[Question #405] Help?

95 months ago

Hi experts! Thank you for being here to field questions from the public. I’ll try to keep this brief. I had an ill-advised encounter and was a little (okay, desperately) worried.

For the record, I have had the following tests done and all came out NEGATIVE: 

- Gonnorhea, Chlamydia, Syphillis, Trich, HIV (regular test), 5 days from encounter

- HIV RNA Early Detection test, 10 days from encounter

- HSV-2 IgG Type-Specific HerpeSelect, 7 weeks from encounter (perhaps 6 weeks and 6 days)

1) Can pubic redness, generalized pubic/vaginal itch, burning, and irritation, and occasional pain be symptoms of HIV or HSV-2 without obvious lesions or sores, especially/even if those symptoms have not really returned? Or can these things more likely be caused by severe anxiety (anxiety so severe it impacts your regular functioning and life) and watchfulness after an anxiety-inducing sexual encounter, painful/under-lubricated rough sex, or something like a yeast infection or BV?

2) What is the likelihood of someone displaying those symptoms having caught something from someone after two unprotected encounters (in the same afternoon, both involving penetrative sex) from a man who has frequent casual encounters with women, but normally uses a condom, says he’s clean and gets tested frequently, and did not appear (though it was dark) to have anything out of the ordinary about his genitals at the time of intercourse?

3) Can I consider my test results accurate? Could the oral HSV-1 I have had since childhood have delayed seroconversion for HSV-2? If I decide to test again at 12 weeks, will my results be conclusive?

I have read very many questions and answers for Dr. Handsfield on MedHelp and I believe he once claimed that when people believe that symptoms could be manifestations of anxiety, they usually are, which is why I took my results and got on with my (regular and sex) life, but - surprise! - I am once again anxious. Am I being ridiculously paranoid over nothing?

Thank you kindly for reading and responding to my query and thank you again for this service!

Edward W. Hook M.D.
95 months ago

Welcome to our Forum. I'll try to help.  My sense is that you are beating yourself up over what was an ill-advised, unprotected sexual encounter and that my best advice is for you to move on without further concern.  Let me elaborate on why I say this.  First, despite having had sex with a casual partner who has had numerous other partners, odds are that he was not infected- most such people are not and the fact that he says that he is checked regularly adds to the probability that he was not infected.  Second, even if he was infected with one of the more common STIs such as chlamydia or trichamonas,, even following two unprotected exposures you risk for infection would be less than 50%.  These two facts alone make unlikely that you were infected.  You however took the next step (good job!) and got tested for a variety of STIs and the results are all negative; your test results virtually completely rule out the possibility of gonorrhea, chlamydia, and trichomonas.  The testing for HIV was a bit early but wound have detected many HIV infections if you had become infected, and your HSV results were taken at a time when the test would detect about two-thirds of HSV infections  (your existing HSV-1 infection would slow development of a positive test BUT it is also associated with decreased risk for infection and, when considered in the absence of a genital outbreak, make having gotten HSV-2 most unlikely).  Your syphilis test was too early to be accurate but syphilis is even rarer than HIV and unlikely- for an accurate syphilis blood test, you should be tested at least 30 days after exposure. 

So, what about your symptoms?  The symptoms you describe are highly non-specific and are not those of most STIs.  They are symptoms which might accompany a yeast infection (not an STI) or perhaps accompany repeated self-examination and hyper-vigilance, something you may be vulnerable to.  My advice:  personally I would try not to worry further.  Your anxiety may not allow you to put these concerns aside however- if that it the case, for peace of mind you may wish to repeat your syphilis and HIV test (using a 4th generation, combination HIV antigen/antibody test) 4 weeks after the event.  You may also wish to have your own doctor look at your public area (self-medication, even for yeast would be a mistake and is more likely to confuse things rather than help).  Similarly, if your doctor offers you treatment "just in case" I urge you not to take it as it may increase your risk for a yeast infection or lead to an allergic reaction.   If you do chose to re-peat the testing, I am confident that tests will be negative. 

I hope these comments are helpful to you.  I would not be worried and would not test further were I in your position.  EWH

95 months ago
Thank you so much for your reply, Dr. Hook, it is very much appreciated. Hearing this from an expert will hopefully put my mind at ease. This is an amazing service you three do here!
Edward W. Hook M.D.
94 months ago
I'm pleased I could help.  EWH