[Question #490] What could it be?

38 months ago

Good evening,

I am a male, currently 37 years old.  On July 18, 2014, I had a "low risk" encounter with a high risk individual (TS Escort, male to female).  After conversing and cuddling, the encounter included aggressive deep french kissing for approximately 2 minutes.  I kissed and licked her breasts for about a minute or so.  Then she performed unprotected oral sex on my penis, while I rimmed her for about two minutes.  I ejaculated inside her mouth.  That was the end of it.

In nearly 5 years of being married to my wife, this was the first and last time I was unfaithful to her.  Immediately after the encounter, I went on a guilt trip and an STD testing spree at doctors' offices.  I had severe panic attacks for 8 months and did not sleep well during that time period as well. Please see the dates below, which will lead to my question.

-7/19/14 (morning after):  HIV RNA, RPR, HSV 1 & 2 (Ab IgG), and N. Gonorrhea AB.  All non-reactive.  Doctor performed this as a baseline.

-7/20/2014 (morning):  In deep anxiety, I visited an urgent care clinic.  I asked for and received 1G of azithromycin with a 250mg shot of rocephin (ceftrixone).  They took urine for chlamydia and gonorrhea and the tests were non reactive.

-8/16/14 (29 days after exposure):  HIV 1/2 Ag/Ab (4th gen duo) and RPR.  All non-reactive.

-10/11/14 (12 weeks after exposure):  HIV 1/2 Ag/Ab (4th gen duo).  Non-reactive.

-11/1/14 (15 weeks after exposure):  HSV 1 & 2 (Ab IgG), HCV Ab, and RPR.  All non-reactive.

-November:  Swollen lips and two sores inside of lower lip.

-11/28/14:  I confessed to my wife that I was not faithful to her, but did not give her the details.

-December:  rash below my left knucle.

-12/13/14 (21 weeks after exposure):  RPR.  Non-reactive.

2/4/2015 (7 months and 4 days after exposure):  RPR, Gonorrhoeae NATT (urine), Chlamydia NATT (urine), HIV 1/2 Ag/Ab (4th gen duo), Hepatitis panel (A, B, C Ab).  Non-reactive for all.  They said I was immune to Hepatitis B (had surface antibody, but on reactive on surfce antigen).  In 2008, I received 2 of 3 hepatitis B vaccine shot.

Mid August:  Itchy skin and hives was diagnosed as excessive yeast on arms.  I was prescribed Ketaconazole and Selenium Sulfide shampoos.

9/12/2015:  I broke out in shingles on my tail bone.  Dermatologist’s office culture tested negative for herpes, but positive for varicella (”varicella zoster virus isolated”).  I was very stressed with school and work at this time.

Could I have syphilis because my antibiotics in July 2014 threw off the RPRs?  Could I have something else like EBV?

Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago

Welcome to our Forum.  I will try to help.  My message for you is that you did not acquire an STI of any sort from the exposure you have described.  I suspect you have discussed these concerns with other providers and I suspect that they, like me, have told you that this is not something to be concerned about any longer.  To elaborate:

1.  Your exposure was low risk, most persons do not have STIs, even when they do, most exposures do not lead to infection and the activities you describe- French kissing, cuddling, receipt of oral sex and rimming are all relatively low risk exposures with little likelihood of infection.

2.  The testing you have received PROVES, without a doubt, that you were not infected with any of the organisms you have tested for.

3.  The antibiotics you received would have prevented gonorrhea, chlamydia, syphilis, and NGU had you been exposed.

4.  Your shingles (varicella zoster) is unrelated to your exposure and is due to re-activation of chicken pox virus which you most likely acquired during child hood.

My suspicion is that your guilt over this exposure is creating a state of anxiety which is seriously affecting you.  There are several ways to address this problem- one is to acknowledge your mis-step to your wife and ask forgiveness, the other is to seek the help of a trained mental health professional to help you deal with your guilt and anxiety.  I specifically and emphatically recommend AGAINST further testing for STIs related to the exposure you have described.  Searching for other STIs like EBV) is not recommended either.  EWH 

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38 months ago
Dear Dr. Hook:

Thanks for your answer.  It is an honor and privilege to interact with you.  I read countless passages during my frantic state of mind.

Yes, my guilt had/has gotten the best of me.  I still feel horrible to this very day.  I remember my heart racing for 8-months straight.  Not eating and sleepless nights became routine.  I could not even kiss my daughter because of guilt and fear of transmitting anything infectious.  I know it sounds silly, but the state of mind consumed me.

Before I can close this topic, is it necessary to tell this back story to any doctor that I see for my current medication conditions (headaches, ringing ears, fungal infection, shingles, etc.)?    Can constant long term stress/anxiety, not sleeping, and not eating actually affect my physical health and immune system?

These are my last questions that need to be answered before you close the discussion.  Thank you Doctor Hook.
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
My advice is to address your anxiety and to do this you need to be truthful about its source with your health care providers.  Without understanding this doctors may be led astray as to how to best help you.  Long term stress and anxiety, by exhausting you, can make you more vulnerable to other illnesses.  EWH
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38 months ago
Doctor Hook,

I informed all my doctors every step of the way and some of them do look at me like I am crazy.  They all provided similar advice as you did.  Hopefully, one day my subconscious mind will put this behind as well.  I did seek out therapy from November 2014 to January 2015, but stopped because of the cost.  I will seek out help again because this has gotten the best of me.

Once again, thank you for the help.