Herpes with rash?

[DonSoriano]

Doctor,
I read the FAQ's, but did not see this question previouly addressed.  I recently had an encounter with an escort.  She performed fellatio without a condom for maybe five minutes.  We then had intercourse with a condom.
This occurred 18 days ago.  About two days later I was paranoid I might have contracted something. I never had dysuria or a discharge.  I was treated with Zithromax 1 gm and received ceftriaxone 250mg IM, but to be honest had minimal symptoms.  I badgered my provider because I was paranoid and received an additional 7 day course of Tequin and also a one time dose 2 gm of flagyl becase I had vague lower abdominal pains.  At the most I was having vague irritaion or "suprapubic pain" that seemed to radiate to the base of my penis, but also developed lower abdominal cramps and diarrhea (I was guessing was due to my anitbiotic overload.)  I've had no fever, myalgia, etc.
I also saw a urologist had a normal urinalysis and prostate massage.

My concern is that I've felt an off and on burning or stinging around the head of my penis particularly in the last few days (about 14-17 days after encounter.) Sometimes it goes away, other times it is mild to moderately uncomfortable.  I have had absolutely no rash or skin changes on my penis, yet I'm very paranoid I've contracted herpes.  Things just "don't feel right" as everyone seems to say.

1. I realize Herpes can be asymptomatic but can Herpes start with skin tingling/ burning but no rash?  If so, how can I be tested (blood test now and in three months or is there a more immediate method?)

2. Do I have risk for HSV-2 in this encounter?  I know you say that HSV-2 isn't spread oral to genital, but the CDC seems to suggest otherwise, who is correct?  Is there risk for HSV-2 during intercourse with a condom?

Thank you for helping a guy who made a huge mistake.

[H. Hunter Handsfield, M.D.]

The risk of getting genital herpes after a single episode of sex with a partner not known to have an overt herpes outbreak is very close to zero (but not quite zero).  Among monogamous couples in which one has genital HSV-2 and the other doesn't, who don't use condoms, and who have sex 2-3 times per week, transmission to the uninfected partner occurs in only about 5% of couples per year.  You can calculate the risk per episode of sex--close to zero.  And that's without condoms, which you used.  There also is a risk of genital HSV-1 infection from fellatio, but that is rare in the absence of a visible cold sore, which presumably your escort didn't have (or you would have mentioned it).  Finally, your symptoms do not sound particularly suspicious for herpes, or for any other STD (especially after the treatment you had).

Perhaps I will ahve to re-read the CDC web site, but I doubt it says HSV-2 can be transmitted oral to genital.  (Oral to genital HSV-1 happens, but never for HSV-2.)

So, COULD you have acquired HSV-1 (or even HSV-2), and COULD your symptoms be due to herpes?  Yes.  Is is likely?  No, extremely unlikely.  You could be tested for HSV-1 and HSV-2, but even if positive, I would not be suspicious it is the actual cause of your symptoms or that you acquired it during the encounter you describe.

Good luck--  HHH, MD

[DonSoriano]

OOPS, the header should read Herpes WITHOUT rash.
sorry

[DanKipiti]

"Perhaps I will ahve to re-read the CDC web site, but I doubt it says HSV-2 can be transmitted oral to genital. (Oral to genital HSV-1 happens, but never for HSV-2.)"

I am curious about the validity of this statement.