[Question #7576] Std or

2 months ago
Hi Dr’s

I am still concerned over my oral sex exposure almost 12 weeks ago.

Have you Dr Hook or Dr Handsfield, ever seen or come across a person catch HSV2 from a man receiving oral sex off?

I thought Syphilis initially, testing proves this incorrect thankfully:

The symptoms I have had are all new to me, the particular issue is an anal rash / small  marks or scabs that have been here for almost 7  weeks, the look of it changes almost daily, the inner skin to anus looks grey, red, pink and dark red lower down, almost claw like.  Most of the visible issue outside between the testes and anus appears like a big bubble around the mid-line.

I am negative for HIV, syph, gon  and chlamydia 

My question is are there any medical condition  that could cause very mild single genital ulceration in a couple of olaced and also the above issues in the anal area, other than HSV?

Would it be typical for a small ulcer, very pale almost skin colour, to be on the shaft of a penis for 10 days without turning to a scab? 

Thanks Dr, i know I am anxious and trying to find answers
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
Welcome back to the forum, but I'm sorry to learn you're still concerned about the sexual exposure descirbed and these symptoms. I reviewed both our earlier discussion and your more recent one with Terri Warren.

I am completely confident that your anal area symptoms and other skin problems in the area are not due to any infection from the sexual exposure described. We've previously discussed why syphilis is impossible (doxycycline). And neither herpes nor syphilis cna cause symptoms at sites not directly exposed. If you had acquired either infection from receiving oral sex, the initial symptoms would only be where your partner's mouth contacted you. It isn't possible to acquire either of these on the penis and have symptoms fist show up in the anal area. As for what IS causing those symptoms, your description doesn't give good enough clues for me to even guess. It could be some sort of dermatitis -- but not any known STD. My advice is to see a doctor for in-person evaluation.

As for your previously described small genital ulcer, we've already discussed the fact that herpes is the most common overall cause of genital ulceration. But if it's herpes, almost certainly it isn't from the exposure you described previously. Equally important, your detailed description is not at all typcal for herpes; and a herpes ulcer cannot persist unchanged for 10 days or more. And from your description, I'm not sure it's even an ulcer. Here too, I would recommend professional exmaination for diagnosis.

You're never going to have a clear diagnosis from this or any other online forum. Once you've seen a health professional, I'd love to hear the outcome. Please keep me posted. But otherwise, this forum really can't help any further. In the meantime, I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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2 months ago
Dr,  I am truly grateful for your reply, it would have been fair enough to decline comment given the number of questions.


I am scheduled to see a Dermatologist here is Scotland next week, I will be sure to share the verdict.

Its reassuring that the ulcer (if it is one) is not likely to be related due to the time it has been there. It is slightly shallow and could be easily missed.  Another one has appeared close by today which does sting a bit, although in any normal day, I’d flinch and think nothing of it, I would not have a magnifying glass and spotlights on it.

Do herpes ulcers change and scab quite promptly?

If I am just confirm that the anal symptoms came about five weeks after the encounter, with the first  ulcer thing appearing at three weeks after a white sold spot on the shaft cane at some point, but cannot recall when. My thought was that the anal symptoms were perhaps a 2nd OB, but they have been here for almost seven weeks and have gotten worse, yet strangely, no pain.  The ulcer on the foreskin is still here almost nine weeks later, its smaller and closing, slowly. 

You 110% reassured me on Syphilis, thank you.  

My anxiety question I guess is about HSV2, is this something you have ever seen, or come across for a man receiving oral off a female to contract it this way? 

Also, if she had a genital lesion and had touched it or her lady parts before masturbating me, could GHSV2 of transferred this way?

I am so grateful Dr, your patience with me and others (as hard as  it must be) is really appreciated....

Thank you.



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
I'm very glad to hear you'll be seeing a dermatologist and look forward to hearing the outcome.

I wonder if you have not an ulcer, but just a depression in the skin. If ulcerated, it would have a red base and probably would be tender -- not unlike a canker sore in the mouth, or a recently skinned knee after removing the scab.

Herpes ulcers always evolve over several days -- on dry skin, it would have scabbed over before 10 days, and way long before 9 weeks.

My experience is the same as Terri's. To my knowledge or recollection, I've never seen a patient with genital HSV2 acquired by oral sex. Among other things, oral HSV2 infections are rare, so it is the rare oral sex event that even has a theoretical chance of HSV2 transmission. And no, HSV2 is not so easily transmitted to just be transferred by touching of the sort you describe. New HSV lesions almost always occur at sites of maximum friction during sex (penis head, vaginal opening, etc):  that's because it usually requires prolonged or vigorous rubbing, i.e. massaging the virus into the tissues, for infection to take hold.

As you know, each question includes two follow-up exchanges, so you have one coming. Let's hold off until you've seen the dermatologist.
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2 months ago
Hi Dr,

I was trying to hold off until after the derm but worry got the better of me.

As most if the sore area appears on one side towards the anus, then as it get to the inner parts which you can only see by pulling your buttock apart, the scabs appear ok both sides, until the exit on the other side where the pink colour is close to the centre line but does not cross it.  My question on this is. Does the central line run through the middle of the anus, ie, if it is herpes and a recurring BO, would bilatteral 
2 months ago
Hi Dr,

I was trying to hold off until after the derm but worry got the better of me.

As most of the sore area appears on one side towards the anus, then as it get to the inner parts which you can only see by pulling your buttock apart, the scabs appear ok both sides, until the exit on the other side where the pink colour is close to the centre line but does not cross it.  My question on this is. Does the central line run through the middle of the anus, ie, if it is herpes and a recurring BO, would bilateral Sores be possible within the buttocks?

The area that heads in to the anus away from the testes has a one inch x 1.5 inch area of what looks like spilled clear glue on pink skin, it has some red marks underneath and the appearance at the mid line is quite red.  Have you ever seen Herpes look like this?

Final question is as the anal region has had moving and evolving scabs etc for seven weeks, have you ever seen herpes do this for this long before?  

Thanks for your patience, I will come back with what the Derm says, even if I need to pay again to do so.

Thank you. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
2 months ago
You're seriously overthinking this, which still doesn't sound like herpes, either from your description or its duration. This is some sort of dermatologic problem, not an STD. I have a book titled Genital Dermatology Atlas. As the name implies, it is filled with photos of genital rashes, ulcers, discolorations, etc. Of its 300 pages, all STDs take only 15 pages. In other words, the large majority of genital area skin problem are non-STD problems. The same is true of the anal area.

As I've said before, I remain confident this has absolutely nothing to do with the sexual event described -- just a coincidence in timing. You can expect the dermatologist to agree. In the extremely unlikely chance s/he diagnoses herpes or other STD, feel free to return to the forum with more questions about it. Otherwise, please do not return to this forum for further discussion:  we do not attempt to deal with non-STD genital or anal area problems. Thanks for your understanding.

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