Herpes/HIV prostatitis varicocele?

Hello Doctor,

I was in morocco last christmas where I had unsafe sex with a prostitute. I already had a bit of a dry rash on my glans (glands) penis for two months. Maybe two days after this specific intercourse I saw a strange rash on  the long side of my penis as well. However these ones looked like a mosquito bite. I counted three of them. A couple of days later the "mosquito bite" changed into small bumps like a cold sore. After a week maybe I also started to feel a strange painfull feeling in my scrotum area.

After 3 (since intercourse)weeks my doctor prescribed antibiotics for a possible epididymitis. And for possible herpes valaciclovir I insisted on that. Doctor said herpes is unlikely after seeing the bumps.


After 4 weeks(since intercourse) I went to a hospital and they diagnosed a varicocele in my scrotum but NO epididymitis. They also made an x-ray of the lower stomach area and took some blood and urine for a possible bacterial infection but no STD test as far as I know. Results next week. The urologist I visited the same day, told me I have a prostatitis. That explained the pain. Pain however is gone now after almost 10 days of antibiotics (ciprofloxacin). Still some small scars on my penis of the bumps.

Im afraid of herpes but more of HIV. I heard a story about herpes and HIV collaborate during infection. Now my question is : If you look at the symptoms Is it possible that Im infected with HIV because of herpes or that Im infected with both herpes and HIV at the same time. And do the prostatitis and varicocele fit in that picture?

I would like to thank you in advance doctor.

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum.  I'll try to help.

Let's first talk about the HIV risks.  Most commercial sex workers don't have HIV, especially in countries like Morocco with low HIV/AIDS rates.  The chance your partner had HIV probably is under 1%.  And since the average rate of HIV transmission is around 1 in 2,000 for each episode of unprotected vaginal sex, the chance you were both exposed and infected is very low, even if an STD is involved.

It is true that genital herpes and other STDs increase the chance of catching HIV if exposed.  But we can dispense with the prostate problem and varicocele.  Prostatitis is not an STD, and varicoele is an anotomic anomaly which cannot have anything to do with the sexual encounter; these issues definintely do not "fit in that picture".

So that leaves herpes.  Your description of the lesions suggest herpes was a possibility, especially if the "mosquito bite" appearance included blisters that later became scabs before they healed completely.  However, a doctor's opinion that it wasn't herpes is against the diagnosis -- but even experts often can't be certain, so you could have had it.  And the highest risk of HIV probably occurs when someone catches HSV-2 during the same exposure.  But even there, the maximum increase in HIV transmission probably is around 10 times.

So here is the worst case scenario:  Chance your partner had HIV 1%; chance you caught it if exposed, 1 in 2000; effect of new HSV-2, 10x increase.  That mans the chance you caught HIV can be calculated as 1/100 x 1/2000 x 10.  That comes to 1 in 20,000.  Perhaps those odds are higher than you would like -- but still 1 chance in 20,000 is a very low risk.

You should be tested for HIV.  I recommend a standard antibody test about 4 weeks and against 6-8 weeks after the exposure.  If you can find a doctor or clinic that does the Duo test (simultaneous testing for HIV antibody and for a marker of the virus itself, called P24 antigen), that would be great; a negative Duo test at 4 weeks would be solid evidence you didn't catch HIV.

It would also be a good idea to have blood tests for HSV antibody.  The standard type-specific tests often become positive by 4 weeks, usually by 6-8 weeks, and for sure by 3 months.  So you could have HSV testing at the same time as your HIV tests.  Be sure you ask for a type-specific IgG antibody test; it is possible some labs in Morocco are still using older, non-type specific blood tests, which would not be very helpful.  (You can go to the STD forum and use the search link to find discussions about "HSV blood test" or "HSV diagnosis" for more information about it.)

Feel free to return to post your test result(s).  In the meantime, try not to be too freaked out over this.  All things considered, it is very unlikely you caught HIV and I expect your tests to be negative.

Best wishes--  HHH, MD

[Maurice113]

Hello Doctor,

I just got my result on a HIV antibody test. It was negative. So 5 weeks after exposure this is what I got right now. I have to wait untill 15th of february for a complete STD test with HIV test again included. Im almost sure that I have got herpes. Is it possible that a herpes infection can slow down the antibody to show up in a HIV antibody test?
Im very worried..

Thank you doctor for your previous advice.

[H. Hunter Handsfield, M.D.]

Congratulations.  Your HIV test result is reliable; herpes doesn't delay or otherwise alter HIV test results.

I'm less convinced than you are that you have herpes.  But feel free to return one more time with that test result.

[Maurice113]

Hello Doctor, I did a full STD test today. I will get the results next week.
Im very anxious because Im having some new symptoms that might be related to HIV infection.

Three swollen neck glands in a row on left side of adams apple and a painful throat. Diagnosed with scan. And one swollen gland in my left armpit (about 1,5 cm) which I discovered myself two days ago that doesnt hurt. I have had a sore throat for the last 2 weeks combined with the glands in my neck. These symptoms dont match with the HSV symptoms I read about. Thats why I fear the worst..

You really calmed me down with your last message about the 5 weeks HIV test being reliable. But im really freaking out now. I wont post anymore my apologies.

Greetings and thank you.

[H. Hunter Handsfield, M.D.]

As for herpes, your symptoms are not consistent with a new HIV infection.  Among other things, HIV can't cause symptoms starting several weeks after exposure or after a negative HIV test at 5 weeks. Do not post anything else until and unless you report your upcoming final HIV test result.  You can expect it to remain negative.

[Maurice113]

Hello Doctor,

My HIV results 8 weeks after intercourse are negative again. This time I did a duo test in Belgium, so I'm pretty reassured now.

However the herpes infection is hard to identify as they told me in Belgium as well. I must wait until I feel an upcoming attack to go to a test centre asap.

Anyway I would like to thank you for your time and advise. You have been helpful doctor.

Greetings

[H. Hunter Handsfield, M.D.]

Congratulations on the HIV test result.  That issue should now be out of your mind.

You have been misinformed (twice) about HSV testing.  It is not necessary to wait until an outbreak occurs to diagnose infection; even when that strategy is tried, often it doesn't work. And of course it cannot work if there isn't an outbreak.  The blood tests for HSV aren't perfect, but a positive result fo HSV-2 would show you are infected and a negative result would reliably prove you don't have it.

Where are you (country, city)?

[Maurice113]

Right now I'm in Rotterdam (Netherlands)

[H. Hunter Handsfield, M.D.]

I would think you could pretty easily find a provider who understands herpes and use of the HSV blood tests.