[Question #5152] Exposure event / symptoms

23 months ago
Hello Experts,

Unfortunately I (male 23) put myself in the position to be exposed to STDs after a night of heavy drinking. Last week I ended up blacking out and having unprotected sex with a 38 year old female whom claims to have testing around December but with partners since. Can you shed some light on my potential risks and symptoms?

1. I had recent and negative std testing including hsv prior to this event

- 4-5 hours after the event I received medical care and started PEP ( truvada and tivicay)

- partner states she will get labs and report back but I'm unsure if she'll follow through

- 24 hours post event I have slight burning sensation in groin area and what I think is tender groin lymph nodes. Tenderness gradually disappeared in less than 36 hours.

- I tend to have sensitive skin and feel I might be psychosomatically obsessing over non-existent symptoms and "self checks." I'm a pretty sweaty guy and in the past I've had some irritation in my thigh/groin area from friction. But I think I do feel a " tingling / burning " but unsure if in my head, related to chaffing, or actual manifestations.
- it's been over 7 days and no signs or symptoms such as pain/blisters/vesicles/lesions etc.
- I've enrolled in therapy to address the unsafe drinking

Any professional insight into my situation is appreciated. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
23 months ago
Well, nothing you have described here sounds anything like herpes to me.  Normally, if someone is going to have lesions with a primary infection, they will develop those symptoms within 2-10 days from the time of the concerning encounter.  You said "last week" so I'm not sure how long ago your actual encounter happened.  Try to avoid pushing on our groin lymph nodes to check them because that pushing itself can cause them to enlarge.  I am assuming you've been tested previously to know that you don't have HSV 2?

Terri
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23 months ago
Yes mam, I tested negative for hsv 1 and 2 roughly a month ago with no in between partners.

The exposure was a little over 7 days ago....roughly midnight in between the 18th and 19th.

I suppose a good follow-up question would be your opinion on psychosomatic symptoms and how you deal with patients that present in similar situations and what helps them move forward until confirmatory testing. I'm alarmed by what I read about how  it seems common for individuals to be infected but remain asymptomatic. Does that generalization on staying asymptomatic include primary outbreaks? I realize I can't be sure of any std, but my body has convinced me otherwise and all professional insight is appreciated.

Thank you
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
23 months ago
I don't really think this is "all in your head" but I do believe very strongly that when people have a risky sexual encounter, they start observing all of their body sensations very carefully and things that normally would go unnoticed, become a focus of attention.  Does that make sense?
You are too early to get any sort of accurate antibody test. 
The good news is that you are pretty close to the 10 days in which we would see sores, so hang in there and if you are still worried about this in 12 weeks, think about obtaining a herpes western blot as the best test available to reassure yourself or at least get clarity

Terri
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23 months ago
So, in your experiences, is lack of lesions within that time period a "decent" predictor of infection? I'm curious on the difference in resources as far as when it goes unnoticed for many. Are they just missing the lesions in general because it's so minor? I'm still a bit under confident on how often experiences show a painful primary break out of lesions while certain resources say it may never occur.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
23 months ago
Yes, it is a decent predictor - not perfect however, but decent. 
It is true that 80% of those infected do not know they are infected.  Some confuse their symptoms with other things - thinking it is a yeast infection or a urinary tract infection or getting a penis caught in a zipper or a bite or bug bites.  Others miss their symptoms because they are so minor (that's mostly people who acquire type 2 who already have HSV 1).  But some people truly don't have symptoms, apparently.  But this lack of symptoms in some people and confusion in others is why I personally do include herpes testing in someone who asks for a panel of STI tests (I know others do not).  The fear is false positives, but in the many years of clinic experience, the rate of false positives is 3% and we can clear up those issues with western blots or Biokits so I don't think that is a reason to skip testing for everyone.  That's just my opinion about this.  The best test is the herpes western blot though the Igg picks up about 92% of HSV 2 infections as well

Terri
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