[Question #555] High Risk Exposure

43 months ago
I had a high risk exposure when I was on a business trip in China. I was drunk and met a girl at an upscale bar. We came to my apt and started a condom protected vaginal sex (she asked me to wear a condom first). 
I was drunk and after a while I got soft and she removed the condom and gave me an unprotected oral. After that point I stupidly continued vaginal sex without condom for maximum 3-5 minutes and 
the unprotected vaginal sex was on and off because I got soft once more during that time. She wanted to give me oral again but I finally realized the mistake, I stopped and didn't continue anything.
She was a foreigner as well and from one of very high risk countries for STDs especially HIV and Herpes.

Next day I realized how big mistake that was when I got sober and called her right away. She told me she was clean but I doubt she would tell me the truth being a foreigner in China.
Also she turned out to be a working girl because she asked for money after sex before she left. I guess this was a new way in China for foreign sex workers since it is now illegal in China.

I am married and first time in my 7 years of marriage I cheated on my wife.
After that exposure I almost lost my insanity and had extreme stress, anxiety and guilt. 
At early times I thought I contracted HIV for sure altough I never had any common HIV symptoms.

I did following tests all from Labcorp in USA.

1) 2 Weeks after exposure, 
HIV 4th Gen Duo - Negative
HIV RNA - Negative
Chlamydia/Gonorrhea/Syphilis - Negative
Hep A/B/C - Negative
HSV-2 - Negative
HSV-1 - Positive with high index value of 50.24 (I had oral herpes for a while but never had any cold sores or blisters)

2) 4 Weeks Test,
HIV 4th Gen Duo Ag/Ab - Negative
Chlamydia/Gonorrhea/Syphilis - Negative
Hep A/B/C - Negative
HSV-2 - Negative
HSV-1 - Positive with high index value of 48.70

3) 6 Weeks Test,
HIV Antibody - Negative
Chlamydia/Gonorrhea/Syphilis  - Negative
Hep A/B/C - Negative
HSV-2 - Negative
HSV-1 - Positive with high index value of 50.64

4) 9 Weeks Test,
HIV Antibody - Negative
HSV-2 - Negative

I never had sores, bumps or blisters etc but 2-3 weeks after the exposure I started to have an irritated/red meatus with some redness on glans and redness on my scrotum skin, which have been going on for 8 weeks now.
Redness on my scrotum skin is with sharp borders, no tingling, no burning, no itching. Irritation around meatus used to bother due to friction with underwear. No discharge, no pain during urination. 
Just some slight burning at the tip of my penis after urination and I think this is due to irritated meatus skin. Both issues are getting a little bit better but didn't go away completely.

I visited 3 urologists, 2 Dermatologists, 1 STD Clinic and a Physician in last 8 weeks. Did urinalysis which came back clean also.
They all told me this is not Herpes and I don't have any Herpes lesions. One Dermatologist told me I had a dermatitis, second dermatologist said it could be yeast/fungus or dermatitis.
He did a swab culture test for yeast/fungus which came back negative. The creams dermatologists prescribed gave some relief but didn't cure the redness on my scrotum and around meatus. 
Physician and a urologist treated me with Doxycycline and Metronidazole for any possible UTI/NGU.

I have been on the internet searching everything crazy and decided to ask experts to stop searching and go on with my life.

My questions are,

- Is my HIV test conclusive with 2 Weeks RNA, 4 Weeks Duo and 9 Weeks Antibody Tests all negative. No HIV symptoms at all so far.

- Now I am mostly worried about Genital Herpes as I know it might take up to 12-16 weeks especially with HSV-1 positive person. Should I have another HSV-2 test at 12 weeks and 16 weeks? Or my 9 weeks
test is conclusive based on one time short exposure and no blisters/sores?

- Are other tests Chlamydia, Gonorrhea, Syphilis and HEP A/B/C conclusive at 6 Weeks? Should I get tested at 12 weeks again for those?

- Could red scrotum, irritated meatus/glans be Herpes related? If not, could these be any other type of STI/Bacteria/Virus?

- Is it safe to have unprotected sex with my wife? I have been avoiding to have sex with the fear of transmitting something to my wife.

- Could anxiety and stress cause redness on my scrotum and irritation around meatus?

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. I'll be happy to answer your question. However, it is almost double the 2,000 character limit (about 400 words) described on the forum's introductory page. YOu must have written it in another program then pasted it into the question field, which bypasses the software that would have cut you off at 2,000 characters. In any case, the moderators can't be expected to read such long essays, and we have never had a question (or multiple questions together) that could not be easily stated within the limit. Please edit down to under 2,000 characters (including spaces), post it in a follow-up field below, and I'll be happy to reply.

In the meantime, on quick scan, it seems exceedingly unlikely you were infected with any STD. I doubt you have much to worry about.

HHH, MD
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43 months ago
Sorry for this. I was not aware of this limitation. I am using website's editor now.

I was on a business trip in China, got drunk and met a girl at an upscale bar. We started a condom protected vaginal sex (she asked for condom), after a while I got soft and she removed the condom and gave me a short unprotected oral. After that point I stupidly continued vaginal sex without condom for maximum 3-5 minutes and 
the unprotected vaginal sex was on and off because I got soft once more during that time. She wanted to give me oral again but I finally realized the mistake, I stopped and didn't continue anything.  She was a foreigner as well and from one of very high risk countries for STDs especially HIV and Herpes. She turned out to be a working girl because she asked for money after sex before she left. Next day I called her and asked her status. She said she was clean but I doubt she would tell the truth.

I am married and first time in my 7 years of marriage I cheated on my wife. After that exposure I almost lost my insanity and had extreme stress, anxiety and guilt. I did following tests all from Labcorp in USA. 

- 2 Weeks after exposure, 
HIV 4th Gen Duo - Negative
HIV RNA - Negative
Chlamydia/Gonorrhea/Syphilis - Negative
HSV-2 - Negative
HSV-1 - Positive with high index value of 50.24 (I had oral herpes for a while but never had any cold sores or blisters)

- 4 Weeks Test,
HIV 4th Gen Duo Ag/Ab - Negative

3) 6 Weeks Test,
HIV Antibody - Negative
Chlamydia/Gonorrhea/Syphilis  - Negative
Hep A/B/C - Negative
HSV-2 - Negative
HSV-1 - Positive with high index value of 50.64

4) 9 Weeks Test,
HIV Antibody - Negative
HSV-2 - Negative

I never had sores, bumps or blisters etc but 2-3 weeks after the exposure I started to have an irritated/red meatus with some redness on glans and redness on my scrotum skin, which have been going on for 8 weeks now. These are my only symptoms after the exposure. I visited 3 urologists, 2 Dermatologists, 1 STD Clinic and a Physician in last 8 weeks. Did urinalysis which came back clean also. They all told me this is not Herpes and I don't have any Herpes lesions. 

My questions are,

- Is my HIV test conclusive with 2 Weeks RNA, 4 Weeks Duo and 9 Weeks Antibody Tests all negative?
- Now I am mostly worried about Genital Herpes as I know it might take up to 12-16 weeks especially with a HSV-1 positive person. Should I have another HSV-2 test at 12 weeks and 16 weeks? Or my 9 weeks test is conclusive based on one time short exposure and no blisters/sores?
- Are other tests Chlamydia, Gonorrhea, Syphilis and HEP A/B/C conclusive at 6 Weeks? Should I get tested at 12 weeks again for those?
- Could red scrotum, irritated meatus/glans be Herpes related? If not, could these be any other type of STI/Bacteria/Virus?
- Is it safe to have unprotected sex with my wife? I have been avoiding to have sex with the fear of transmitting something to my wife.
- Could anxiety and stress cause redness on my scrotum and irritation around meatus?

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Thanks for the shorter question. The exposure was potentially risky, given the unprotected vaginal sex exposure. On the other hand, at any point in time, most sex workers don't have active, transmissible STDs, including HIV. Second, all STDs are transmitted inefficiently -- i.e. most exposures to infected persons don't result in transmission. Of course the risk isn't zero, but even before we consider symptoms and test results, the odds were in your favor. In addition, absence of typical symptoms of STDs or HIV is additional good evidence you weren't infected -- and none of the symptoms you report is typical for STD, with the possible exception of the "irritated" meatus. Finally, the standard tests you had are highly reliable, if enough time has passed since the last possible exposure -- and certainly there was plenty of time for all of them.

To your speicfic questions:

1) "Is my HIV test conclusive...?" Yes. it is not possible to have HIV and have those tests all negative.

2) "Genital Herpes...etc": You have no symptoms suggestive of genital herpes, and therefore I would not recommend HSV testing. And most people (probably 90%) would have positive results by 9 weeks. But if you feel you must have a truly conclusive test result, you should have another HSV2 test at 16 weeks. I'm confident it will remain negative.

3) "Are other tests Chlamydia, Gonorrhea, Syphilis and HEP A/B/C conclusive at 6 Weeks?" Yes. You don't need any more tests for any of these infections.

4) Red scrotum etc:  Herpes never causes symptoms like this. Neither does any other STD.

5) Unprotected sex with your wife? For sure you should resume unprotected sex with her. Certainly I would do so (would have done several weeks ago) if somehow I had been in your situation.

6) Anxiety and stress probably cannot directly cause such symptoms. However, they certainly could affect your objectivity and perception of the appearance of your scrotum, meatus, etc. And you have been examined and reassured by several knowledgeable clinicians. You should believe them. Nothing is physically wrong.

So all is well. My final advice is to not confuse your shame, guilt, and anxieties about sexual decision you regret with the health consequences of the decision. They aren't the same. Deal with the former as you need to (maybe including discussion with your wife?) -- but you can move on with no concerns about the latter.

I hope this has helped. Best wishes--  HHH, MD


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43 months ago
Dr Handsfield, thank you for your quick response. I have some additional information and follow up questions.
You said irritated meatus could be an exception. Which STD could cause irritated meatus? 
Could this be due to some resistant NGU, Trichomoniasis or M Genitalium infection? Because I  was treated with following antibiotics with no relief at all. 

Cefuroxime 500Mg for 7 Days 2x a day
Doxycycline 100mg for 14 Days 2x a day
Metronidazole 500mg for 10 Days 2x a day
I was recently prescribed Cipro for 10 days but I haven't started it yet.

I will stop having any further test for other STDs including HIV as per your recommendation except HSV-2 test at 16 weeks to ease my fear about asymptomatic infection. I will follow up with the dermatologist for red scrotum because urologists didn't find any issues when they examined. 

I am mostly worried about the irritated meatus. Is there any other STI test I should take to find out what is causing this meatus issue? 
My consistent symptoms are red, irritated and slightly swollen meatus. I also sometimes have  frequent urination urge but it is not consistent so I don't know if it is only in my mind due to anxiety.

I am positive for HSV-1 but I don't remember having any cold sores around mouth or my genitals so I don't know if I have an oral or genital HSV-1. 
My wife has oral HSV-1 since childhood and she gets sores on her lips 2-3 times a year.

Could my symptoms suggest a genital HSV-1 without any blisters? I never had any HSV-1 symptoms or outbreak before but I was wondering whether all the stress I was recently going through might have caused an HSV-1 outbreak. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
No, it is not possible that herpes (HSV1 or 2) is the cause of your symptoms. I didn't say an STD is a likely explanation of your meatal "irritation", only that it's the only symptoms that could hint at an STD. But based on the tests done, treatments you have received, and that herpes never causes prolonged irritation of this sort, it is not possible that any STD explans this or any other of your symptoms.

You have been overtreated with antibiotics. Whoever prescribed additional treatment with ciprofloxacin doesn't understand STDs. Cipro is not a reliable treatment for any STD and will not help your symptoms. In fact, it could make it worse. One slight possibility that could explain irritation of the meatus and head of the penis is a yeast infection, triggered by overtreatment with antibiotics. At this point, you definitely should not take the cipro, stop all treatment, and resume sex with your main partner.

You are obviously obsessed with this and it is frankly irrational. My last advice is to suck it up, believe the reasoned, science based reassurance I have tried to give, resume unprotected sex with your partner, and move on with your life.

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