware that there are new lesions.  Early on they appear as small "water blisters" which quickly, over a period of 24 hours or less, tend to become open, punched out appearing sores.  Repeated, anxiety-driven self examination will typically lead you to notice things which have been there for a long time but went unnoticed.  I would warn you against repeated self-examination.  If you develop HSV, you will know it.  EWH
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