Pretty Sure I have Herpes

[Americannightmare]

Hey there thank you for your help. I am a 25 year old bisexual male and had two encounters, one of which caused the symptoms I am having now. A week ago I had unprotected vaginal intercourse with a female who I have had unprotected sex with before on multiple occasions. I know for a fact I am clean because I was tested 3 months ago for everything and it all came back negative and I have not had any sexual experiences up until last week. That same night I also received unprotected oral sex from a man for a very brief period of time. He had no noticeable lesions or outbreaks on his lips. Now to my symptoms which I am pretty sure are herpes related. Two days later while masturbating I started to feel a little pain on the shaft of my penis, low and be hold it was a sore. It is a single open painful sore that has remained there for a week, it is almost perfectly round, a little bigger than the size of a pen point, painful, itchy and it weeps. I have also noticed that the lymph node on the left side of my groin is swollen and sore to the touch, which is the same side as the sore. The biggest question I have is that I thought herpes presented itself in a cluster of multiple sores, which lead me to maybe suspect syphilis but then I learned that syphilis doesn't normally cause pain. Im really devastated, I have a doctors appointment tomorrow and will asked to be tested for herpes and syphilis. Am I at risk for HIV as well?
My only other question is, I need to notify both partners but in your best guess do you think I probably got it from the acts of unprotected vaginal sex or the unprotected oral sex? Where should I go from here? Sorry one more questions would it be possible for the female to not know she had herpes because she claims that she has never had any symptoms.

Oh one other thing, sorry I am just kind of freaking out and scatter brained. I am taking Aldara for HPV is there any way just by a long shot that this sore could be caused by that?

[Edward W Hook, MD]

Good questions and you outline a good plan.  A few comments:

1.  Do you definitely know you were tested for HSV?  Often when folks ask to be tested for "everything" they are tested for gonorrhea, chlamydia and perhaps syphilis and HIV but not for HSV.
2.  Telling what you have without testing or a direct exam is difficult.  There are several possibilities.  The lesion you describe DOES sound as though it could be HSV but if it is, it sounds in many ways more like a recurrence than a first episode.  Syphilis can be painful if there is a bacterial infection on top of it.  Finally, Aldara certainly can cause erosions.  Seeing your doctor and requesting both herpes testing and a syphilis test is a good idea.  If the sore is still present you may want to request both a swab test for HSV (i.e. a culture or, even better yet,  a PCR test) as well as a type specific test for HSV such as the HerpeSelect.  A syphilis blood test will tell the syphilis story and the issue of Aldara reaction will need to be dealt with by examination.
3.  Notifying your partners is always a good idea as it may provide a clue to what is going on with you.  On the other hand, I and I suspect you, do really not know what is going on yet and thus you will not be able to inform your partners about this.  One approach might be "I have a penile sore and in talking to the doctor, there are several possibilities including a medication reaction, herpes or syphilis.  Are you OK?  I will let you know as soon as I have a clearer idea of what is going on." or something to that effect (not to try to put words in your mouth).
4. Herpes is common.  One in 4 American women have genital herpes (as do 1 in 5 men) and of those, 9 out of 10 do not know it.  the absence of symptoms recognized as herpes, sadly, does not assure one that they do not have herpes.  
5.  HIV screening is always a good idea.  Nothing you have mentioned raises specific concerns but we recommend annual testing (for HIV and STDs) for anyone who has had two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly).

Hope these comments are helpful.  Please let us know what your doctor says.  EWH

[Edward W Hook, MD]

You are correct that syphilis is rare in women in North America.  However, there are very, very rare instances in which people have had oral syphilis and transmitted it to others. This has occurred almost exclusively among men who have sex with other men.  You are on the right path. As I said before, please let us know what your doctor says EWH

[Americannightmare]

Thank you very much for the clearly answered questions. I have been reading the forum and I have heard you and the other doctor say that Syphilis is rare amongst women in the united states unless it is along the border. I have also heard that syphilis is not transfered via oral sex.