STDs Expert Forum
Extreme Worry
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Extreme Worry

I had encounter with a female CSW on 3/7/13.  She did oral w/condom on, then we had vaginal inter. w/condom.   Her fishy smell made me nervous and worry about Trich after reading and how dirty she may have been.  
Start to feel that burning sensation in groin area and in tip of urethra.  Have noticed various bumps, discolorations, etc. and send me into a definite state of crazy anxiety levels.  
Went to my GP the Mon following the event.  STD panel  -including HIV elisa, Chlam, Gon, Syphilis.  All neg.  He was somewhat cavalier about it all, which worried me. He gave antibiotic shot and pills for Trich.  Bseline, but inside window for comfort.

1 wk later, still worried- felt it best to see an expert, so I went for a visual examination at a PP clinic. She examined my penis and said nothing unusual.  

25 day - full physical -same GP.  Now, anus definitely feeling like it is burning, tingling won't go away in my groin / thigh area.  He gave Pennicilin shot, then did a retest for HIV (standard, not PCR), no other testing for STD's.  I am on Solodyn for acne, so he said I am hitting the main three, plus Trich with meds.  He keeps telling me risk for HPV and HSV is extremely low.  He also did a herpes test.  10 years before I was told I had HSV-1 and HSV-2,  never had an outbreak.  HSV negative but not sure if IGG or IGM. He found a skin tag, and a small hemmoroid condition.  

I went to a dermatologist today.  She reviewed penis and said she sees nothing worrisome. She looked at my GP anal area skin tag and said it was possibly HPV, but not sure, so cultured it today
What risk for HSV and HPV have I put myself?  

What do the tests completed indicate (granted, not knowing the IGM or IGG makes it hard) as far as risk mitigation? Am I missing looking for anything / other diseases?   Should I see a proctologist for internal review on anal burn situation?  Any other advice?  What do you see as my chances of being clean?
239123_tn?1267651214
Welcome to the forum.  I'll try to help.

You have seriously overreacted.  You had condom protected sex.  It is true that a fishy vaginal odor can indicate increased risk, but the most common cause if bacterial vaginosis, not trich; and BV in women has no health implications for their male partners. But even if your partner were infected with an STD, you had condom protected sex, both vaginally and orally.  

Your symptoms are not (and never were) typical for any STD; they are most consistent with genitally focused anxiety.  The minocycline (Solodyn) would have prevented chlamydia, gonorrhea, or syphilis, even if you had been exposed.  All the other antibiotics you received were unnecessary.

To your specific questions:

1) HSV and HPV risk?  I agree with your GP:  trivial if any risk.  If the bump (skin tag) identified by the dermatologist indeed turns out to be a wart, it isn't from the exposure a month ago.  It takes at least 2 months and usually 6-12 months for new HPV infections to cause visible warts.

2) Your negative test results show you don't have gonorrhea or chlamydia -- but as already noted, you weren't at risk for them anyway.  All blood tests were done too soon to mean anything, except to show you weren't infected before the March 7 exposure.

3) IgM testing for HSV is meaningless.  Although in theory it is supposed to indicate early HIV infection, it rarely works that way, and we never to IgM testing in my STD clinic.

My advice is that you move on with your life.  I see no reason for any further medical evaluation, by a proctologist or anyone else.  If you just can't stand the uncertainty, you could have another HSV blood test (IgG only, please) 3-4 months after the event; and syphilis and HIV blood tests at 6-8 weeks. You can expect any and all such tests to be negative.

Regards--  HHH, MD
16 Comments
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Avatar_m_tn
The herpes test was both IGM and IGG, both negative.  While I wait for the culture on the skin tag or HPV, is there anything else I can do?

The main issue remaining is opening to my urethra.  The left side only is somewhat red at the interior of the tip.  The interior surface is red, again only on the left side.  Could this be herpes or another std inside my urethra?

I have put petroleum jelly on the tip of my penis lately to avoid rubbing or chafing from worry-rub.  Don't think it is worry related, as you quelled most of my other syptomos with your supportive answer.  This one isn't shaking though....
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Avatar_m_tn
and the left side of the urethra is EXTREMELY sensitive, almost like a shock when it is in contact with other surfaces.
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239123_tn?1267651214
This doesn't change my opinion and I don't have any additional advice.  When someone is under direct medical care, getting additional advice on line really isn't appropriate.  Not knowing what you have (or if anything is abnomral at all), I can't recommend any particular treatment -- only that you follow your own doctors' advice.
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Avatar_m_tn
Thanks for the feedback and patience with me.  The concern has been that my GP doesn't have the experience in STD diagnosis and treatment that you have.  This seems prevalent in the many posts from others on this site with wasteful IGM tests, bad reads, missed diagnosis, etc.  

My culture on the wart came back negative for HPV.  I think I would have had relief to the symptoms as the good news continue to flow in.  It isn't though.  

Still burning/tingling in my thigh/groin area, ultra sensitive urethra opening area.  In the opening, one side has more skin, almost a fold and this seems red, almost blistered red, but never ulcerates. It has a small dot of red at the tip of the penis right outside this skin. Not sure what it is, but it seems the source of the sensitivity.

The burning in my anal region seems to have subsided currently, but worried still it is HSV only to return again.  I have had a lot of muscle ache, mild sore throat, odd acne breakout.

Guess the the guidance I am looking for is not an internet diagnosis, but guidance for me to ask / direct my GP to look /test for to ensure all potential STD's have been covered.  Fungal, bacterial, viral.  

For some reason I can't shake the symptoms even with positive reinforcement from you, recent test results (early in window, another reason not fully trusting the GP).  

Then my last question, if all this was mild HSV outbreak (I know you don't think it is), would all that activity logically kick more antibodies into action making a 6-8 week test much more accurate than 70% probability?
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Avatar_m_tn
Why are you so confident in HSV transmission risk being so low with a condom?   The CDC and other medical information seems to suggest the condom only provides 30-50% protection for HSV transmission.  Is this due to a baseline transmission in vaginal female to male transmission not being 100% already (that information seems hard to find)?  Maybe some factual math will help me back to sanity...thanks again for the patience and input with your experience in a real world STD clinic.  Any stats on HPV are appreciated too, otherwise I will be staring down for 6-12 months as listed above! :)
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239123_tn?1267651214
Condoms are only ~50% effective protection against HSV or HPV over time -- that is, consistent condom users for vaginal sex are at roughtly half the risk as people who don't use condoms at all.  Neither virus can pass through latex; what infections result are because of condom failure or skin contact above the condom.  The effectiveness for any single exposure probably is in the 90-95% range.

You have already been tested for all STDs necessary.  No STD causes the sorts of symptoms you describe.  That you can't "shake them" doesn't change that fact.

Do your best to move on without worry.  If your symptoms continue, I would advise a discussion with your GP about a possible psychological origin and the potential benefit of counseling.  I suggest it from compassion, not criticism.

That will end this thread.  Good luck.
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Avatar_m_tn
not sure if I need a new thread here, as it is related to the scores above, happy to pay again.  I got the call back from my old doctor.  They said the test in 2003 was the following LabCorp with an IGM score of negative then an IGG score of 14.  This seemed numbers I did not recognize.  I asked if it was a type specific test and she could not tell me that either, said it said HSV 1/2.  

Do you think the new Titer test the recent doctor did is false negative or do you think the old score was false positive?  
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Avatar_m_tn
I could not wait the entire 12 weeks as the symptoms wouldn't go away, so I got a test done by a major online company.  The Labcorp HerpSelect test at 8 weeks came back as a 5.0 score on the HSV1 and .9 on the HSV2.  This test seems pretty conclusive that all the symptoms were real and this itching / burning is HSV1 infection in genital area.  I thought I was only rubbing near the left tip of my penis making it a bit red/raw and the couple red bumps like acne on left side pubic area were just that...folliculitis as I have read here.

Doctor, I am more confused than ever now after your assurances I didn't catch anything.  No fever blister on lips, so do you agree it is likely HSV1 genitally?

Do you think my .9 score at 8 weeks indicates I may need to test again at 12 to see if that goes up to positive now also?  I had positive HSV2 many years ago, then two recent negatives (4 and 8 weeks).  

What do I do now?
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239123_tn?1267651214
"This test seems pretty conclusive that all the symptoms were real and this itching / burning is HSV1 infection in genital area."

That is incorrect.  Your symptoms probably were not due to herpes at all and your positive blood test for HSV-1 probably has nothing to do with your sexual encounter last March.  Half of all adults (in the US) have positive blood tests for HSV-1, usually due to infection during childhood.

Your HSV-2 test result remains negative.  As long as the numerical value is 0.9 or below, it is negative; there is no difference between values of 0.9, 0.6, 0.2, or any other number below the cut-off value.

In other words, I continue to be confident you did not catch herpes or any other STD during the encounter last March.  You should do your best to stop worrying about it.  Do not have any more STD tests.

That will end this thread.  Take care.
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Avatar_m_tn
Sir, I know there is a big thread here now, but please realize I tested type specific 4 weeks ago also and it was negative, so my test 4 week ago was either wrong....or I have recently caught HSV-1.  

So at 8 weeks with HSV-1 infection I am at .9 on HSV-2 also, which is the top limit....man sorry that scares me.  If co-infection, couldn't that possibly make the score slower to result on HSV-2?  

My wife has HSV-1 and cold sores, so I could have gotten from her, and comically we thought I had HSV-2 with no outbreak for many years until recent tests....so now my head is spinning.  I have not read on HSV-1 with asymptomatic, as I never really cared about even getting it...wrote it off as probable with time and her infected.  If I get it genitally, I do care...as that is different.   In a polite way, let's just say my wife likely would not infect her oral HSV to my genitals.  unfortunately very rare occurence.

Does this info change anything in your thoughts?
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Avatar_m_tn
4 weeks ago both type specific tests were negative.  So that seems to indicate that as incorrect.  I have not touched, even kissed anyone since then....so now that I am REALLY worried, does HSV-1 co-infection potentially delay HSV-2 antibodies?  Worried it is a genital infection.  Actually it may be the not knowing that is the worst.  Almost want a fever blister to pop up on my lip tomorrow.
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239123_tn?1267651214
I missed that you had an earlier negative HSV-1 blood test.  Your original question said "STD panel  -including HIV elisa, Chlam, Gon, Syphilis.  All neg" (no mention of HSV).  There was a later statement that seemed to refer to negative testing 10 years earlier.

Still, the HSV-1 blood tests miss 20% of infections, so you still could have been infected a long time, with previous false negative tests -- perhaps an oral infection from your wife.  I remain unconvinced that your recent genital symptoms were due to herpes, or that you acquired genital HSV-1 from your CSW contact, which was low risk.

But even if we assume your newly positive HSV-1 antibody test reflects a recently acquired genital infection, it probably will never be a big deal for you.  Here are links to 2 threads that go into detail about the important differences between genital HSV-1 versus HSV-2:

http://www.medhelp.org/posts/STDs/HSV-1--devastated/show/1159077
http://www.medhelp.org/posts/STDs/Recently-diagnosed-with-Genital-Herpes-HSV1/show/969931

At this point, I have two recommendations:  First, have an HSV Western blot test (done at the University of Washington clinical lab in Seattle -- your local lab will know how to refer a specimen to them).  You may find your HSV-1 result is negative after all; and it also will probably show your HSV-2 result is definitely negative.  Second, if and when you have future genital symptoms that suggest recurrent herpes (e.g. blister, open sore, etc), see your dermatologist promptly (within 2-3 days) for direct testing for HSV by PCR.  Probably this will never happen, but it's something to keep in mind.

In the meantime, I really don't think you should be worried.  Even if you have genital HSV-1 (which I continue to doubt), you probably won't have any future outbreaks; and you cannot infect your wife -- her current HSV-1 infection makes her immune to new ones with the same virus type, anywhere on her body.

That should wind up this thread.  Best wishes--  
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Avatar_m_tn
Should I wait until 12 weeks to do Western Blot test?  
Do you really think HSV-1 at a 5.0 HerpSelect IGG could still be negative?  
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Avatar_m_tn
and the 10 year ago testing was actually positive for HSV 2, a "titer" score of 14, which I have no clue what it means.  Thought I had HSV-2 until 4 weeks ago, thought I may be in the clear void of the symptoms you told me were anxiety.  Now HSV-1.  My emotions are a ping pong ball....been a tough time.  

Your continued guidance has been a source of sanity- literally read your post every time I got anxious or worried about things.  
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239123_tn?1267651214
You can have the WB test at any time -- no need to wait until 12 weeks.  It will clarify whether you are infected with HSV-1, HSV-2, both or neither one.

My previous comment and the links to other threads were an attempt to address your "ping pong" emotions, and I'm glad to have been "a source of sanity".  However, this discussion cannot go on indefinitely.  If you do an HSV WB, I will be happy to comment one last time when the result is available.  Other than that, there is nothing more I can offer, so so I won't have any further replies until then.
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