[Question #2689] Oral Risk and Testing

43 months ago
Hello,

About 11 weeks ago I received unprotected oral sex from a female of unknown status. I have alot of anxiety around STDs in general but just to give a little background. Two weeks after the encounter I went to an urgent care and got blood work for chlamydia, gonorrhea and syphilis. I had some diarrhea and made me nervous. All of which came back negative. The next day after the tests I notice a small red patch on the side of my penis which resembled rug burn. So I went back to the urgent care and the doctor who looked at it said it didnt look like herpes and didnt require any further testing (it went away in about 2-3 days). He asked me if I had any other symptoms such pain in my lower pelvic/groin area and I did not.  I have not had any sores or lesions.

At 7 weeks I was seeing my primary care and just to be extra safe I asked for a HIV test (HIV 1/2 ANTIGEN/ANTIBODY,FOURTH GENERATION W/RFL) and it came back negative. 

Of course after meeting with the urgent care doctor for the past two or three weeks I have felt a pain in my lower left pelvic/groin area. I went to the doctor as I thought maybe it was a lymph node but they said they couldnt feel anything. I workout alot and thinking maybe due to that.

-Is the groin pain/rash a symptom of herpes?
-Would you recommend any herpes testing based on the facts? I am very nervous reading about false positives and such on the internet. If so, should I test for both HSV 1 and HSV 2? 
-Is the HIV test considered conclusive?

I really appreciate the time and help.



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum and thanks for your confidence in our services. I happened to log in a few minutes after you posted it:  most users should not expect nearly real time replies!

Oal sex is safe sex. It's not totally risk free, but the risk of all STDs is low (much lower than for vaginal or anal sex) and virtually zero for some, including HIV. (There has never been a proved case of oral to penile transmission of HIV.) Your test results are uncertain:  as worded, it sounds like you had blood tests for gonorrhea or chlamydia. If so, the results are useless; only urine or swab testing of the exposed site is valid for those infections. However, the chance of either one, especially in the absence of obvious symptoms (penile discharge, urinary pain) is nil. Diarrhea isn't an STD symptom, at least not from receiving oral sex. Your description of the penile/groin rash is not consistent with herpes. Your negative HIV test at 7 weeks was conclusive:  the 4gh generation tests are 100% reliable any time more than 6 weeks after exposure (and as noted above, you weren't at risk for HIV).

To your specific questions:

1) No, these symptoms are not at all suggestive of herpes. It started too soon (herpes can't start to cause symptoms sooner than 2-3 days after exposure); herpes doesn't look like your description; and initial herpes cannot clear up in only 3 days.

2) I do not recommend HSV testing.

3) Yes, the HIV result is conclusive.

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes and stay safe!

HHH, MD

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43 months ago
Thank you very much for the quick response!

Sorry for the confusion but the rash/diarrhea symptom showed up about two weeks after exposure and the groin pain about 7 weeks after exposure. Does this change your answer at all if they could be related to anything?

The chlamydia and gonorrhea test was in fact a urine test I misspoke.  The syphilis was the blood work I believe. 

Also I was dating a girl at the time (feel guilty/horrible about it). We had unprotected sex about two weeks after the exposure and she developed a UTI and it was cleared up from antibiotics from an urgent care. About two weeks after the first UTI she developed another UTI and again was cleared up by antibiotics from an urgent care. I dont think she went through any STI testing but her urine testing confirmed the UTI. Is the fact she had two UTI's any indication that I could have been giving her something I dont know I have?

With not having any typical symptoms (sores/lesions) 11 weeks post exposure is this a good indication everything is fine? Should I have any reservations about being sexual active with someone?

Thank you again for the help!


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
The timing of those symptoms doesn't change anything. You describe very common symptoms due to large numbers of mostly minor conditions. There is no reason to suppose they have any relationship to the oral sex exposure you have described.

Glad to hear you had a proper gonorrhea/chlamydia test. Those tests are highly reliable and you can be confident you didn't have either at the time you were tested. However, it takes up to 6 weeks for syphilis blood tests to become positive. But without an obvious penile sore (chancre), plus the nature of the contact, there is no concern for syphilis.

UTIs in women are commonly triggered by sex -- not as an STD, but because sex introduces a woman's own genital bacteria into the urethra. However, gonorrhea and chlamydia can mimic UTI in women. But any concern about STDs is because your partner may have already been infected, not because of something she caught from you as a result of the earlier oral sex event. I'm not saying this is likely:  probably her UTI diagnoses were correct.

Absence of typical STD symptoms, plus the low risk nature of your oral sex exposure, plus the negative gonorrhea/chlamydia tests all make it very unlikely you have anything. But as already implied, you may have been at higher risk of STD from your more recent partner than from the oral sex event. Both you and your more recent partner might consider STD testing. But this is optional; from all we know so far, at this time there is no reason you should have reservation about sexual activity.

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43 months ago
That is good to hear and helps calm some nerves. Everything I have read and heard from experts such as yourself is they do not recommend testing. I guess my biggest fear is that I got herpes and it is laying dormant with no symptoms. Which I have read is very common (I need to stay off google sometimes haha)... is that truly the case? Especially with oral to genital cases?

 I know you dont recommend testing (which is great to hear as well) but if I were to test for herpes just for peace of mind should I test for both HSV 1 and HSV 2? As I have read HSV 2 is rare to find in the oral region. I honestly would like to get tested just to ease my mind but if I test for HSV 1 & 2 would having HSV 1 trigger a positive in HSV 2 as well? I guess are the tests reliable? And I have never had a cold sore (that I can remember) so would it be safe to say if I did come back positive for HSV 1 it would be related to genital? Sorry I am just trying to get some clarity on the testing as I am scared of a false positive or misreading the results. 

Last, if for some reason I did have herpes from the oral exposure. Is it possible that the initial outbreak happen on my buttocks and me not realize? Even though there was no contact at that region. Of course Ive convinced myself any pain or feeling I have in my "boxer" region is related to herpes.

Thank you again for the help and time really helping to calm my nerves.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Your exposure was no risk for herpes. Why is that fear so burned in your brain?? But since it is, feel free to be tested. You can expect a negative result for HSV2 (except for a small risk of a false positive or indeterminate result). Half of all adults have positive HSV1 blood tests, mostly from childhood infections (without symptoms of cold sores etc), so be prepared for a positive result that has nothing to do with the recent sexual exposure. OTOH, if both HSV1 and 2 are negative, you'll know you're home free. (There is no cross reactivity between the HSV1 and 2 tests. Being positive for either will not "trigger" the other.)

Initial herpes almost always shows up exactly where the infection enters the body, i.e. the site(s) of maximum friction during sex (e.g. penis head, labia minor or vaginal opening in women). The location those symptoms is one of the reasons I was confident fromt he outset that you didn't catch herpes.

If were somehow in your situation, knowing what I know, I would not be tested for HSV. The chance of a confusing or misleading result is a lot higher than the chance you caught herpes. Assuming you go ahead with testing, wait a few more weeks, i.e. 16+ weeks after the exposure; that time is required for conclusive HSV2 results. Assuming the results are negative, you won't need any further input from the forum. If positive or indeterminate, feel free to start a new thread, which would be answered by Ms. Warren, who handles all the herpes issues.

In the meantime, stay mellow. Probably the results will be negative.

That concludes the two follow-up comments and replies included with each new question, and so ends this thread. I hope the information has been helpful.

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