What's going on?

Hello Doctor,

I get annual Paps done, which always come back normal. I have never seen or felt anything that suggests STD
symptoms, so other than checking for abnormal cell changes on the Paps (which would suggest HPV) I haven't been checked for any STD's to my knowledge.

I'm a 33 year old female, been sexually active for 13 years, had 3 long-term monogamous relationships and 5
(protected) casual encounters in my sexually active life.

I have been single for about two years and have had infrequent sex with a long time friend over the course of a year.

All protected encounters.

This year in January, I had a risky encounter with someone I met on vacation. Unprotected foreplay, slight vaginal
penetration, and protected vaginal intercourse. To my knowledge, the condom worked fine. (I was a little tipsy)

Two weeks after I returned, (January 23rd) I developed a severe sore throat followed by a week of sinus infection.
Then I had symptoms of a yeast infection. I have had maybe three yeast infections in my life, twice due to antibiotic
medication I was taking and once as a reaction to a condom (latex, spermicide).

I treated what I thought was a yeast infection with an over the counter medication, a suppository.

That night I developed a high fever & chills. Had my period the following day (Feb. 1st). Yeast infection symptoms
resolved over the next few days but fever and chills remained.

After 4 days of fever & chills, I went to ER. Doc there checked me inside & out, did bloodwork, cultures and
urinalysis. All came back fine. No lesions on or in vagina, no pelvic pain or swelling, no swollen glands. I was pretty
out of it so I didn't ask what they tested me for, but I assumed because of the sexual history questions he asked and
the pelvic exam, he was looking for possible STD infection. Doc said it was "probably a viral infection but didn't
know for sure" and sent me home.

After the fever & chills subsided, I had burning, pins & needles sensation all over, particularly in the groin region,
buttocks and around my mouth.

The burning, tingling, pins & needles began on  Feb. 7th. It's now March 2ND and I still have these sensations and
though not as severe are still there. Also, the yeast infection seems to have returned.

SO:

1) what are my risks for STD's? I did have a culture taken for Herpes at an STD clinic but if the results are negative,
and based on my history, should I still be worried? There is no type specific testing (like HerpesSelect) where I live.

2) Do I need to get an HIV test?  

Thanks in advance for any insight you can provide. I am having a lot of difficulty getting answers from anybody here
other than "it's a virus" and will not be able to get in to see my GP until next week.

[H. Hunter Handsfield, M.D.]

It sounds to me like you had safe sex; the risk of STD transmission via the brief contact before the condom was in place probably was very low.  The combination of genital symptoms suspicious for yeast, plus fever and chills, raises the possibility of genital herpes, but that seems unlikely if the doc who examined you did not see anything wrong genitally.  The burning/tingling symptoms you describe are not typical for herpes of any other STD, including HIV.

1) On balance, it seems unlikely you have herpes.  However, it would make sense to have a blood test to be sure.  I don't know why you would have trouble getting a type-specific test such as HerpeSelect, assuming you live in an industrialized country.  (Taking a guess, are you in the UK?  "GP" remains in more common use in UK and other commonwealth nations than in most other countries.  If so, visit your local GUM clinic for expert advice, including a type-specific HSV blood test.)

2) The risk of HIV is low from any single episode of vaginal sex, and in your case vanishingly small.  But if you are anxious about the possibility, you probably will sleep better knowing you have had a negative test result.  So it's up to you.

Good luck--  HHH, MD

[Lutheran122]

As long as the intercourse was with a condom you have no hiv worrys. If the condom broke trust me both of you would have noticed as its not something that go's unnoticed..they break completely down to the base of the penis when they fail. Even if it did break the chances of hiv are still incredibly low even with someone who is definitely hiv positive as your partner. Of course that doesn't mean it cant happen so make sure you always use a condom. You should make sure exactly what they tested you for at the ER.

[siobhan_d]

Dr. H,

Thank you for your response. I received the results of the herpes culture (negative).

Here is a direct quote from the STD clinic where I was tested (in Canada):

"The standard, widely available blood test is not a useful test for diagnosing herpes because it will not differentiate between HSV I and HSV II. For this reason, this blood test for HSV is not recommended for diagnosis of herpes."

It does go on to say that there is a new blood test that is type specific, but not available in Canada. The herpes western blot is not covered by the universal healthcare system here and only available by order to the United States.

If its true that genital herpes is as widespread as the statistics I've read on this site as well as others (1 in 4 people infected?) and some people that are infected may be asymptomatic, why aren't all sexually active people automatically tested?

[H. Hunter Handsfield, M.D.]

Canada's drug regulatory authority had its head in the sand for 5 years, refusing to license HerpeSelect or other type-specific HSV serological tests.  Partly they were following the lead of selected STD experts who, in my opinion, had their own heads in the sand about HSV diagnosis and the importance of genital herpes.  However, the HerpeSelect test was approved in Canada several months ago. Your clinic apparently doesn't yet know that, and I'm not surprised that many (most?) STD clinics continue to offer only the older, non-type specific tests; it's time they started to play catch-up.   In the meantime, you should be able to find proper testing from a private health care provider.

The facts you state about both the frequency and asymptomatic nature of genital herpes (HSV-2 infection, specifically) are accurate.  There is legitmate debate among experts as to whether all sexually active persons should be routinely tested.  Personally, I think not; I believe testing is best limited to people with symptoms that suggest herpes or known exposure, and for people at high risk for HIV infection (e.g., gay men).  The debate centers around the cost of testing and the extent to which knowing about an asymptomatic infection will result in reduced transmission risk to partners, improved treatment, etc.

Feel free to print out this message and take it back to the STD clinic!

HHH, MD

[HHH,MD]

Please see the forum rules on new threads on the same topic.  Only a limited number of new threads can be accepted daily, and new ones on the same topic prevent someone else from asking a new question.  I deleted it.

I'm not going to get into an online debate about my risk assessment vs that of another counselor.  Everybody knows that HIV transmission risks indeed are higher if an STD is present, but you didn't ask that in your original question.  I also won't get into criticizing individual clinics' policies about HIV testing in worried-well people at low risk.  In general, public clinics don't want to do 2 or 3 tests when one will do; therefore, they may very reasonably require people at low risk to be tested only once at 3 months.

HHH, MD

[siobhan_d]

Sorry Doc!! Won't happen again!

Thanks just the same for your response.