Hello, I asked my original question #6689. You can see my encounter details there.

Dr. Hook mentioned I really should not be worried about viral STI's like hpv and hsv, but just a day later (5 and half weeks post exposure) I started getting what looked like warts on my penis. 

The dermatologist agreed that they were most likely warts but we are waiting for the lab results for them.

1. Obviously having genital warts would suck. But I'm now really nervous about Herpes. Dr. Hook mentioned my chances were lower than 1 percent, and with a condom even lower than that. What were my chances with Genital warts? Since it seems I have contracted that.

2. Since I contracted HPV, does that make it more likely I got Herpes in the same session? I'm not sure if there is a link between the 2.

3. I'm remembering now, a week post encounter I had a bad headache for a few days, which I know is a symptom for herpes. But as far as I know I didn't have an outbreak. Is it possible to get some symptoms without an outbreak?

4. Assuming I contracted Genital warts or another HPV. What would my chances be to transmit them 2 weeks later having unprotected sex with a female partner (to this partner)?

5. Same question as above but with Herpes ^?

Welcome back to the Forum.  I'm glad that you saw a dermatologist.  When you say that the lesions you noted "began to appear" a day after we interacted, what do you mean?  Is it possible that you began to notice lesions that were there previously?  Also how were you tested and when do you anticipate having a result?  The reasons I ask are that, as I have already told you, a single episode of condom-protected intercourse is very, very low risk for acquisition of either HPV or HSV and for warts to appear just 5.5 weeks after exposure would be unusual (and what you describe does not suggest HSV).  Meanwhile I will address your questions:

1.  My assessments of risk are unchanged.  For these lesions to be either HPV or HSV from the exposure you describe would be unusual.  On the other hand, if the lesion is a wart, you may have had it and not noticed it.   I would wait for the lab tests before assuming that this was a wart or HSV.  On the other hand, most unvaccinated persons will acquire HPV at some time in their life.

2.  simultaneous acquisition of HPV and HSV is extraordinarily are.

3.  The headaches that occur with first episode herpes typically occur at the time visible lesions are occurring.  I suspect your headache was coincidental.

4.  The precise transmission rates of HPV following a single episode of sex is unknown but most single encounters do NOT lead to transmission of infection.

5.  Same answer. Estimates are that if a partner has HSV and a persons has an unprotected exposure, the risk for infection is less than 1 in 1000.

U hope this information helps.  I will be most interested to hear what sort of testing you had.  EWH. 

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I continue to thing about your situation.  Can you describe the lesions you have more fully? Where are they located, how many of them are there, how large are they, are they raised of flat, is there a color to them?  EWH
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There were 5 spots I noticed.

1. On the underside of my scrotum. I noticed this one probably a week prior to the others. Just looked like a normal skin tag to me and I wouldn't have cared much until I noticed the others I'll tell you about soon. It's small round and raised. Same color as my scrotum. Dr. agrees it's probably a skin tag, but could be a wart since it's got that cauliflower look on top.

2. A small slightly raised bump in the middle-right-bottom of my shaft. This tiny bump had a black dot in it when I noticed it. But by the time I got tot he dr the entire bump had turned blackish in color. Dr said it's probably a cyst due to the color.

3. 3 bumps all in around the same area. middle-right of my shaft. They are more or less the same color as my shaft, maybe a whitish tint. They are slightly raised, though 2 of them are so small they are hard to see with the naked eye. 1 of them is raised enough to noticed. They are round, almost dome shaped, and the tops seem smooth. Again all 3 are really tiny, but 1 of them is raised enough to notice. The Dr. said these were either warts or possibly another type of skin tag (something that started with an F, I can't remember).

I don't remember noticing #2 or #3 until this past week. I actually remember last week taking a video of my entire genital area and not noticing anything besides for the tag on my scrotum.

I haven't checked if the other 2 spots in section #3 have raised any more since I have bandages down there right now.

For these 3 cases we did a biopsy and it was sent to the lab. I don't know the exact test he was doing but he said we'd know what they were. 

If you would like pictures I can supply them.

Thank you for the additional detailed information.  No need to send a photo as past experience shows that they are rarely much help.  As the doctor indicated, numbers 1 and 2 are unlikely to be warts.  As for the lesions described in 3, they sound more like cysts than warts.  Further, from your description, they sound like they are on a part of the penis covered by your condom making their appearance not only early for warts acquired 5 1/2 weeks ago but if the area was covered by the condom, unlikely to be due to the encounter you are concerned about and, IF they are warts, unlikely to have been acquired from that encounter.  IF they are warts, they were likely acquired further in the past (remember nearly all sexually active persons acquired HPV.  For instance, within a year of beginning to have intercourse, over 60% of monogamous women have acquired HPV.)  The biopsies will tell the story and I hope that you will share the results which should be available in the next week or so.  EWH

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Hello Dr. Here are my results:

1. wart
2. cyst
3. wart

I am now 7.5 weeks post exposure and noticed more spots on my penis. So I went in the dr to take a look and he confirmed those were warts as well and we froze them off.

1. I also started getting some of my old symptoms back. Sore throat, pain near urethra, and pain (feels like swelling) on my scrotum. As far as I can tell these are all symptoms that come with warts correct? When can I expect these to end?

2. I know you said it is unlikely I got these from this exposure, but I personally do not think this is a coincidence. You said getting HPV and HSV from the same exposure is extremely rare. Can I assume then that I likely don't have HSV? I took a blood test which I know isn't a great idea, but I needed some reassurance.

3. You mentioned in 1 post that chances of HSV are 1% and in another post you mentioned it is 1/1000. These numbers are quite different. Which is it?

4.  Based on odds (1/1000). Can I assume that my partner does now have HSV from 1 encounter? If I understand the odds correctly, her odds would be 1/100,000

5. When can I assume this outbreak will end and I can resume my normal sex life?

6. How often do outbreaks occur? How often do I need to be checking myself?

7. Can getting the HPV vaccine help prevent future outbreaks?

8. Can I of gotten more than 1 strand of HPV in one encounter?

9. Can I of transmitted HPV without the initial outbreak starting? (2 weeks post exposure)

10. In regards to classic STD's, you mentioned there is no need for further testing, but some tests (such as Hep a/b/c) want testing after 6-8 weeks, and other tests say to retest after 3 months. Do you still think there is no need for me to test again for things like syphalis, hep, and trich?

11. You mentioned " most commercial sex workers/exotic dancers do not have STIs, when they do most unprotected exposures do not lead to infection". I'm curious as to the second part, why would most unprotected exposures to sex workers not lead to infection?

I'm not sure if I'll have more to ask later, so for now I want to thank you for your help.

Thanks for sharing your results.  You clearly have warts.  Whether or not they came from your exposure less than 2 months earlier is unclear and scientifically unlikely.  Two of the most common questions we received about STIs in general and HPV specifically are "Who give this to me" and "How long have I had this" . Neither can be answered in most cases.  As you should know, over 80% of unvaccinated, sexually active persons have HPV.  It is just not that big a deal.  As you know, this will be my final response as part of this thread.  I hope that my follow-up question responses will be helpful.:

1. I also started getting some of my old symptoms back. Sore throat, pain near urethra, and pain (feels like swelling) on my scrotum. As far as I can tell these are all symptoms that come with warts correct? When can I expect these to end?
These are not symptoms of warts/hpv. HPV is typically asymptomatic and when symptoms are present they are local irriatation, not the symptoms you describe.

2. I know you said it is unlikely I got these from this exposure, but I personally do not think this is a coincidence. You said getting HPV and HSV from the same exposure is extremely rare. Can I assume then that I likely don't have HSV? I took a blood test which I know isn't a great idea, but I needed some reassurance.
Yes, you can assume that you do not have HSV from the encounter you describe and that you have not transmitted it.  I hope the blood test will be negative.  if you, interpretation will be confusing but we can cross that bridge if you get to it.

3. You mentioned in 1 post that chances of HSV are 1% and in another post you mentioned it is 1/1000. These numbers are quite different. Which is it?
The risk of getting HSV from DIRECT lesion contact is less than 1% (1 in 100).  The risk of getting HSV from a person with HSV who does not have lesions is at least an order of magnitude less (i.e. less than 1 in 1000) (0.1%)

4.  Based on odds (1/1000). Can I assume that my partner does now have HSV from 1 encounter? If I understand the odds correctly, her odds would be 1/100,000
Yes, you can be comfortable that you have not given your regular partner HSV.

5. When can I assume this outbreak will end and I can resume my normal sex life?
I would not have suggested any changes to your regular sex life. Your regular partner, if she is unvaccinated, is already exposed.

6. How often do outbreaks occur? How often do I need to be checking myself?
On average, persons with HSV-2 get 3-5 recurrences per year

7. Can getting the HPV vaccine help prevent future outbreaks?
The HPV vaccine will almost eliminate your risk of acquiring new HPV infections.  It is not clear that it will impact exisiting HPV infections

8. Can I of gotten more than 1 strand of HPV in one encounter?
Yes/

9. Can I of transmitted HPV without the initial outbreak starting? (2 weeks post exposure)
The transmission rate for HPV is unknown.  Like other STIs, most single exposures, on average, do not lead to infection.

10. In regards to classic STD's, you mentioned there is no need for further testing, but some tests (such as Hep a/b/c) want testing after 6-8 weeks, and other tests say to retest after 3 months. Do you still think there is no need for me to test again for things like syphalis, hep, and trich?
I see no need for additional testing

11. You mentioned " most commercial sex workers/exotic dancers do not have STIs, when they do most unprotected exposures do not lead to infection". I'm curious as to the second part, why would most unprotected exposures to sex workers not lead to infection?

Think of the flu or the common cold.  You contact persons with these illnesses but usually do not get them. The likelihood of infection increases with multiple contacts and the intensity of exposure

I hope that this information is helpful.  EWH 

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#6 was in reference to HPV not HSV

Final response.   HPV i snot a recurring disease.  If treatment fails (which is different from a recurrence), visible warts will typically be noticeable within 3 months of treatment, sometimes as early as 6-8 weeks.

Thread now being closed. EWH

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