[Question #5608] STI, herpes, mono, EBV??

22 months ago

Doctor, I’m a male of 37 years from India. I engaged in deep french kissing and protected sex at a massage parlour with a female massager about 10 days back. The next day I was down with severe body aches and extreme fatigue followed by a sore throat. The sore throat is not constant, it comes on and off with a slight hot and burning feeling. The fatigue and sore throat has been going on for some 10 days now. The last 2 days there have been burning sensations in the tongue. However, I’ve had no blisters. I’ve had no herpes outbreaks in the past and 5 years back I’ve tested negative a number of times for HSV-1&2 igg tests. 5 days after the said exposure, my ESR was elevated at 20 mm/hr (normal values being 0-15) indicating infection. What do you think I’ve possibly caught? I’ve never been so sick for such a long time ever. Is it possible that I’ve caught HSV-1 or EBV related infectious mononucleosis or some other viral or bacterial infection?

If you think the symptoms relate to HSV-1, should I wait for blisters to appear before taking valacyclovir or take it beforehand? Will taking it before the appearance of blisters relieve the current symptoms of sore throat and fatigue and suppress the likely future associated pain and symptoms of cold sores near the mouth? Also what is the appropriate dosage of valacyclovir for oral herpes? Please advise.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
22 months ago
I don't believe that herpes fits with your symptoms.  First, if someone acquires herpes, they don't develop symptoms so soon.  Have you noted any sores in your throat?  Have you had a clinician look at your throat?  that would be important I think.  ESR can be elevated for any number of reasons - it is non-specific and should not be used to try to diagnose something specific, like herpes.  I doubt that you have new herpes as you've had no visible lesions (unless you are seeing something in your throat like sores that you didn't report here).  I understand that you have not had sores externally.  You could have acquired mono, have you done tested for mono with your clinician? 

I don't recommend that you take antivirals at this point.  If you do decide down the road a ways to retest for herpes, taking antiviral medicine can interfere with getting a proper and accurate test result.

Again, have you seen a doctor or someone to evaluate you and do testing?

Terri
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22 months ago
Terri, Thanks for your response. I've already showed myself to a skin & VD doctor. Upon looking at my throat, he only said it was inflamed.  I'd asked him if it was mono to which he replied that it is unlikely to be so as mono and EBV are not much prevalent in the Indian population as it is in the US  for much of the older generation here have mostly been in monogamous relationships and are unlikely to have contracted it and passed on to their children. He could be right here as I've never encountered anyone with even oral herpes in school, college and work and extended family. But then he also holds the view that kissing could transmit HIV and asked me to get tested for HIV.  When I told him that CDC associated STD experts rule out kissing as a way to transmit HIV, he told me that they are theoritical.  One gets the sense that most general medical practictioners and venerealogists in India don't read and update themselves much with the latest research and lack ethics.  Should I be getting tested for HIV? The doctor asked me to take valacyclovir, 500mg for 7 days if external blisters were to appear. From what I've read the dosage on websites and medication document for oral herpes is recommended at 2gm twice for one day 12 hrs apart. Thanks for your advice to take anti-virals only if external blisters appear.  Please advise on the right dosage if external blisters were to appear. I don't think I've seen anything out of the ordinary in my throat and have not had sores externally. But it feels different from a bacterial throat infection as I'm frequently prone to it and the extreme biting feeling of the throat it causes, which is almost intolerable and resolves only with antibiotics, I've not experienced it. The sore throat currently is like a bad irritation and adding to the general malaise from fatigue.  I've felt tingling sensations around the lips but it could be psychological as I've feared contracting HSV-1. I'm not using ESR for diagnosing herpes but it indicates some infection that I've most probably acquired from the deep kissing as my ESR was normal a month ago. 
If you think its infectious mono caused by EBV, what blood testing should I do and after what time after the exposure to ensure correct results? I’ve read that EBV is linked with a number of cancers. Do the EBV linked cancers occur only with immunocompromised patients or is everyone at risk equally though it is rare? Also do people with EBV who do get these cancers like Burkiitt Lymphoma, nasopharyngeal carcinoma and others get them at only at an old age or are at risk the moment they contract EBV? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
22 months ago
You can do an EBV antibody titer.  Most of the population in the US has EBV and I don't think cancer is a big worry though it is possible of course.
Remember that if you have herpes in the throat, it wouldn't continue to be an ongoing irritation - it would be very intermittent. 
I think you might be overthinking this a bit.

Terri
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22 months ago

Terri, I’ve tested negative for mono test and syphilis. These tests were 16 days after the current exposure of deep kissing and protected intercourse. But the symptoms of fatigue, intermittent sore throat and sweats after waking up, and body aches persist even now, 18 days after the exposure. On a related note, about two months before the said exposure, I’d also contracted urethral infections twice from the same female massager from just minimal contact with body skin. There was no intercourse or oral sex involved. I had burning sensations in my urethra and a painless bump next to the urethral meatus. The urethral meatus had swollen slightly too but went away later on. The burning sensations in my urethra went away after a course of antibiotics but the bump did not go away completely. Can one contract urethral infections from just minimal contact with body skin of another person? The current symptoms aren’t related to that, would they be? Do I need to get tested for HIV? Have any of the above-mentioned sexual activities exposed me to the risk of contracting HIV? Please advise.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
22 months ago
No.  I don't know what you had going on there, but your "urethral infection" was not due to minimal body contact.  What bacteria, if any, was recovered to make the diagnosis of infection?  I do not believe that you need to test for HIV at all.  Nothing you have done puts you at risk of an STI.  An if you basing all of this an on ESR of 20, I would put that aside.  it is a very non-specific indicator and could be elevated for many many reasons.

Terri
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22 months ago
Terri, majority of the doctors here in India don't do urethral swabs. I also don't see anyone doing throat swabs. They just prescribe antibiotics if they think it is a bacterial infection. Also most clinics don't have testing facilities for swabs. For that one has to go to specialised laboratories or big hospitals. Anyways the past exposure over two and half months back just involved me being naked and the female massager in her undergarments engaging in kissing and body contact and a handjob. There was no frottage involved. Its possible my penis rubbed with her body skin while kissing naked and that maybe she did'nt wash herself after having had possible contact with other men on the same day. I had broached the topic with the massager afterwards but she said that she didn't have sexual activity with everybody. This exposure had  led to burning sensations inside the urethra, my urethra meatus being swollen for a little while and having a bump next to the meatus on my penis glans. The burning sensations inside the urethra had continued for 4-5 days and weren't resolving after which I went to a doctor who prescribed me antibiotics (Lymecycline on the first occasion and Cefpodoxime Proxetil on the second). The second exposure had additionally involved my penis rubbing against her buttock cleavage and the symptoms were burning inside the urethra after the exposure. These symptoms got resolved after taking the antibiotics. I wanted to put all these facts and concerns  in my first question itself but the 1500 character limit for the 1st question prevented that. So you would rule out my current symptoms of fatigue, intermittent sore throat and sweats after waking up, and body aches being related to HIV in respect to the past exposures and current exposure of kissing and protected intercourse?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
22 months ago
I would indeed rule out those symptoms being related to HIV from this encounter, no question at all.  What you did was completely safe.

Terri
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