Acquired STD from Oral Sex - HIV risk

[stoopid]

Event: I had unprotected oral sex with a sex worker 16 days ago.  I noticed she had a sore on her lip, but I stupidly assumed that it was just a cold sore, and having had cold sores all my life didn't take it as a warning sign.  We also had protected vaginal sex.  After the ordeal I examined my penis and didn't see any cuts, etc.

Symptomes: About 2 days later I developed urinary discomfort.  I treaded it with Nitrofurantoinum and it went away after about 8-9 days.  After about a week after contact I had developed 3 sores, 2 on my penis shaft, one on my nose.  All initially appeared as rashes (i.e., top skin layer removed).  One on my penis healed quickly, the other, near the base and the hair line got disturbed quite a bit, and kept growing for a few more days.  The one on my nose healed, however, I am now noticing that a cold sore is developing on the same spot.  Another rash/ulcer appeared about 4 days ago on the spot on my groin where one of the sores on my penis was pressing against.  The large sore on my penis base is now almost healed.

Medical care/tests/treatment thus far:  I saw a doctor about 8 days after the event.  He ordered STD tests.  HIV and Syphilis came back negative (too early, I understand).  Gonorrhea and chlamydia - still waiting on the results.  Due to the negative syphilis test the doctor suspected chancroid and gave me Cipro.  I saw another doctor who said that it doesn't look like chancroid (because usually there is only one, and it's more in a form of a boil), but ordered another chlamydia and syphilis test and gave me a weekd's supply of Doxucycline.  He also tested me for HIV ab (negative at 14 days), and ordered an HIV antigen test (waiting on results).

Here are my questions:

1.  In light of these facts (and the fact that it was acquired via incertive fellatio), what STD do you suspect could be causing these rashes/ulcers.

2.  Understanding that risk from HIV acquisition from insertive fellatio is low, how much is risk amplified in light of the fact that the woman had a cold sore (or other lip sore), was STD infected and has in fact transmitted that STD to me?  How much does this risk vary depending on what STD it was (i.e. chancroid v. LGV. v. syphilis etc.)?

3.  If all STD tests come back negative, do you recommend further retesting, or is it safe to assume that it's chancroid?

[H. Hunter Handsfield, M.D.]

In general, an online expert cannot diagnose a problem that remains uncertain after other providers have evaluated it in person.  But some general comments:

As you suggest, genital herpes due to your partner's apparent oral herpes is unlikely, assuming your own recurrent oral sores are herpes; you are at least highly resistant, if not completely immune, to a new HSV-1 infection.  Still, it wasn't smart to permit oral sex by a person with an overt oral sore.  That person might have had oral HSV-2; that's generally uncommon, but why take any risk at all?  Chancroid isn't acquired by oral sex or through condoms, and is extremely rare anyway, with fewer than 100 cases per year in the US, mostly of those in people who acquired it in other countries.  Syphilis wouldn't appear so soon and also is extremely rare in heterosexuals in most of the US.  Currently there is no LGV in heterosexuals in the US, and it is not acquired by oral sex.  And although in theory LGV causes genital ulceration, that is an extremely rare event; I have never seen such a case.

1) For the reasons above, herpes still is possible and approriate testing is warranted, if not already done.  You do not have chancroid, syphilis, or LGV.  Maybe not sexually transmitted, e.g. staph or strep.

2) Even when an STD or other condition increases the risk, when the exposure is almost zero risk anyway, it doesn't change things appreciably.  Double a zero risk and you still have zero risk.

3) If all STD tests are negative, as I expect them to be, and if the lesions persist or new ones appear, return to your provider for further diagnosis--for non STD causes.

Good luck--  HHH, MD

[stoopid]

I do realize that partially my questoins have to do with other STDs, but my primary concern is obviously with HIV, therefore please rather than removing this post if you think it is inappropriate for this forum (I hope it isn't), just answer the HIV question.

Thanks!

[stoopid]

Doc,

Thank you very much for a prompt response.  Just one follow-up.  The sex-worker was in UK.  Does that change any of your responses?

Thanks again.

[H. Hunter Handsfield, M.D.]

No, my responses apply to virtually all industrialized countries, not just the US.

HHH, MD

[stoopid]

Doc,

Last follow-up, I promise.  I've read a lot how risk is greater for uncircumcized males.  I am uncircumcized - does that weigh in at all in my particular situation?

Thank you very much.

[H. Hunter Handsfield, M.D.]

See no. 2 in my original reply.

[salesrep2005]

Dear Dr. Hansfield,  
Sorry to see you deleted my post. Looking back I do realize it may have been "low risk" but a simple response of "no risk - low risk stop being paranoid" would have meant a lot more than you deleting it.  It may only be $15.00 but money doesn't grow on trees and in all seriousness it was in my mind a question of importance.  I have asked multiple questions, donated multiple times and respected your feedback over the past year or so - I'm really dissapointed and still stuck here wondering if I was in fact just being paranoid, over reacting, etc. or if there was merit to my question.  I'm dissapointed but still appreciate the work you do for many.

[who_dis]

If there was any merit to your question, he wouldn't have deleted it.  It says pretty clearly on the front page, that he will delete certain questions without refund.  

If you still feel confused, ask it over on the HIV forum.  Most everyone there has Dr HHH's answers in their internal memories, and can cite what he would say in an uncanny manner.

[HHH,MD]

You are asking anxiety-driven questions whose answers are well known--like the one I deleted about catching HIV from shaking hands with someone with a blister (!), and an earlier one about being nicked on the ear by a barber. Also, forum rules clearly state that nobody may post more than 2 questions in a 6 month period. This attempt was your third (or maybe even fourth?) in only a few weeks.

This site is not designed for online counseling of irrationally frightened people. Please do not keep trying.

HHH, MD