Worried- need testing??

[jackinthebox767]

Male, 24, bisexual
Hi-  My question is related to all STDs, including HIV, so I hope that posting the question here is the correct place.
I am quite worried right now because I had a few unsafe sex experiences earlier in August, I've always used a condom in the past.  Also, I had some bloodwork done recently to test my liver function both before and after starting medication for fungus, and the WBC results have me worried too.
Experiences: Aug 8, exchanged oral sex with a male stranger 10mins duration, no ejaculation but definitely some precum in my mouth. Aug 15, one night stand with a girl, oral and full-on sex 3 times, unprotected.
Aug 25, I notice a very small red lesion (sort of open, not painful)- almost like the small blister from masturbating too vigorously that I assume we all get occasionally, seems to be fading now.  I will monitor this one, but it doesn't really look like the photos of syphilis on the net...
Most concerning is that I haven't felt very well at all in the past two days- headache, very tired, sore front neck muscles, neck nodes are a bit swollen.
Most worrying to me: my bloodtest results before (8/5) and after (8/26): total WBC: from 58 to 55 (35-97normal); neutr from 60% to 72.4%, lympho from 27.7% to 17.3%.  The doctor that I saw is a skindoctor treating my toe, so I did not ask why, but I'm a bit worried for this very large drop.  Should I be?  What STDs are most likely with these symptoms and at this stage?  Should I order a full STD panel?  I will never have unsafe sex again.
So sorry,
Jack

[Edward W Hook, MD]

If your lesion is syphilis, the lesion, but not the infection, will go away without treatment.  EWH

[wonderingaloud]

Dr,

You said above in your reply that syphillis will go away without treatment I think you meant to say the chancre of syphillis will am I correct sorry for the intrusion.

[Edward W Hook, MD]

Regarding your follow ups:

1.  No matter what it is, it will go away over a period of time.  Either syphilis or herpes will go away without treatment.  IF you want to know what it is, allowing it to heal will not help.  
2.  I was talking about the componets too.  This sort of fluctuation is normal and does not suggest HIV.
3.  I've already commented on your symtoms.  The blood work is of no concern to me.  Also, just as an fyi, we recommend STD/HIV "screening" (testing in the absence of symptoms) for anyone who has had multiple partners over a period of less than a year.  As a matter of personal protection, we recommend annual testing for anyone who has had two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly). EWH

[jackinthebox767]

Thank you for your prompt feedback.  I just have a couple of follow-up items.
With respect to the lesion, I will see if this heals within a few days, if not, then I will see a provider.  Would herpes leave only 1 spot?  (HSV1 is far more common than HSV2 in my part of the world).
With respect to the WBC, I am worried not about the total (55), but about the component movement.  To confirm, is it normal for Neutro to move from 60% to 72.4% and lympho to drop from 27.7% to 17.3% (below range, and flagged as such on the result sheet) in this timeframe?  The reason I ask is because I've read in several places that the lympho count is something affected by the onset of HIV and the drop seems to be large and rapid.  I'm quite worried by this since I'm not sure what else would cause this drop.
Finally, do you recommend STD testing based both on the risks AND the described symptoms/ basic bloodwork?  Thank you kindly.

[Edward W Hook, MD]

You've asked a number of questions, some of which are beyond the scope of this forum.  I'll try to work through them briefly although before doing so I want to point out that the answers must be rather brief in order to deal with so many.  I agree that even these exposures are relatively low risk.

1. Your exposures.  You do not know the status of either of your partners. If this post comes from North America, unless there is some compelling reason to think otherwise, most persons, even in risk groups such as men who have sex with other men, most persons do not have HIV.  In the unlikely event that either of the partners you mention were infected, the odds of getting HIV from oral sex are less than 1 in 10,000 and for vaginal sex the figure is less than 1 in 1000.  Thus by just doing the math you can see that your risk of infection from the exposures you describe is quite low.

2.  The lesion.  It sounds like this is the first time you have seen such a spot.  If so, it indeed could be due to masturbation but it also could be an STD.  Even if it looks like syphilis, because of your exposures, the probability that it is syphilis is low and it would, of all STDs be most likely to be herpes.  The best way to get this sorted out is with a test taken from the sore area for herpes.  If you go to a local STD clinic, they may also be able to test the lesion for syphilis.  Blood tests might help but not as much as a test of the lesion.  In most situations such as yours, the lesions do not turn out to be STDs of any sort.

3.  White blood cell counts fluctuate a great deal from day to day and as influenced by many factors.  I would consider the results of the two tests you describe as being normal fluctuation within the normal range.

Hope these comments help.  I would recommend a visit to your doctor or the local STD clinic.  EWH

[jackinthebox767]

I should mention that the test indicated that the bottom of the normal range for lympho count is 18%, so I am already below...  What would cause this?  My exposures seem to be relatively low risk.