[Question #3331] To Dr Hunter,

38 months ago
Hi Dr Hunter,

I received unprotected Oral from a guy(not sure he is gay or bi) who is working in a spa in Goa, India on Jan2. Out of sheer fear, I took my blood tests on Jan11(By 9th day) and my report are as follows,
Hsv -1 IgG  : 1.07 OD ratio. (Equivocal)
Hsv-1 IgM : 0.39 OD ratio.       Neg: <80
Hsv-2 IgG : 0.19 OD ratio.         Equ : 0.8 - 1.20
Hsv-2 IgM : 0.54 OD ratio.         Pos: >1.20
And also I took blood test for HIV, syphillis, Hepatitia B and C , all came back Negative.
Actually my Oral sex last for 3-4 mins and eventually I ejaculated inside his mouth.And coming back to my equivocal result does it suggests that I have herpes or not? I don't have any blisters or sores in this 40 day. Even though I have dull/mild pain in my left testicle and sometimes I feel like my right thigh is burning and I too got a one single little cysts in right thigh which eventually gone after a week. Pls advise me did I get anything from this sex counter. Previous to this act, I had a sex with escort which is protected vaginal intercourse and unprotected oral(just for 1 min). It happened in June 2017 just 6 month before to this encounter. These are my only 2 sexual acts in my life.Please advise me, do I need to take any tests in coming days especially for herpes. And also advise do I have herpes due to my 1.07 equivocal range. Many Thanks in advance Dr


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. FYI, it is only by chance I am replying. As described in the instructions and FAQs, users do not select the moderators who reply to their questions.

Most equivocal HSV blood test OD ratios are false, i.e. no HSV infection is present. So your result suggests you do not have HSV1. However, it is possible you have it. But if you do, it is not from the oral sex exposure only 9 days previously; it takes a few weeks for antibody to develop and be detected by blood test. Also, the negative HSV1 IgM result suggests you were not infected recently. A very high proportion of healthy people in many developing countries (often 90% or even higher) have HSV1 from childhood; although I don't know the data for India (and certainly not for any particular part of the country), it would not be at all surprising if you are among the majority of Indians in this regard.

Oral sex is safe sex in regard to all STDs, and rarely if ever transmits HIV or hepatitis B or C. However, you were tested too soon in regard to the oral sex event; these (and the syphilis test) typically take up to 6 weeks to become positive. However, the results show for sure you weren't infected during your other sexual encounter last June.

Finally, you don't mention gonorrhea or chlamydia. For complete reassurance, I suggest a urine test for them. This test can be done any time; the results are valid any time more than 3-4 days after exposure.

All things considered, you really needn't be worried at all. I'm confident that any and all additional testing you might decide to do will also give negative results.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

---
38 months ago
Not sure whether my follow up ques has been registered. So, I'm going again. First, Thank you very much for getting back to me, Dr. And your service indeed provide a great relief and conveys right information across Globe. Special Thanks for making this world a better place through ur service. My follow up quests are as below,
1) Reg Chl/Gonn urine testing, I'm not able to find any centers which provides NAA Testing in my city, but I do find labs which provide PCR qualitative urine test for Chlamydia Tracomatis and Neisseria Gonorrhoeae. Is PCR qualitative urine test a worthy?
2) Do I also need to go for NGU testing?Or chances of me getting NGU is a once in a billion, since I didn't get any obvious symptoms except mild/dull pain in my testicles?
3) Reg Herpes: If it is not for my only 2 sexual encounters in my life, I do believe I don't have herpes in my life. So, with the above results is it safe to say, that I don't have Herpes at all or else do i need to take one more test after 3 or 4 months?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
This is the first and only follow-up question that came through. I'm glad the information so far has been useful.

1) PCR is a kind of NAAT. It's a perfectly good test.

2) There is no test for NGU. Your risk for NGU is certainly higher than one in a billion, but it's still low, probably only one in a few thousand (that's only an educated guess -- there are no data). In any case, NGU not due to chlamydia is generally harmless, and in particular, NGU from oral sex probably is often due to entirely normal oral bacteria, probably clears up without ever doing harm, and is unlikely to harm future partners. If you don't have abnormal discharge from the penis, you can  be confident you don't have anything to worry about. Neither NGU nor any other STD causes the sort of testicular pain you describe.

3) The large majority of herpes is not sexually acquired, and you could well be infected with HSV1. But probably not, and it really shouldn't matter if you are. I don't recommend any further testing.

---
38 months ago
Got my results back for Chlamydia, Gonorrhea and syphillis which was negative.

And I have some follow up queries for you Doctor,
1) Does IgM blood test results for hsv1 are accurate at 9th day? I heard that pretty much IgM antibodies get developed in blood between 5-10 if it is a new infection. If that is true, can I say I didn't get infected recently for sure for hsv1. The reason why I am asking is this I pretty much like to take out the chances of getting hsv1 genitally from the equation.
2) And also incase if I acquired Hsv1 in my childhood, does the result should shows the OD ratio for IgG more than 5.0 atleast? Since my results value for IgG is low, Does this indicate my blood results for hsv1 might be false? 
And some Anxiety related questions,
3) What amount of chance for me to acquire HPV by receiving Oral?
4) Hope I already mentioned my dull/mild consistent left testicle pain in my earlier posts and when I tried exploring the left testicle especially the part where the pain comes from, I got to see a One little dark/grey coloured rough skin texture popping out in my lower left scrotal area and it consistently touching with my left thighs. I have noticed this on my 11th day itself(13/01/2018), but later ignored it due to the fact it was rough and it didn't looked like bumps which has some liquid inside it. But all in all it is some rough dark/grey coloured skin texture and looks like a piece of rice clinging tommy scrotal skin. Is it sounds like a Genital wart or Skin tags or some other skin textures? When I tried to touch and press or squash it, I can feel the pain from that little wart/skin tags/textures.
4) The reason for my above quest is, as I mentioned in my earlier posts reg dull consistent testicular pain might be the result of genital warts in my left scrotum which is probably is pinching the nerves which sends pain signal to the brain? Do u believe this?
5) And also If it is wart, does it appear so soon ? I got to identified it from my 11th day from
My last oral encounter as stated above. And the place (penile area, penis area) looks clean as usual, wher he performed oral on me. Or else, will this be a wart from my last June sexual encounter with an escort where we involved in protected vaginal and unprotected oral (lasts only <40 secs) .But am not sure y something popped out and giving me pain in lower left scrotal area . And also will wart/skin tags give pain?
6) I'm 25 currently And do u advise
Me to get HPV vaccine now after all this scenario considered to avoid any HPV turn into cacncer in future?
7) Of all the sexual acts considered from
My past, am I move on from the guilt and get married and have babies? Or do I need to request my future wife to get HPV vaccinated to secure her in getting HPV from me which me turn cervical cancer in later years?
8) One final quest, Of both the sexual acts considered, what is the chance for me to acquire HPV that leads to cancer ? Thanks for all your help and sound advises Doctor.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
1) The IgM HSV tests are highly unreliable and are never used by knowledgeable STD or herpes experts. Positive reports often are false, and they don't work as well as they are supposed to (in theory) in distinguishing early from longstanding HSV infection. You can draw no conclusions either for or against an HSV infection from your IgM result.

2) The OD ratio is unrelated to duration of infection.

3) There are no good data on the chance of oral HPV from any single exposure (assuming this isn't a typo and you mean HPV, not HSV). It's a lot lower than for genital infection, but many peolple acquire oral HPV. Most infections never cause symptoms and are cleared by the immune system.

4a) This doesn't sound like HPV, but only in person exam by a professional can tell. I won't speculate on other possible causes, but most genital skin problems are not due to STDs.

4b) "Dull testicular pain" is often referred from the prostate area or elsewhere inside the abdomen. But many (most? nearly all?) probably are psychogenic, i.e. with anxiety or other stresses magnifying trivial symptoms or normal body sensations that otherwise would not be bothersome and maybe not even noticed. In any case, HPV for sure doesn't cause such pain.

5) Warts never appear sooner than 4-6 weeks after exposure, and usually it's 2-6 months. 

6) I advise every sexually active person worried about HPV, and potentially at risk (likely to be having new sexual partners) to be immunized against HPV. However, the vaccine only prevents new HPV infections; it has no effect on existing ones or the chance they will progress to cancer. However, the chance you will have HPV related cancer someday is extremely low anyway. 40% of all humans die of cancer, so maybe that's the problem that will carry you from this earth someday. But almost certainly it won't be from HPV.

7) Having casual sex and/or past STDs, including HPV or herpes, never prevents someone from forming committed relationships, getting married, having babies, etc. Cervical cancer will be unlikely in your future partners, and in any case is never a problem in women who follow standard recommendations for pap smears etc.

8) There's a good chance you have had HPV, including infection with high risk (cancer causing) types. This is the same for every person who ever has sex with other people. You're no different than all human beings. With common sense approaches (HPV vaccine, prompt medical attention to symptoms that appear, and women following pap smear recommendations) the risk is extremely low. Most people don't worry about it and neither should you.

That concludes this thread. I hope the discussion has been helpful.
---