scared to death--please help

[mks06]

Hi Doctor.  Hoping you can help a very anxious person here.  I'm thankful for a forum like this, but I have to admit that I find the reading on the internet somewhat obsessive.  I've searched your archives but can't find anything quite like my experience.  Here it goes: I had an experience 1 1/2 weeks ago where a guy sucked my nipple and part of my chest one night. (I'm a guy, and don't do things with other guys normally...long story how I got into this situation, but I had been drinking and it just happened) No oral sex, kissing or anything else.  I had shorts on but no shirt.  He pinched my nipples hard during this time.  Anyway, the next day my nipples were red but I did not notice any broken skin or blood.  (there was however a mark that looked like a hickey under the nipple that went away the next day)  What freaked me out (leading to this post) is that 2 days later after taking a shower the top of my nipple bled while showering after I had ran across it with a washcloth.  I thought I was going to freak out.  I know that the nipple was tender and I irritated it..but it got me thinking.

My concern is this:

1) could I have been eposed to an STD of any kind given that there could of been an abrasion on my nipple area?  What about the fact that there was a hickey mark?  The fact that my nipple bled 48 hours later concerns me.  I've read about herpes, syphillis, HIV, Hep...they all scare me to death.  It seems that so many of these (not HIV I know) can be transmitted by saliva if there is an abrasion or cut. (and, there could of been blood in his mouth, right?) Again, I did not notice any broken skin (outside the hickey mark, which wasn't really broken skin..more a mark) the next day but the bleeding 2 days later on the nipple scared me to death!!

2)I started to worry about herpes.  The CDC line told me ANYTHING is possible if there is an abrasion.  The herpes hotline (by the American Social Health Society) said no, this is not likely, because the virus does not infect areas not in the genital area or mouth, and that my risk is only theoretical but not to worry.  I started to think my chest was burning over the last few days, but no outbreak has occured. (I'm pretty sure its my mind...I keep staring at my nipple and chest) Do you think this is a concern?

3) I don't want to test if it is not necessary due to the anxiety it causes....but if there is any risk, should I?  The timeframes are all over the place on the Internet for all the different diseases.  Do you think I need to get tested?

There's not much on the Internet similar to my experience....I'm embarrassed to go to a doctor over this.  I thank you (more than you can imagine) in advance for your advice and any assurance you can give.

[H. Hunter Handsfield, M.D.]

From your description, there seems no doubt the blood is due to trauma only and not an infection.  Sufficiently vigorous manipulation to cause a hickey certainly could cause bleeding into the milk ducts; the bleeding occurred at the same time, but you squeezed it out 2 days later.  (Yes, men have milk ducts.  Male breasts are fully functional, if given the necessary hormonal push.)

In response to all 3 of your questions:  I once saw a case of HSV-1 infection of the nipples from a partner’s oral herpes, but to my knowledge, no STD, including HIV, has never been transmitted that way, and from a purely anatomic perspective the HIV risk is zero or close to it.  The advice you got from ASHA is right and that from the CDC hotline wrong.  You do not need to be tested for anything, but see a health care provider if your nipple continues to bleed or if you get blister-like sores of the nipples in the next couple of weeks.

This seems a good time to comment again--as I have done several times--on the poor service currently provided by CDC’s STD/HIV phone line.  CDC used to contract with ASHA for the service.  The phones were staffed by well-trained people, many of them health educators themselves, who knew their stuff well, and quality control was excellent; for 15+ years the service was superb.  But last year ASHA lost the contract (not their fault, basically an attempt at federal cost savings that backfired, both in quality and cost). Now the folks on the phone know only what is written down for them in model telephone scripts.  They have little or no real understanding of the diseases and are not trained or expected to vary their responses based on nuanced questions, social context, etc.  And the conservative, medicolegally driven, CYA response is to inflate risk, with little distinction between "CAN it happen?" and "Is it likely?"  It’s quite sad, and I’m sorry that you were one of the many (thousands?) of people who have been misled by their responses.  Maybe the service will improve with time and experience, but they're not there yet.

Good luck--  HHH, MD

[Imdumb]

I'm not sure why the CDC told you that...but no one has ever gotten HIV or an STD that way.  If it was that easy we would all hvae AIDS by now and the human race would be wipped out.

Have you ever had an abbrasion on your hand and shook hands with someone?  For an STD to be transmitted there has to be sex.

Agian, if the CDC says ANYTHING is POSSIBLE doesn' mean it is likely to happen or that it has even ever happened.  It is POSSIBLE a meteor will come through my roof and kill me in the next 10 minutes.  I am not particularly worried about it though.

Move on and get back to life!!

[Willl]

That is exactly right on the CDC. I have called them several times in the last year and they just read word for word what is written on the website.

[mks06]

I appreciate the comments.  One last question though..I assumed the bleeding 2 days later was due to a cut or abrasion on the skin and it drove me crazy...I didn't even think about the scenario you described. (I don't think most guys would)  I guess my only concern is that I continue to think my chest is burning, and that I'm going to wake up and see blisters on my chest.  (thus, I'm looking at it constantly)  This has been going on for a week now but no signs of any blisters...everything looks normal.  I guess I have to get over this whole thing but I'm curious if you've ever heard of a burning chest for a week as being a "sign" of a future outbreak for herpes?  The American Social Health hotline told me that the signs usually can occur up to 72 hours prior to an outbreak...other literature say just a few hours or so....so, I tend to think it's all in my mind.  Does that make sense?  Lastly, I have to thank you for this forum and your advice....it's a great service that is provided......