[Question #6563] Dr. Handsfield, please give me your opinion on STD possibility

14 months ago
Dr. Handsfield, please help.  I sensed my anus was irritated and checked it.  I found a late-stage lesion as big as a shirt button on the perineum just outside the sphincter.  One-third was deep red/purple along a line in the perineum, like the lesion healed without scabbing or the scab was gone.  The rest was a mottled, lighter shade of red and didn’t appear the skin had broken.  It was a bit sore to the touch, but otherwise I wouldn’t have known it was there.  The perineum was slightly irritated, maybe a light rash in places.  No other sores on my penis/genitals.  I had six red, pimple-like spots spread-out on my buttocks and thighs (not atypical).  Exactly 14 days prior I had condom-protected vaginal sex.  No anal/oral contact.  My hand touched her vagina.  The base of my penis contacted her vagina briefly.  I touched my anus with my hand later when I showered.  I’d estimate the lesion developed a week prior to finding it or seven days after sex, which is consistent with STD incubation.  I saw in a recent post you advised someone that HSV shows up at the sight of inoculation (for me, the penis).  Others say an anal presentation is possible without direct contact.  Autoinoculation is unlikely but theoretically possible.  My instinct is to move on, but I can’t find another more plausible explanation than HSV for an otherwise healthy butt.  To me, a deep red healing lesion with red perimeter suggests infection.  Seems too far from the sphincter to be a fissure or tear.  Doesn’t look like a yeast sore.  No trauma.  A slight hemorrhoid is visible, but I don’t think there is any involvement.  I guess a fungal infection is possible, but the lesion seems inconsistent and it cleared up.  Past igg testing neg HSV-1/2.  No systemic symptoms.  In sum, what do you think?  Should I cease further sexual contact until I can be tested?  Any recommendations appreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Welcome back to the forum. Thanks for your confidence in our services, and your personal request for me. But users do not have the option of selecting the moderator who responds. I happen to be up for new questions at the moment, but it could just as easily have been Dr. Hook. Our expertise and advice are identical.

You use professional terminology. Are you involved in health care?

These questions have been largely answered in your two very recent discussions with Terri and there is little more to say. I agree there was little risk of herpes (or any other STD) from the events described and that you could not have acquired anal area herpes from those events. I don't know what sources "say an anal presentation is possible without direct contact", but that's not true. Initial herpes only appears at the site(s) of inoculation. Recurrent outbreaks can occur regionally, but not the initial one. I've never heard of HSV autoinoculation to the anal area -- I can't say it doesn't happen, but first you would have to have HSV elsewhere, and I agree with Terri that your oral sores aren't typical for herpes.

I can't argue about the possibility that the anal lesion you describe could be due to an infection, but of course that doesn't necessarily mean herpes. Your description of the differential diagnosis seems fairly reasonable. But beyond that, what can a distant forum do?  You should be examined by a knowledgeable provider (and if you're a physician, you've undoubtedly heard the aphorism that a doctor who treats him/herself has a fool for both doctor and patient). Despite the apparent lack of direct contact of your anal area, both herpes and syphilis should be evaluated, perhaps including (if the examiner agrees) HSV PCR of the lesion and perhaps your oral lesions, if perssiting; and perhaps more usefully, HSV and syphilis blood tests. For all the reasons discussed, you should expect negative results. The main purpose for such evaluation is for the reassurance value you might gain.

HHH, MD

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14 months ago
I'm a researcher/writer and when I have an area I don't understand I try to learn as much as I can.  To say I've read a lot on this topic is an understatement.

I felt like I may have biased Terri's input with my words and I thought the best way to remedy that is to ask you...especially after I saw a similar post from you that got directly to the point I was interested in.

If initial herpes only occurs at the site(s) of inoculation, I think it is impossible this is the cause.  My case is closed.  Thank you so much for your time and your consideration.  Very much appreciated!

14 months ago
… Oh, and I'm also going on the assumption that transferring a STD/HSV from her vagina to my anus via my hand is extremely improbable.  Thanks, again!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Correct.

That concludes this thread. Please note that repeated questions on the same exposure, symptoms, etc are discouraged. This being your third, it should be your last. There is no realistic chance you'll think of other aspects that would have any chance of changing our assessments and advice so far. Thanks for your understanding.
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