Advice on Strategy and Risk Exposure Assessment

[bobsmith12345]

Ten days ago I made a mistake and had unprotected vaginal intercourse with a young college female (microbiology major) that I had just met and am not interested in.  It was a drunken mistake in which I stopped after only 4-5 minutes because of feelings of guilt.

Only a day or two after this encounter I started to perceive a few symptoms of a possible STD.  The primary symptoms that I am having include: light tingling and slightly itchy feelings in the pubic region especially on base of shaft and scrotum.  Feels like pubic hair piercing my skin and not very noticeable unless I'm walking or wearing tighter pants.  I also feel that I have waves of headaches which are very rare to me.  No real noticeable bumps to be concerned with at this point besides for several innocuous fordyce angiokeratoma.  I do have a brown spot or two that look moles (1 on tip and a couple on scrotum) but believe these have been there for years without problems and this is the ONLY time in my life that I have ever engaged in this type of risky behavior.  At this time, I have had no other noticeable symptoms (no urethra burning or swelling, no fluid leaking, no burning peeing, no problematic bumps, no noticeable lymph-node swelling etc)

I have done hours of anxiety-driven research on STD's and am concerned about all STD's but at this point I'm primarily concerned that my symptoms could be irritation for a possible oncoming HSV-2 outbreak.

My questions are as follows:

1.  If no lesions occur after three weeks, would you reason that I'm probably safe?

2.  Having already pre--paid for a comprehensive STD test, how long should I wait to get tested?

3.  If no other symptoms occur, how long should I wait to continue my life of having monogamous sex?

Thank you in advance

[bobsmith12345]

Another Update:

A few weeks ago, I went to an experienced dermatologist in my area (Past President of local Medical Society and past president of state Dermatological Society).  He didn't know what the bumps (located on buttocks and legs) were either and told me just to wait and take another blood test.  He said if I get any blister-like formations to come in to get swabbed.

It is now 9 weeks since possible exposure and I still am getting many off and on symptoms.  Right this moment, I have many small and medium sized, painless bumps (that are mostly flat or slightly raised - the real small ones can feel slightly hard but most are soft) located primarily on thighs, rarely around genitals, on buttocks.  I also have a bump that has come and gone on the inside of my left mouth cheek.  This usually appears simultaneously with bumps around my mouth.  These bumps don't really look like blisters either but I'm pretty confident that this hsv-1 and looks like a lot less intense version of this picture (for lack of better pics) http://0.tqn.com/d/std/1/0/7/-/-/-/herpesface.jpg.

I've read tons of research to make sense of my symptoms.  I think it's possible that this is a herpes labialis late life infection and/or hsv-2 infection that is causing recurrent atypical erythema multiforme as my body's attempt to build immunity to one or both of these viruses.

On a side note: You would think that with the amount of money that society spends on healthcare and the popularity of hsv-1&2 that physicians would be more educated on these issues, testing would be more precise, and websites like this would allow secure and private photo uploading. I have read the argument against photo uploading and agree that nothing will replace physical examination and it is not appropriate for the vast majority of people.  However, there are still a lot of people that have had experiences like mine that doctors who don't specialize in infections diseases/viruses/stds cannot diagnose or are unable to perform cultures for various reasons that would greatly benefit from a specialized set of eyes (even if it happens to be an imperfect picture).  The diagnosed picture would obviously not be a final diagnosis but could be taken into consideration.

I will be taking another blood test shortly.

[bobsmith12345]

Another update:

Result from Day 40 Blood Test:

HSV I/II IgG Rflx I-II Type Specific Test:
Less than .9 = Negative for both

Medically, because of the timeframe that this test was taken - it is probably a waste of time/money but it is well worth it for just the little mental reprieve it provides while I wait for the 12 week mark.

[bobsmith12345]

Just an update...

Tonight, I had a large sore just appear just north of my quad.  Looking closely at it, it looks like a really ugly pimple with a huge pink halo around it.  

Extremely concerned, I rushed to action and took your advice and rushed to the After Hours Doctor's Office.  He looked at the sores around my mouth and leg and couldn't tell me for sure if it was herpes because he said they didn't have the classic cluster/vesicle appearance.  I asked him about a viral culture and he told me that he couldn't culture it because it had to be vesicles/cluster to culture (thought this was wrong and he just didn't want to culture... he didn't even want to really inspect it up close).  I did inform him that I took another IgG blood test yesterday.

He prescribed me 5 days of Valacyclovir and told me to take 3 1,000 mg pills a day. (suspect this to be way to high of a dose).  I need to find a better doc.

[Edward W Hook, MD]

Most unlikely.  Further, a blood test for HSVis a waste of time.  You need to have a culture.  You need to see a health care professional who can evaluate you and do cultures of the lesions you describe.  I suspect that you will find you have folliculitis on your buttocks.  

This will end this thread.  EWH

[bobsmith12345]

Unfortunately, my symptoms over the last week have worsened dramatically.  My lips have broken out with cold sores indicating an hsv-1 primary infection (have never had them before).  In addition, I still have just minor genital irritation just light itching.  I notoced a slight pink spot next to my genital area but wasn't very alarmed.  However, I just noticed several large pimples on butt cheeks.  I have purchased an hsv 1/2 igg blood test to confirm.  Any chance of these pimples caused by a primary hsv-1 outbreak?  I'm 30 years old.

[Edward W Hook, MD]

It appears to me that your result was less than 0.90 which is a negative result.  In the absence of the appearance of lesions, there is no need to repeat the test.  In fact, with this test, it turns out that sceintific studies have shown that even once persons have levels in the "equivocal" or even "low positve" range (that is levels of less than 3.0, about half of persons with positve results still do not have herpes but have false positive tests.  

I would not worry and would not repeat the test.  EWH

[bobsmith12345]

Don't think the results read correctly.. I was copying and pasting it from results.  Here is how it looked.

HSV 2 IgG, Type Spec   <.90     index     0.00-0.90

Negative 1.09

Basically, question is - Do you think that my HSV2 antibody test result is .90 or just somewhere from 0.00 to 0.90 but they don't specify.  Because to me, a result that borderlines the equivocal mark (.90) may warrant another test in a month or two and a need to remain celibate.

[bobsmith12345]

My LabCorp results for STD's were all negative.  However, I was wondering if you could help me understand the HSV2 result.  It says...

HSV 2 IgG, Type Spec <0.90   index 0.00-0.90 01

Negative 1.09

Does this mean that my result was .9 which is pretty close to equivocal?  Should I wait a few months and get retested or does this number just perceive to be high.

Sorry if I come off as another paranoid person, I'm just trying to put this whole thing behind me.

Thanks in advance and this will be my last question.

[Edward W Hook, MD]

Welcome to our Forum. My sense is that you are probably over reacting. That is not to say that you are not at some, modest risk for an STD as a result of your unprotected encounter but the risk is small. By way of context please remember that most people do not have STDs, that most single encounters do not lead to STD transmission and that no STDs lead to the onset of symptoms within 24 hours of exposure and most typically symptoms take 3+ days to develop.  On the other hand, following an exposure that, in retrospect, one wishes they had not had, it is common for persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  The sorts of sensations and hypersensitivity you describe are amongst the most common symptoms experienced in this situation.

An addition, rather than try to use the internet for self diagnosis, there really is no substitute for being examined by a trained clinician who can not only tell you if you have an STD or not but who can tell you what things you are worried about might be due to.  Self medication, including for public lice (which would be VERY unusual in the situation you describe) only complicates things.

With this as background, let's work through your questions:

1.  Your risk for herpes is tiny and the symptoms you describe do not suggest the onset of HSV. When an initial outbreak of HSV occurs, the abnormal sensations which precede the appearance of lesions is typically less than 24 hours and usually far quicker.  If you were to develop HSV, you would develop lesions within 14 days.

2.  It’s been 10 days. At this time testing for the common problems (chlamydia, etc) will be completely reliable.

3.  If your test is negative, there is no reason to delay further.

Hope this helps. EWH

[bobsmith12345]

After looking at my symptoms etc, I am now thinking that this could be pubic lice (headache, irritation, itching).  The spots that I thought were fordyce angiokeratoma may be slightly purple and could be bite marks. And that could explain the brown/gray oval spots.  Last night I didn't have any shampoos etc and it was late so I googled home remedies.  I washed the area well with Listerine and today I feel 5x better.  Still some itching and a little irritation and headaches are better too.  I just went and bought some real lice shampoo to see what that does.