[Question #460] Asymptomatic Herpes or Syphilis?

33 months ago
Hello Doctors I would like your input and guidance.  I received upnrotected oral sex just over 3 months ago.  I developed a rash about 3 to 4 weeks after the encounter. I am circumcised and the rash goes from where my skin folds over a bit when flaccid up to the corona of my penis.  When erect you can see redder than usual skin and what appears to be small red "irritated" spots or Mark with red striations.  Not noticeable really unless erect.  Now I have tested negative for Herpes 1 and 2, HIV, Syphillis, Gonorrehea and Chlamydia at 4.5 weeks and approximately 7 weeks. I have visited the dermatologist twice and they were puzzled.  They said it didn't look viral, bacterial or fungal... So that was confusing.  Tried steroid cream with no affect. Been told that this may just be skin irritation and to ride it out.  Questions:  should I test again for Herpes 1 and 2 again now at12 weeks? I have never had a cold sore in my life.  Syphillis? Although negative twice... Maybe I should test again? The rash has never had blistering, ulcers or lesions.  Your guidance is greatly appreciated.  Thank you.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
The rash that you describe does not sound herpetic, from your description.  And the timing is off - if you were going to get herpes from this encounter of receiving unprotected oral sex, I think you would have noticed symptoms within the first 10 days are so - 14 at the outside.  However, the testing is not accurate until 12 weeks out if you are doing the standard screening test.  The problem here is that the standard screening test for HSV 1 misses 25% of infections so you could be infected with HSV 1, even from childhood, without any symptoms and the test might miss it.  The herpes western blot is a far better test but even then, if you are positive for HSV 1, and you've never in your life had a cold sore on your lip or in your nose, we couldn't know if your infection is oral or genital.  So I"m not sure that testing is going to be all that helpful for you (HSV 1 is the most likely herpes infection that people get from receiving unprotected oral sex, vs. HSV 2).  You could check out pictures of candida balanitis on the web and see if that rings any bells for you.

Terri
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33 months ago
Terri, thank you so much for your quick response. All of you are awesome and I know the community here really appreciate the plethora of knowledge you all have. I definitely do.  Alright, so if I understand correctly this is more than likely not herpes, correct? Meaning I can pass on retesting for that I assume.  If that is indeed the case, what about Syphillis? Again, I just want to be sure I am clear of these STD's.  I would assume that a 4.5 week test and a 7 week test that are negative for Syphillis would be conclusive.  Also, back on Herpes, I have had this bizarre rash for 2 months now.  Does Herpes or any other STD present itself like that or last that long?  From what I have read, herpes have lesions... Then they go away after a bit.  From childhood, occasionally I would have canker sores in my mouth in the underside of my gums.  But that was it.  To my understanding that is not Herpes.  But... I am not a medically trained pro like yourself.  Regardless, would retesting now be a waste of time and money?  Sorry for the repetitiveness here, I am just making sure.  I stepped outside of my relationship like an idiot and I feel I am paying the price.  This was so outside of my character.  Again I appreciate your time on this matter.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
I don't believe that a herpes rash would last 2 months, no.  Would retesting be a waste of time?  Well, sometimes testing provides a lot of reassurance and that is not a waste of time, but in this case, given that oral herpes is the risk and the screening test isn't great (if it misses it once it will likely always miss it), then yes, it may well be a waste of time. 
And welcome to the world of fallible people. 

Terri

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33 months ago
Thanks for your time. I guess I have one more follow up so here are my final questions:
1) Syphilis, do I test again?
2) Does it make logical sense to test for Herpes again?
3) What is my next course of action? I guess I could go back to the Dermatologist for a biopsy. (Sounds painful considering where this thing is.)
4) Outside of STDs, can anything else be transmitted sexually that could potentially cause this?

I realize this is my last follow up. Thank you for your time.  You have no idea how much I appreciate this.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
I believe that Drs. Hook and Handsfield would agree that further syphilis testing is not required.  As for herpes, I always say I like to allow 12 weeks time for seroconversion (becoming positive on a blood test). I think infection is unlikely, yes, but that's the gold standard timing.  Yes, I think a follow up with a dermatologist would be useful.  I think it would be OK to try an antifungal over the counter cream for a few weeks and see if that improves things.  Did you look up candida balanitis and see if that looks anything like what you have?

Terri
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