[Question #6938] Symptoms Assessment

9 months ago
Hello,

Thank you for this great service that you provide.

My questions is as follows:

I had a possible exposure to STIs in the form of an unprotected blowjob, rim job and mutual masturbation from an escort. I don’t usually do this type of thing and I am very ashamed of my drunk actions.

This happened about 12 days ago and it has me all messed up and worried. I reached out to the escort and although she was at first willing to have a conversation she did not agree to get tested. She said that she does not have any deceases but would not tell me the last time she was tested. 

 At 7 days post exposure I had a standard STD panel which came out all negative except for HSV-1 which I have had in the form of Oral Herpes since about 8-10 years ago.  Chlamydia and Gon. both urine and oral came out as negative.

At around 8-9 days post exposure I started getting itchy in the genital area (might have been from anxiety since I started googling everything on earth or from shaving down there). 

At 10 days post exposure I noticed that my scrotum was noticeably red (except for the line running down the middle). I went to a local Sex Health Clinic and showed it to the PA on call the PA said that it didn’t look like herpes and I should leave it alone, maybe get some cortizone cream since it looked like a contact rash.

After two days of applying the cream my scrotum is noticeably less red and does not cause as much discomfort. At this time there are no lesions or typical herpes sores/pimples. 

1. Could this be a case of HSV2? When can I get tested and what is the best test to use IgM, IgG, PCR?

- what is the accuracy of the IgG test at
14 days ?
28 days ?
42 days ?


2. Does HSV-2 ever present as just a scrotal rash? Looks red but no boils or anything like that.

3. When do symptoms of HSV-2 usually appear?

Thank you for your help
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago

Welcome to our Forum,.  I'' do my best to help.  Oral sex is a low risk exposure for acquisition of STI.  Most people do not have oral STIs and even when they do, most exposures do not lead to infection.  Your test results rule out gonorrhea and chlamydia which are the most common STIs to follow receipt of oral sex.  As discussed below, it is also quite unlikely that you acquired HSV from the exposure you describe. In answer to your specific questions:

1.  HSV-2 is almost NEVER acquired from receipt of oral sex.  Oral HSV-2 is vanishingly rare at the oral site and when present is rarely transmitted to others.  If lesions were present, the best test for HSV is a PCR test taking using a swab from the area of irritation.  Blood tests can take weeks or even months to become positive.  HerpeSelect blood tests are positive in persons who already have HSV-1/cold sores are  59%, 73%, 83% at 6wks, 3mos, and 6mos


2.  The appearance of HSV infections can be quite variable. That said, your rash sounds little like HSV-2.

3.  The symptoms of genital HSV (1 or -2) typically appear within 9 days of an exposure. 

I hope that his information is helpful.  I would urge you not to worry that you have acquired an STI from the exposure you described.  EWH

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9 months ago
Dr. Hook thank you for your prompt reply and assessment of the situation. Here are my follow up questions.

There was maybe 2-3 minutes of unprotected oral and about 10-15 minutes of mutual masturbation (I did not see any open sores in her)

1. What about the mutual masturbation could I have transferred HSV-2 from her genitals to my own with my hand?

2. You said that HSV-2 comes on with variable symptoms. Have you ever seen it come on as just a red itchy rash in the scrotum?

3. If the rash is HSV-2 could I get it swabbed and tested or it needs to be an open lesion?

4. Is there any point to getting a HSV-2 test IgM and IgG at two weeks post exposure. I know it will not be conclusive but it might help my anxiety.

5. Also I have a young daughter living and she sometimes sleeps in the same bed as me and my wife. Should I sleep in a different bed until this gets resolved. I am afraid I might itch myself and then my daughter or my wife.

6. Does me having oral HSV-1 provide any kind of immunity to Genital HSV-1 infection?

7. Does me having oral HSV-1 provide any kind of immunity to Genital HSV-2infection?

8. Would what you suggest I do at this time?

9. Also if the rash is eczema/dermatitis what kind of cream would work best to resolve the issue? Could you recommend something. I have had kick itch on the folds of the thigh before could this be fungal?

Thank you for your help.



9 months ago
As you can tell from my responses I am more worried about HSV-2 than HSV-1 genital infection since from what I read it presents as more aggressive.
Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago

I'm saddened to here of your continuing concerns about having acquired eHSV-2 through either mutual musturbation or receipt of oral sex.  Neither occurs with any appreciable frequency.  I'll provide brief responses to your questions but must again emphasize, having acquired HSV-2 from the encounter you describe is just not a realistic concern, Further since you have already had HSV-1 (cold sores), you need not worry that you might have acquired genital HSV-1 from the exposure you describe.  Once a person has HSV-1 at one site, people simply do not get it at other sites.

1. What about the mutual masturbation could I have transferred HSV-2 from her genitals to my own with my hand?
HSV is not transmitted from person to person on the hands during mutual masturbation.

2. You said that HSV-2 comes on with variable symptoms. Have you ever seen it come on as just a red itchy rash in the scrotum?
No.

3. If the rash is HSV-2 could I get it swabbed and tested or it needs to be an open lesion?
Swabbing the area for PCR testing will be helpful in ruling out the possibility that it your rash is HSV.  I really do not think it si necessary but, of course, it is up to you and your money. 

4. Is there any point to getting a HSV-2 test IgM and IgG at two weeks post exposure. I know it will not be conclusive but it might help my anxiety.
EVERY expert and official body recommends AGAINST HSV IgM testing.  At two weeks very few people have positive blood tests for HSV-2.  If you were to test and the test were positive, it would be likely that it reflected and earlier infection than an infection acquired just two weeks ago. 

5. Also I have a young daughter living and she sometimes sleeps in the same bed as me and my wife. Should I sleep in a different bed until this gets resolved. I am afraid I might itch myself and then my daughter or my wife.
No, your daughter is not at risk from sleeping in your bed.  This is another internet-based myth.

6. Does me having oral HSV-1 provide any kind of immunity to Genital HSV-1 infection?
Persons who have HSV-1 infection have some modest resistance to acquisition of HSV-2 but that resistance is not absolute.

7. Does me having oral HSV-1 provide any kind of immunity to Genital HSV-2infection?
My response to question 6 is the same irrespective of the site of the HSV-1 infection.

8. Would what you suggest I do at this time?
Relax and move forward without concern.  Stay off the internet.

9. Also if the rash is eczema/dermatitis what kind of cream would work best to resolve the issue? Could you recommend something. I have had kick itch on the folds of the thigh before could this be fungal?
Eczema is typically treated with topical steroid creams.  The rash also could certainly be fungal.  Asking your doctor to take a look would help sort this out.  The steroid cream you were taking might actually make a fungal infection worse.

Hope this helps to get beyond your concerns about STIs. EWH
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9 months ago
Hello,

Thank you for your response could you also please answer the following questions for me.

1. I was very upset and scared by the whole incident described before since I did not ask for a BJ without a condom and as soon as I realized I stoped everything. Because the girl did not want to get tested and blocked me afterwards you can understand my panic. At approximately 14 hours post exposure I was started on PEP (Truvada and Viticay. 

Could I have caught HIV from this exposure and the rash be an HIV rash? 

Or could this possible be a side effect of PEP?

2. I had a 4th Generation Test at baseline and at 19 days post exposure. When would you recommend I test again for HIV?

Would you recommend also a HIV RNA test and when?

3. Could the rash that developed after 8-9 days post exposure be an HIV rash?

4. I also had a IgG test for HSV-2 at 19 days post exposure it cane back as negative. I will be getting another IgG test at 6 weeks along with the 4th Gen HIV test. Would I need to test again after this?

5. The rash on my scrotum got a little better after several days of anti-fungal cream (not as itchy and not as red)  but it is still  quite red and noticeable on the scrotum. No lesions anywhere on the Penis, Scrotum, or Anus. What would you suggest I do?

6. If the rash is HSV-2 would it cause lesions and this time? I have had the rash for about a week now.

Doctor please help me, I don’t know what to do.



Edward W. Hook M.D.
Edward W. Hook M.D.
9 months ago
For your follow-up questions. I wish he had known the concern earlier. I certainly would not have described PEP for you and fear that the physician who did understands little about HIV. There has never been a case of HIV acquired through receipt of oral sex, not ever. Thus, even in the unlikely circumstance that your partner had HIV, your risk for having acquired HIV would be zero.  Brief answers to your follow-up questions will follow:

1.  See above. This was a zero risk exposure for HIV. There is no way the rash you described would be due to HIV. Further, the description you provided is atypical for HIV.
2.  Once again, this was a no risk event for HIV. There was no medical or scientific reason for testing related to the event you described.  Thus there is no need for further testing either.
3.  It’s been answered. Repeating the question will not change the answer. What you have noted is not a rash of HIV.
4.  I would not have recommended testing for HSV to begin with. I see no need for further testing and certainly no need for testing after six weeks.
5.  If the antifungal treatment was helping, it may take a week to 10 days of treatment for complete resolution.
6. No, if this rash for HSV-2, it would not be persisting at this time. As I have stated repeatedly above, there is virtually no chance that this is HSV-2.

I hope the information I have provided has been helpful to you. My sense is that you are embarrassed and troubled by the encounter you described. Acknowledging that, there is still no reason for you to be concerned about herpes, HIV, or other STI’s. I hope that you will now be able to move on without continuing concerns.

As I suspect you know, we provide up to three replies to each clients question. This is my third reply. This thread will be closed shortly without further replies. I wish you the best. EWH

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