[Question #569] unportected oral sex with a "bar girl" in South America

42 months ago
I am a pretty healthy male in my mid 30s.

22 days ago I received unprotected oral sex from a "bar girl."   I realized after the fact that (isn't that always the case) that I had a sore that may not have completely healed on the base of my penis from masturbating without lubricant.

1) After the "incident" the area began to feel aggravated pretty much within a few hours.   2 days later  I had pain in my right inner thigh (only when I touch) which I assume may be lymph node pain, which may mean that there is some sort of viral infection infection.  After that I began to notice random muscle aches and some knee pain in my right knee.   The lymph node pain lasted for a about a week and after that the area just remained slightly swollen, but I never noticed anything that I would think would be lesions that might indicate herpes.  Could this have been primary herpes?

2) 9 days after the incident I decided to get bloodwork and urine work for gonorrhea, syphilis,  and chlamydia, which all came back negative.

3) 19 days after the incident I decided to get a IGG test for HSV 1 and 2.   I got a 39.7 U/ml for HSV1 and a 15.6 U/ml for HSV 2.    Apparently in their scale anything over 30 is positive and less than 20 is negative.  The test was a enzyme immunoassay, ELISA.  I got all of these tests while still in South America so it looks like the numbers are a bit different.   Is there anyway that I can tell if this positive result is from the incident 19 days prior or have a had HSV1 for quite some time.

4) What other STDs should I screen for?  What's my risk for HPV?  I am worried about transmitting it.   I have told my wife about this situation that happened and we are in a really bad place right now.  We might not make it through, which I obviously couldn't blame her for. 

Thank you
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your question.

Many people assume oral sex carries a high risk of STD. It does not. Oral sex can be considered safe sex, with low risk for all STDs and zero for some. Even the most sexually active persons (like some "bar girls") are unlikely to have transmissible STDs orally, and even when present, transmission is uncommon. If I somehow were in your situation, I would be continuing unprotected sex with my wife with no worries of infecting her with anything. To your specific questions:

1) No STD (or any other infection) can start to caus symptoms "within a few hours". If the groin discomfort is related to the oral sex event, I would ascribe it to just physical irritation and perhaps a bit of inflammation from common skin bacteria. If you actually have apparent swelling or tenderness in the area at this time, the area should be professionally examined. Otherwise I wouldn't worry about it. Almost certainly this is not herpes, primary or otherwise. Initial herpes almost always starts with blisters/sores where the virus enters the body, with is at the site(s) of the most friction during sex. That would be the orally exposed parts of your penis, not the possible sore in the upper area. 

2) Your 9 days tests were conclusive for gonorrhea and chlamydia, but too early to say anything about syphilis.

3) Your HSV tests show you are infected with HSV1, probably long before the oral sex event; 19 days is too soon. The HSV2 result is negative. Up to half of all adults (up to 90% in some countries, including some in South America) have positive blood tests for HSV1, usually the result of oral herpes as a child. HSV2 is virtually never transmitted by oral sex, so I don't recommend repeating the HSV blood test. But if you decide you need to do it for reassurance, have another test about 3 months after the event. If you do so, I'm sure it will remain negative for HSV2.

4) I don't recommend any other STD tests. HPV is rarely transmitted by oral sex. Anyway, assuming you and your wfie have had other sex partners before you were together, you can assume you both have had genital HPV and could already have shared an infection with it. This event will not increase that possibility. Anyway, there is no reliable test for asymptomatic HPV and no way to treat it. You could consider another syphilis blood test about 6 weeks after the oral exposure, but I'm sure it also would remain negative.

Bottom lines:  If your groin symptoms continue, see a doctor to be safe. Consider follow-up syphilis testing at 6 weeks, but expect a negative result. Finally, work on your relationship with your wife, and resume sex with her if that is also her desired; no reason not to, with almost zero risk you have anything that will show up with later testing.

Best wishes and good luck--  HHH, MD

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42 months ago
Thank you Dr. Handsfield.  And thank you for all the work that you and your colleagues do.

I forgot to mention (and there were word count restrictions) that I got a yeast infection, which I self-diagnosed because I had them before.

My penis had shiny skin and one day I went swimming in a chlorinated pool 22 days after the incident and I had all this flaky peeling skin all over my penis head, shaft and testicles.  I got some vaginal yeast infection cream and that seems to have cleared things up.  I read online that this could also cause swollen lymph nodes.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Thanks for the additional details. But they don't change my opinions or advice. Oral sex is unlikely to transmit yeast, so if your penile skin problem indeed was a yeast infection, it was just a coincidence, unrelated to that event. Assuming the diagnosis is correct, I would be more suspicious that you and your wife are sharing a vaginal yeast infection. In any case, I'm somewhat skeptical of yeast or other fungus as the cause of such symptoms, or that a localized infection of that sort would cause lymph node enlargement. If or when this problem recurs again, consider seeing your doctor or preferably a dermatologist. If confirmed as yeast, your wife might benefit from treatment as well.

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42 months ago
Not to have this thread go on longer than it should, but how sure are you that 19 days isn't enough time for the HSV1 antibodies to show up in an IGG test?  I think this will be a key factor in saving my marriage.

Again...Thanks again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Although it is possible for an HSV antibody test to become positive as soon as 19 days, it's unusual. Typically 6 weeks or longer.

Even if you had acquired HSV1 genitally, it shouldn't affect your marriage. Genital herpes due to HSV2 is easily transmitted sexually, but genital HSV1 usually is not. There are few recurrent outbreaks and rare times the virus is present. Your wife probably is at risk from your probable oral HSV1 infection anyway. While I can understand that having extramarital oral sex might jeopardize your marriage, the possibility of herpes definitely should not.

That completes the two follow-up questions and replies that come with each new question, and so ends this thread. Do your best to move on. Work on your relationship with your wife, but do your best to stop worrying about any STD from this event.

Best wishes to both you and your wife.


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