[Question #424] Follow up to Question #378 (unprotected oral sex at massage parlor)

34 months ago
Quick recap- unprotected oral sex at massage parlor for less than 5 seconds. "Symptoms" include an off and on dull ache in testicles, sensitivity tip of penis and an unseen but paranoid clear dripping sensation. No colored discharge and zero burning when urinating or ejaculating. Primary concern has been chlymidia and ghonorreha tho I understand risk is very low to receive an STI from a sex worker especially via oral receipt with limited exposure. Nonetheless I am getting tested this coming week approx. 6 weeks after exposure to put my mind at ease.

I woke up today and fear I may have a cold sore on my lip developing. It could also just be chapped or cracked lips with the changing weather, I am unsure. I had also kissed the woman's breasts for a moment but we did not kiss. Could I be at risk for something beyond my initial concern of STI or is this all likely in my head? I assume I have HPV as I have had many sexual partners before getting married but never recall having a true cold sore. I also realize off and on again symptoms esp without burning during urination nor a noticeable discharge suggests these symptoms are likely brought on by anxiety nonetheless I continue to worry. I would've been tested sooner but this coming week was the first chance with holidays, travel, visitors etc. Please put my mind at ease or let me know what else I should get tested for when I go in to my doctors. There are some days where I feel nothing likely cause I am not thinking about it and days I can feel every tingle and stress about having to explain this unfortunate mistake to my wife. I am eager for closure and seeking some reassurance and guidance here one last time. Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Welcome back to our Forum.  I happened to pick up your new question.  I have reviewed your earlier interaction with Dr. Handsfield and agree with all that he said.  From your post it is clear that your concerns about having acquired an STI from your unplanned exposure continues to worry you.  With this in mind, I agree with your decision to get tested, anticipating that the test will be negative and, hopefully, give you peace of mind.  I would recommend against testing for other STIs for all of the reasons Dr. Handsfield has already outlined.

As for the possible cold sore you may be experiencing, IF it is a cold sore, I am confident that it is not a consequence of the events 6 weeks ago which you have described.   My confidence comes from your statement that you did not kiss your partner and your mouth only contacted your partner's breasts.  Cold sores are caused by herpes simplex virus type-1 (HSV-1) and are most often caused by contact with an infected person's mouth (or, less commonly, from genital exposure).  I am not aware of any instances in which someone has acquired HSV-1 from contact with another, infected person's breasts.  Parenthetically I would also point out that the majority of American adults have HSV-1 even though the majority do not experience cold sores from their infections. The majority of these infections are acquired in childhood or the teenage years and most infected persons are not aware they have HSV-1.

Personally however, given the information you have provided, I am skeptical that your lip discomfort or the continuing, intermittent urinary symptoms you mention are in any way related to the events six weeks ago that you have described.  Rather I suspect (as Dr. Handsfield has already mentioned) that you have become hyper-aware of normal body sensations and are attributing them to this exposure.  My suggestion is that you get the testing you plan for gonorrhea and chlamydia, and then put your anxiety/guilt behind you.  EWH

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34 months ago
Thank you doctor. One thing I'm also stressing out with next week's test is a false positive. Dr Hansfield mentioned that there is more a likelihood that the test would be incorrect compared to chances of me catching something given the facts and situation. So my added anxiety is if something does turn up positive the need to do a second test Before seeking treatment (and conversely having a difficult discussion with my wife) and if that second test shows up positive than I'll get treatment and have the talk. Is that smart to confirm the results twice or am I just making excuses to avoid my guilt and shame and delay confronting this? Everytime I'm confident I'll be okay a new "symptom" shows up and my denial will even exist with a positive test on a single test I fear. Thanks for listening. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Part of the reason Dr. Handsfield suggested you test only for gonorrhea and chlamydia is that these tests, in particular, are very sensitive and false positives, while they do occur, are quite rare.  Odds are that your tests will be negative.  When they are, believe the result.  On the other hand, asking to be tested for "everything and HSV in particular, is asking for a false positive test result.

As I wrote my reply to your original question, I found myself whether you mentioned your accidental exposure to your wife or not.  Now it is clear that you have not.  This strengthens my suspicion that a major contributor to your concerns is guilt/shame and suggests that having that all so difficult talk with her might be helpful to you (although I would mention the part about you kissing her breasts during your accidental exposure- hard to make that sound un-intended).  Perhaps telling her about the fact that your guilt has plagued you might help as well.    EWH

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