[Question #2944] Could I have contracted HPV, or am I experiencing somatic symptoms?

39 months ago

I'm a married man who, for the typical reasons, has decided to see sex workers from time to time. STIs have been my greatest fear, so I only receive massages that end with manual release.

About 15 weeks ago I received such a massage, but this time the woman invited me to touch her vulva, which I did. She then got on top of me in such a way that kept our pubic areas apart (she was facing away from me), and masturbated me with lotion against her stomach. I was touching her vagina while this happened. I was mindful to not touch my penis with that hand, but I can't be 100% sure that I didn't as I cleaned up and got into the shower.

About 5 weeks after this happened, I developed a burning sensation on my penis. No bumps or sores, just burning irritation around my circumcision scar. Over the next 10 weeks I’ve been to a dermatologist (twice) and my primary care doctor. No one can find anything wrong. It’s not fungal or bacterial. STD tests negative. I’ve been in a state of terror over this. I’m distraught over having to tell my wife, and the over the effect this will have on my family. I can’t sleep and I’ve lost 25lbs. Both the dermatologist and my primary care doctor are telling me that this irritation is due to my emotional stress and compulsive checking for warts. I’m going to see a therapist about this tomorrow.

So, my questions are: 1) How possible was HPV transmission, and 2) is it possible for somatic symptoms like this to be brought on by intense anxiety?

Edward W. Hook M.D.

39 months ago

Welcome to our Forum. I'll try to help. The short answer to your questions is that I do not think you should be worried about HPV, do not think your symptoms are related to your exposure and yes, focus on the possibility of symptoms related to a recent, worrisome sexual exposure can make sensations more apparent and heighten normal sensations and transform them into symptoms. I have elaborated on each of these comments below.

Exposure. STIs, including HPV are not transmitted from person to person, or from site to site on an infected person, through transfer on a person's hands. Thus your risk for HPV from this specific event is quite low. Further, I would add that since just about everyone (over 80% of sexually active adults) will have HPV, whether or not you have it is really immaterial. I would not worry about HPV and would urge you to do the same.

Symptoms. I do not have a good explanation for your penile irritation but I am confident that these symptoms are not related to an STI acquired at the encounter you describe. The irritation occurred far longer after your exposure than would be expected for an STI and the nature of the symptoms is not suggestive of an STI. Like your dermatologist, I do not have a good explanation but I am confident that this is not an STI.

finally, an related to my comments- guilt is a powerful emotion. We regularly see patients who pay far closer attention to genital sensations than they would if they did not feel guilty. As a result, they tend to be hyper-aware of sensations which are entirely normal. Repeated self-examination only makes this worse.

I hope these comments are helpful. If there are remaining questions or if part of what I have said is unclear, please feel free to use your up to two follow-up questions to seek clarification. EWH

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39 months ago

Thank you for your reply.

My irritation has persisted for 3 months now and no doctor can find a cause for it. My primary care physician, dermatologist, and now a urologist all see nothing wrong. I was in a normal mental state (at least consciously) when this burning sensation first appeared. My symptoms appeared 5 weeks after this incident, and from what I'm reading, the only pathogens that have that long of a latency period are viruses, which is why I'm fixated on this as a possible cause.

Have you ever heard of herpes causing symptoms such as this? I understand that the virus inhabits nerve cells. Is it possible that I'm infected, it's affecting my nerves (causing the pain), but not manifesting with any of the characteristic legions? I asked my doctor for an HSV antibody test, but she refused, saying that the test results can cause more harm than good. But I can't stop fixating on the idea that a virus is at work here.

Of course, it's also possible that a) this condition has nothing to with sexual transmission or b) it's a somatic expression of psychological stress. I'm trying to convince myself that this isn't an STI, but the anxiety surrounding that idea is quite strong.

Again, thank you for time and attention!

Edward W. Hook M.D.

39 months ago

I really wish I could provide you with a better explanation for your persistent symptoms. I can tell you from substantial clinical experience that once a person is aware of a symptom or sign, the increased attention does heighten awareness and perceived intensity. This includes awareness of otherwise normal sensations which are often overlooked. One indicator of this phenomenon is that symptoms of this sort are not noticed during other activities which require concentration on the task at hand.

Indeed, herpes virus infections are infections of nerves, not skin but there are no data to suggest that they symptoms or herpes, particularly in the absence of lesions last more than a few days or even as long as two weeks at the very outside. Thus the duration of your symptoms are really not consistent with any known characteristic of herpes infections.

I hope these further comments are helpful. EWH

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39 months ago

Thank you, Dr. Hook.

I've read that it's possible for the initial outbreak to be so mild that it's confused with a fungal or yeast infection, which is what I thought I had at first.

I've also read about "Postherpetic neuralgia", in which damage to the nerves produces lasting neuropathy such as burning sensations, which is what I'm experiencing. I understand that PHN is normally associated with herpes zoster, but I've been reading conflicting reports online about it also occurring with HSV. Is this possible with HSV?

Despite my doctor's objection, I'm getting an IgG blood test done tomorrow. She's stressing to me that a positive result does not mean I was infected 4 months ago, but I would find that very hard to believe. My wife and I have been together for 15 years, prior to my infidelity. In that time I've never experienced any symptoms.

Thank you for all of your help.

Edward W. Hook M.D.

39 months ago

The sort of post-herpetic neuralgia you describe does not occur following HSV infections. It does occur following the occurrence of shingles which is caused by a distantly related virus, the herpes zoster virus (the same virus causes chicken pox) and typically follows an outbreak characterized by a visible rash. The reports that PHN follows genital HSV infections is, unfortunately another example of why the internet is not a good place to go for health information. All too much of what is there is overly extrapolated, taken out of context or misstated.

I wish you the best. I remain confident that this is not an STI acquired from the exposure you describe. As per Forum Guidelines, this thread will be closed later today. EWH

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