[Question #961] Follow up questions and concerns regarding single exposure from question #922

50 months ago

Hello Doctor, I have come back again with more questions and concerns. I originally posted a question last week, it was #922 to be exact. If you could go back and read through that so you know what my exposure and previous questions are.

 

I’ll get to the point of this post now.

I have returned here again because I have been very afraid of certain things that have happened recently and things that have returned again.

Like I mentioned in my old post, I have been feeling very minor pain in my penis that my Doctor has told me was just being caused by my mind. I am trying to accept this as the reason, but I can’t get myself to believe/understand this. Last Saturday, I got my latest negative tests, I started to feel happy again, but later that night my “pain” seemed to grow a little. The next day I felt similar pain but in smaller “pulses”.  Since that Saturday, that similar “pain” has either disappeared or has reduced in strength.  I would also like to mention that that same pain I felt Saturday doesn’t seem to occur when I have an erection or when I ejaculate. It seemed to occur randomly. I still have no kind of pain when I pee.

1)If this “pain” was being caused by my mind/anxiety, why did the pain seem to get a little stronger at the time I was starting to finally move on?

2)Does this sound like any sort of symptom for any STD or infection?

3)Can the mind cause these types of pains in the penis?

I have also had some small white chunky stuff under my foreskin, I first noticed this about 1 week after my exposure. I think its smegma, one of my Doctors also said it was something normal. I never checked under my foreskin before my encounter so I’m not sure if I have always had it. I have been washing under my foreskin daily ever since I noticed it, most of the time there is hardly any under there if any, but sometimes there is a small build up the next day after I have cleaned under the skin.

4)Does this seem to be something normal? I have tested negative for Gono/Chlamydia at 11 weeks and 2 days.

My last and biggest concern now is related to HPV/warts and herpes. Because I have tested negative for all the other STDs (I haven’t tested for herpes as I was told not to unless I have an outbreak), HPV/warts are my last worry simply because of there being no test for males to take. What makes me worried is a lump in my throat that I had biopsied by an ENT. It came out to be just some enlarged tonsil tissue. I also have some dark “marks” or lines on the back of my throat which the ENT says are probably enlarged veins. The biopsy was done on June 28th, and for about 2 weeks I had forgotten about the lump. Just yesterday I noticed it coming back again in the exact same spot. This has me worried about HPV/warts. I DID NOT have any oral sex with the escort I was with, I DID NOT put anything in my mouth that was inside of her or around her. I didn’t put anything in my mouth while I was here.

5)Could this be HPV related at all?

6)If the escort had warts, and I had gotten infected through the bottom of my scrotum, will the warts appear first in the place that was infected or could they appear on the tip of my penis first?

 

7)How soon do warts appear? When can I stop worrying about HPV/warts.

 

8)Can I stop worrying about herpes since I’m this far out and have had no signs or outbreaks. How soon do outbreaks occur?

Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago

Greetings.  I will be answering your questions this time.  I have reviewed your earlier interaction with Dr. Handsfield and am sorry that you have had trouble accepting what he told you.  I agree with what he told you- the exposure you describe was safe sex with very little risk for STI or HIV and your follow-up tests prove that you were not infected.  The continuing symptoms you describe are in no way suggestive of STI but they do suggest that you are anxious about the exposure and perhaps guilty, fueling unnecessary concerns.   In answer to your continuing questions:

1)If this “pain” was being caused by my mind/anxiety, why did the pain seem to get a little stronger at the time I was starting to finally move on?

Anxiety is a powerful force. That you notice your discomfort at times when you are not otherwise occupied by activities of daily living makes it all the more likely that this is an anxiety related problem.  STD symptoms do not come and go in the way you describe.

2)Does this sound like any sort of symptom for any STD or infection?

See above, no!

3)Can the mind cause these types of pains in the penis?\

Yes.

4)Does this seem to be something normal? I have tested negative for Gono/Chlamydia at 11 weeks and 2 days.

I agree with your doctor, this is likely to be normal. Your anxiety is causing you to notice things that went unnoticed in the past.

5)Could this be HPV related at all?

No, you were not exposed

6)If the escort had warts, and I had gotten infected through the bottom of my scrotum, will the warts appear first in the place that was infected or could they appear on the tip of my penis first?

Sigh, there are no data to answer this wildly hypothetical question.  Warts typically take 6-8 weeks to appear,  Please read our responses to other clients- this really should not be a concern,

7.  How soon do warts appear? When can I stop worrying about HPV/warts.

I don't think you should be worried about HPV/warts at all.  If you were going to develop visible genital warts, they would appear no sooner than at 6 weeks.

8)Can I stop worrying about herpes since I’m this far out and have had no signs or outbreaks. How soon do outbreaks occur?

Yes, you should stop worrying about HSV, as well as other STIs.  If you were going to experience an outbreak, it would have been within two weeks of exposure.

Your concerns are really not warranted.  I hope these responses will help you to move on. You need to.,  EWH





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50 months ago
Thanks for the reply Dr.Hook.

I know I have issues with moving on, my anxiety is only worsened by the lump in my throat. This lump is next to my uvula, looks smooth and is firm when I touch it. As I said, I had it removed 2 weeks ago and was told from the biopsy that it was enlarged tonsil tissue. The paper I got from the ENT office describes it as a "Lymphoid Hyperplasia in Squamous Mucosa". It also says there "is no evidence of malignancy present". (What does this even mean? What caused this in the first place?)  I plan on setting another appointment with my ENT Doctor to have this new lump looked at and removed again but I worry that it may come back again. I know you said I had no encounter with oral HPV simply because I didnt have oral sex with the escort, but is it possible for me to infect myself in the mouth if I was infected by the escort genitally? I have not had any obvious wart like growths on or around my penis/scrotum so this makes me all the more confident that I dont have HPV/warts, plus I have the Gardisal vaccine for HPV.

All my tests have come out negative (the latest done on July 7th)  , and I am set to take (what I hope are)  a last set of HIV and syphilis tests this week so I can follow up with a GYN next week on the 25 about the results. I was recommended by a PA to go to a urologist for a check up on my "pain" just to make sure everything was ok with that and for reassurance. I have been told by various doctors (plus from reading on websites) that I SHOULD NOT  test for herpes as it can show up falsely positive unless I have an outbreak. Should I avoid testing for herpes since I have not had an outbreak ( and as you mentioned, Im past the point at which I would have had one)? 

Since all my tests have been negative up to 11 weeks and 2 days post exposure, is it safe for me to have unprotected sex of any kind with my regular partner?
How long after exposure does one have to wait for to get conclusive/definitive results from any STD/HIV test?


The last thing (I hope) I want to ask from you is for help believing my tests and doctors as well as help to move on and forget about STDs and HIV. Its hard for me to get my mind off of these things because I have this small "pain" and this lump in my throat. I have been told that the pain is caused by anxiety and not STD related and I assume the lump is not STD related after I was told it was enlarged tonsil tissue and nothing to worry about, but I still cant stop my worry. I know the next thing to do is to talk to a professional counselor, but I'm hoping you can start helping me move on here with some info that can help me or point me to a site that will help me believe and move on/forget. Sorry if I am being repetitive and annoying, I just wish to end this nightmare as soon as possible. Thanks in advance. 
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago

Your anxiety (and I presume shame and guilt) are out of control.  My advice is that your highest priority should be to speak with a counselor.  Feel free to share this and your past communications of this Forum with them.  In addition, you need to get better explanations about your concerns from your doctors.  Does the ENT know of your concerns?  The tonsils are lymphatic glans and so what your earlier excision showed was the you had excised was lymphatic tissue.  This is very different than HPV and in no way suggests oral HPV.  And in reference to your question above, there is virtually no risk for HPV from your singe encounter and even if somehow you had been infected, it would not be possible for you to transfer a genital infection acquired from an escort (which is most unlikely) to your mouth on your hand- such thoughts are fanciful.

I continue to avoid herpes blood testing.  You would have had an outbreak long ago and for you testing with the high probability of a false positive result would set you up for trouble.

Finally, in terms of this exposure, it was safe for you to have unprotected sex with your regular partner weeks ago so it will certainly be safe as well at this time- your results were conclusive weeks ago.  EWH

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50 months ago
Hello Dr.Hook.

Tomorrow I have a appointment with a couselor ( I believe it will be a video call done at the local community clinic) and afterwards I  have a appointment with a urologist.

I know you said I should not worry about herpes but I forgot to mention something I noticed during the 2nd week after my exposure. I was reading through Ashas page on herpes symptoms and saw that it mentioned a yeast infection as being a possible first outbreak that is mild. 

On the 2nd week after my exposure I went to a GYN and she looked at a dark mark on my thigh next to my penis and told me it looked like a yeast infection. She told me to apply some miconozal cream on it and that it would go away. After about a month of using the cream sometimes on and off it eventually went away. Should I worry about this as being a sign of herpes? Should I test? I have not hat any blisters or ulcers that have scabed, the usual symptoms. The GYN told me not to test unless I see those kinds of symptoms.
50 months ago
Sorry for coming back again Dr. Hook, I just wanted to let you know that I spoke with the counselor and she said I have depression and a phobia of STDs. She told me that she will place me on antidepressant medication to make me feel better. What is your thought on this? I am going to take the medication to help me feel better but I want to eventually stop taking it when I feel better. My fear about this is that I will become addicted to the medication and will have more trouble than I do now with worry and fear. I have never taken any antidepressant medication so I don't know what to expect. 
Edward W. Hook M.D.
Edward W. Hook M.D.
50 months ago
I'm pleased to hear that you will be seeing a counselor. Please feel free to share the communications with Dr. Handsfield and I with the counselor.

As for possibility that you have herpes which was mistaken for a yeast infection, that is most unlikely. When herpes mimics Yeast infections there are ulcerations and in women those sores occur in the vagina not on the leg or simply as red marks. What you described in no way suggests herpes.   I continue to strongly recommend against testing for herpes both because there is nothing you have told me that suggests infection and also because of your phobia regarding STI's.  I agree with the recommendation of your GYN.

I'm glad to hear that you met with the counselor and that the counselor has suggested treatment.  I do not want to second-guess the counselor and suspect that the recommendation for antidepressant therapy is reasonable.  I would not worry about addiction to antidepressant medications but would suggest that you express this concern to your counselor as well. Good communication is a sensual for addressing such problems.  When you discuss starting medications with your counselor I would also recommend that you ask how quickly you might see effects. It is not uncommon for antidepressant medications to take several weeks to have an effect and I would not want you to be frustrated because changes did not occur more quickly.

Once again congratulations on the steps you are taking to address your concerns. I wish you well. As per forum guidelines and as this is my third reply to your questions this thread will be closed later this evening. EW H
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