[Question #7234] Concerned about recent potential exposure

5 months ago
48 yr old male. 3 weeks ago today (Aug 12, 21 days ago)I had a body rub nude massage with a girl working out of her apartment.  No intercourse, either oral or vaginal, but there was some brief genital rubbing.  Nothing seemed out of the normal until 18 (Aug 30) days later when I found a tiny scab just under the head of my penis.  It brushed off easily and underneath was just a red spot, not raised or ulcerated, just like a bit of raw skin. I saw nothing in this area in the days before that and I had been looking because I was concerned about the possible exposure.  Since it was painless, I put a little lotrimin on it and the redness went away mostly in a day or so.  Today (Thurs 9/3) you have look hard and stretch the folded skin to see that there was anything there at all.   
A few other points to make 
1. I’ve tested negative in Jan in routine std screen for HSV 1&2 by IGG test. So if this was a first outbreak wouldn’t it have been worse? 
2. The skin on my penis is extremely dry that I can see when erect. The underside looks a bit white And ashy actually.  I haven’t had sex in about 10 days or masturbated in a week.  Why so dry? New soaps maybe? 
3.  I reached out to the girl in question and she told me that there was no direct genital rubbing, that she just makes it feel like that, and that she has recently tested negative for HSV 1 and 2 when they took her birth control out? Not sure why she mentioned that part, but also no idea how honest she’s being. 
4. Recently had a physical (7 days ago) and had a urinalysis done as I am having Prostatitis symptoms (for the third time in 5 yrs)  No WBC’s or Nitrites in urine.  I was concerned that urethral herpes may have been part of this too but I think that usually would show up with WBC’s in urine?  My dr saw nothing on my penis in the physical exam either. 
All these things being said, do the symptoms above sound like Herpes?  The small scab concerned be greatly but it was so mild with no initial sore or blister apparent that I saw.  Also, the potential exposure is very limited and the girl claims she is negative. But, I’m still worried.  Question: Should I test at 4 weeks (HerpesSelect IGG) for this (I know 12 wks is best but don’t want to wait) or is there such limited chance I am infected that a potential false positive outweighs the benefit of an not completely conclusive negative test?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Welcome to the forum. Thank you for your confidence in our services.

No STD is at all likely from the sort of contact you describe. Almost certainly the penile lesion -- whatever it was -- had nothing to do with that event. Could it be genital herpes? Unlikely, but I cannot rule it out. But if so, almost certainly you acquired it long before the events of 3 weeks ago. The blood tests are not perfect: the HSV1 blood test misses about 30% of all HSV1 infections; the HSV2 test misses around 5%.

1. Initial genital herpes can be entirely asymptomatic, and conceivably could show up with the single trivial lesion you had. But usually there would be multiple lesions, inflamed lymph nodes in the groin, and often fever.

2. Dry skin, of the penis or anywhere else, isn't a symptom of any STD. I can't explain it in this case, and we really don't get into the weeds in figuring out non-STD genital symptoms. Your doctor is a far better source to sort this this out.

3.  You can judge your partner''s honesty and I cannot. However, my experience is that people rarely lie about STD status when asked directly. Most likely she indeed was teated for HSV1 and 2 with negative results -- adding to the evidence that you didn't acquire herpes from her (and probably don't have it at all).

4. You don't describe your "prostate symptoms" in detail, but urethral herpes typically is extremely painful. I'm sure you don't have it.

I don't recommend any further evaluation or testing for herpes. The only exception would be if a similar penile lesion appears again, or if you have any others like it -- especially blister-like. In that unlikely event, see your doctor ASAP for an HSV PCR test from the lesion, ideally done within 48 hours of onset. But as I said above, in the unlikely chance this happens and you turn out to have genital herpes, I would attribute it to a distant past infection only now causing recognized symptoms.

I hope these comments are helpful. Let me know if anything isn't clear.

5 months ago
Dr. H, thanks for the reply and advice.  As I only have a couple of follow ups, I’ll be judicious with additional information and questions.  
1.  The “lesion” in question was almost invisible until having sex this morning and now it is red again, maybe 1mmx2mm.  Size hasn’t changed.  Doesn’t hurt and I’ve applied Lotrimin again.   It doesn’t appear ulcerated or raised much if at all, it’s hard to tell with the naked eye but looks flat.  It looks nothing like herpes lesion images I have seen online.  I am wondering if this sounds like the tendencies of a herpes lesion?  To go almost away and then be apparent again after sex/friction?
2.  Because it was painless, is it possible that this is Syphillis?  I know odds are against this and it’s fairly rare. Again it looks nothing like the online images I have seen, and doesn’t look like an ulcer or canchre.  It’s redness initially went away in a few days and now is red again.  It’s just that any penile lesion is of course worrisome.  I am currently taking Levaquin for Prostatitis (and the Prostatitis symptoms are actually improving after a few days).  Say this was Syphillis - would Levaquin eradicate it?  Or, would Levaquin skew a test result for Syphillis if I had one??
3.  I trust in your advice about testing for HSV and won’t unless I get a blister like lesion or multiple lesions.  
4. My female partner of 4 years has tested positive for HSV1 and we do engage in oral sex occasionally, but not often, so I understand that could be an exposure risk as well.
5.  Prostate symptoms were slight pain after urination in the tip and perineum, pain in the perineum before and after bowel movements, low back pain, occasional pain in tip of penis, frequent need to urinate.  I’ve had those symptoms for two months and they are getting better after starting the Levaquin after a urologist exam. (5 days in of 14)
Thanks again for your time and patience with my questions. It’s much appreciated to get the advice from and expert and not rely on internet searching.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
1,4) This description doesn't sound like herpes, although it could fit with a healed herpetic lesion. Your partner's diagnosis and your oral sex exposures are certainly consistent and make herpes quite a bit more likely than I previously said. Do follow through with PCR testing if this sort of problem reappears.
2) Syphilis is probably even less likely than herpes in this situation and your description doesn't fit syphilis. Levofloxacin is entirely inactive against syphilis and would not interfere with a syphilis blood test.
3) Good decision!
5) These symptoms indeed are consistent with prostatitis and not typical for any STD, and certainly not due to HSV.