Doctor,

I'm male, married. Exactly 36 days ago I had a brief unprotected encounter with a female (gave/ received unprotected oral; PIV sex, I ejaculated outside, sex was 5-15 minutes in duration.) I’m uncircumcised.

Female was middle aged, Caucasian, married. Took place in suburban AL. No outward signs of infection but I was very drunk.

At 17 days post I was tested for Chlam/Gon/HSV 1&2/Syph/HEP ABC/HIV RNA, all NEG (odd because I was certain I had HSV 1). Online ordered through Quest.

Symptoms:

- Non-specific general tingling but I'm certain it's anxiety; when I'm not thinking about it I don't notice it

- Very mild balanitis symptoms (have had this before, red swollen foreskin/glans) at 33-34 days post. Treated with clotrimazole 1% and cleared almost immediately. Nothing else, and I inspect very frequently.

- My current plan is to retest for everything (only diff. will be p24 test instead of RNA) at 6 wks + 3 days and 11.5 weeks post.

My questions:

1- Approx. how reliable is the negative RNA result at 17 days post?

2- At what point can I be certain I’m clear? I’m currently traveling and will return home exactly 12 weeks post encounter. I obviously can’t infect my spouse with anything.

3- I know HSV testing without symptoms isn’t recommended, but at what point is the result reliable?

4- Is it worth adding Trich to my next test?

5- Is there any way to get precautionary syphilis treatment without going to my provider?

 

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Doctor,

Follow-up: 

1- Believe I had HPV with warts before (24 yo, 36 yo now) but cleared it. Never formally diagnosed. Wife has had multiple checks, never positive for HPV. Concern about reinfection?

2- PIV = penis in vagina 

3- Balanitis symptoms? Had milder symptoms before, not this bad. This only persisted 2 days, cleared immediately with antifungal. Possibility it's linked to an STI?

4- Irregular patches of darkened skin: Noticed 3-4 patches of slightly darker tan skin (I'm white), maybe a little lighter in the center, on the shaft, near the base. Approx 1/8-1/4 inch, varying. Very faint. Possibly preexisting, not sure. Seem to disappear if skin is stretched. Not raised/firm/itchy or anything just discolored. Watching for any change in size. Not caused by masturbation; that has become rare. Assuming they ARE new, would random light brown/tan splotches be indicative of any other infection, or more likely a pigmentation issue? If not, do you have any idea of cause/recommendation?

5- Other tests I should consider aside from Trich after an unprotected encounter? Need to be comprehensive. Cost isn't an issue.

6- Syphilis: I ask about treatment because of timeline. I return home at 12 wks post. If syphilis testing is positive at 6, treated at 7, is 5 weeks sufficient to treat, retest, and be clear/safe?

7- HSV test is included again at 6 wks anyway. I know I'm grasping, but what % reliability would you put on a 6 wk HSV test with no visible symptoms? 

I will save my second follow-up for after my 6 wk testing. Thank you for your prompt response and patience.

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Dr. H,

Just got the results of my 6 wk tests. 4th gen HIV AB 1&2, HSV IGG 1&2, Syphilis; all NEG. Trich test isn't back yet. This has helped my nerves quite a bit but wanted to follow up.

1- HIV: 6 wk AB and 17 day RNA = All clear, yes? Any chance of seroconversion beyond this?

2- HSV 1/2: Both 17 day and 6 wk tests NEG. No symptoms aside from general tingling and the balanitis. However I didn't get the actual index values. Still curious about no HSV 1 infection. Pretty sure I've had it (oral) a while. Possible it missed HSV 1 twice? Understood about 6 wk HSV being about 80% reliable. Is it worth testing again before 11.5 weeks per my plan? Say 8 weeks?

3- Balanitis/Candida: The balanitis still has me concerned. It began aprox. 30 days post with 2-3 days of increased smegma, flared badly for 2-3 days (red, patchy glans, red, irritated, swollen foreskin, possibly red spots but nothing resembling a blister), and reacted immediately to the clotrimazole cream. However, some faint redness remains, and if I don't reapply the clotrimazole 2-3 times daily, the glans becomes extremely dry and almost has a slight dry film. Still some red spots from irritation. Foreskin has returned to normal. Going on day 14 of treating it. Any possibility this is HSV linked having lasted this long?

 I know there is a possible link between balanitis/HSV, but my question is how? Is balanitis caused by HSV simply due to irritation from sores on the glans? Is there a difference between this being possibly fungal or bacterial?

4- Trich: Haven't received results. If positive, what is the recommended treatment?

Thanks again for all your help Dr.

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Thanks Dr.