HIV - Prevention Expert Forum
Problems
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Problems

Hi Doc,

I received unprotected oral sex multiple times from multiple CSWs in the red light area in Mumbai  one night (I know, very stupid of me).  About 1-2 days afterwards, my scrotum was very itchy, I had pain in my right inguinal area where the leg meets the body, diarrhea, and severe fatigue.  This lasted a day and then more or less went away to be replaced by a painless non itchy red rash on my foreskin (I’m not circumcised) that also appears to be very dry and white, but no blisters/ulcers that I can see.  It is on the outside of the foreskin (i.e. where the skin is the thickest).  It is still there (although seems to be getting better) today which is about 5 days post event.  My questions are:

1.  I know it has to be something related to the oral sex, just not sure what it could be.  Could this be herpes?  I think I did get herpes once many years ago since I had painful blisters, so is this possible?

2.  Is there really any point in testing to ascertain this? I live in India and there are no proper STD clinics here, so the only HSV tests I can do are available at http://metropolisindia.com/images/pdf/DOS.pdf.  Should I take any of these and are they accurate?  I am worried about transmitting to my partner.

3.  What other STD’s should I be concerned about (including those endemic to this area which may be rare in the West like LGV, Granuloma Inguinale, Chancroid, etc.)?

4.  I did take  2 g zithro and 600 mg cefixime.  Is that good enough prophylaxis for all potential STDs that I could have been exposed to?  Should I test for any STD in particular - its hard to find a place to test unless its a urine/blood test.

5.  Do I need to worry about or test for HIV?

6.  When can I resume unprotected sex with my partner without putting her at any risk whatsoever for any STD?


Thanks!
300980_tn?1194933000
Welcome to the Forum.  Although the symptoms you describe may be "related" to oral sex, they may not be infection but instead local irritation or, if cleansers or lotions were used before, during or after sex, some of these chemical containing substances could have caused irritation.   What you have does not sound like an STD.

1.  I know it has to be something related to the oral sex, just not sure what it could be.  Could this be herpes?  I think I did get herpes once many years ago since I had painful blisters, so is this possible?

If you had HSV before you would not get it again from oral sex.  Further, the onset of the symptoms you describe occurred too soon to be HSV which typically does not appear until AT LEAST 4 days after an exposure.

2.  Is there really any point in testing to ascertain this? I live in India and there are no proper STD clinics here, so the only HSV tests I can do are available at http://metropolisindia.com/images/pdf/DOS.pdf.  Should I take any of these and are they accurate?  I am worried about transmitting to my partner.

Actually, there are very good Indian dermatovenereologists.  I suspect you can find one and that is what I would suggest that you do.  I am not familiar with the test you mention and since tests for HSV can be difficult to interpret, I would again recommend that you seek a professional evaluation.

3.  What other STD’s should I be concerned about (including those endemic to this area which may be rare in the West like LGV, Granuloma Inguinale, Chancroid, etc.)?

The medications you mention taking below make virtually all treatable (i.e. bacterial) STDs quite unlikely.  What you describe does not sound like a viral infection.

4.  I did take  2 g zithro and 600 mg cefixime.  Is that good enough prophylaxis for all potential STDs that I could have been exposed to?  Should I test for any STD in particular - its hard to find a place to test unless its a urine/blood test.
See above.

5.  Do I need to worry about or test for HIV?

No, there has never been a case of HIV proven to be acquired through receipt of oral sex.  If this was your only exposure you need not be concerned.  

6.  When can I resume unprotected sex with my partner without putting her at any risk whatsoever for any STD.

I doubt that what you describe is an STD I would not worry.  If you are, one last time, I will recommend professional evaluation.  EWH
8 Comments
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Avatar_m_tn
Dr. Hook,

Thank you for your response.  Its a relief to know that this is not an STD.

I did not use any cleansers or lotions, so if not an STD, then perhaps it could be irritation (though I would not suspect irritation to persist for so many days).  

However, regarding HSV, is it possible to be infected with HSV1 and then get HSV2 (or vice versa) from oral sex?  Also, I did party hard that night with only a few hours of sleep, so could that change the incubation period for HSV and make symptoms appear earlier?


Thanks!



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300980_tn?1194933000
Fatigue would not change the incubation period had you acquired HSV.

You cannot get HSV-1 again- you indicate you already have it.  HSV-2 following oral sex is very, very rare.  EWH
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Avatar_m_tn
Hi Doc,

Sorry to bother you. But I am worried about HIV due to symptoms. I have read that primary HIV can cause red dry skin rash on penis.  Plus the fatigue and malaise, one instance severe night sweat, some joint pain, diarrhoea. All within 4 days of exposure.
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300980_tn?1194933000
You are over reacting.  The symptoms of HIV would not start within 4 days of exposure. EWH
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Avatar_m_tn
Last post, I promise.  

Thanks for the reasurance, but 8 days post exposure I started getting diarrhea, nause, and loss of appetite, and a slight rash on my face.  On the 9th day (today), I also have a fever and the former symptoms are still continuing.  I am very worried.  The exposure was oral sex - how can I be having these symptoms?!
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Avatar_m_tn
Fever is 99.4
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300980_tn?1194933000
Last answer to this thread....I promise.  

These are not symptoms of an STD or HIV acquired during the exposure you described.  EWH
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University of Washington
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