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Avatar universal

Need Clarification

Fifteen days ago I rec'd unprotected oral sex from a female stripper (I am male).  The following day I had some red irritated skin on the underside of my shaft.  This may have been the result of her dancing and grinding a leg in my crotch.  I did not experience and fluid filled blisters or major discomfort.  I put some hydrocortizone cream on it and it resolved in the next day or two.  I have also noticed a small bump (maybe the size of the tip of a needle) under the flap of skin that conects to the underside of the head of my penis.  This may have been there forever, just never noticed.  In 15 days from the event this has remained unchanged.  Two weeks following the event I had shown no signs of an outbreak.  I had unprotected vaginal sex w/ my spouse the night following the event and since then she has not complained of any discomfort.

Yesterday I saw an STD clinician for a screening and she suggested I be tested for herpes 6 weeks after the event and prescribed Valtrex in the meantime to protect my spouse from infection.  My questions are as follows:

1.  If I had been infected w/ HSV-1 from the stripper performing oral on me would I have shown signs of an outbreak in that 14 day time period?
2.  Could the irritation that cleared up quickly w/ the cream or the small bump have been a symptom of HSV?
3.  If I had been infected would my spouse have shown signs of infection at this point?
4.  If I test positive at 6-weeks for HSV-1 ho do I know it was from this event or from childhood and whether it will effect me orally or genitally?
5.  Under my circumstances do you think the Valtrex was necessary?
6.  What is my probability of an HSV-2 infection under the aforementioned circumstances?
7.  Should I get tested and what test do you recommend?

This was terrible decision that lasted all of 5 minutes and the fear of what I may put my family through has been very difficult.  Thank you for your help.
10 Responses
55646 tn?1263660809
I disagree with the advice of your clinician.  I would recommend that you get a baseline test now (though it is possible that if you were recently infected, that your antibody test would be positive by now), but not too likely.  Steroids cream normally make a hepres outbreak worse, not better.  Valtrex may interfere with you making a good immune response, so I would stop it.  HSV 2 infection in the circumstances that you describe is quite unlikely, actually.  

Have you had sex with your wife since this encounter?  Have you ever had a cold sore on your lip?  

In terms of the bump, I think what your are describing is likely a pearly papule near the frenulum, which is completely normal and probably has been there forever, but look on the internet for pictures and see if something looks familiar.  Did you point it out to the STD clinic on exam?

terri
Avatar universal
Just clarify, the small bump resembles a tiny pimple.
Avatar universal
Yes I have had sex w/ my wife since the encounter.  We had unprotected intercourse the following night.  I had been away on a business trip and did not know what to do.  That is why I am so concerned.  The picturres I found of the pearly papules online are very similar to what I have noticed.  Do you think that after 16 days since the event and only suffering from what could easily anxiety driven symptoms it would be safe to continue unprotected intercourse with my wife?

I do not recall having cold sores in the past.  Maybe as a child.  I remember getting canker sores but not cold sores.

The clinician didn't even exam my genitals.  So in your opinion go ahead and get an HSV test and stop taking the Valtrex?  I took two doses to date, what type of negative side effects could that present?
55646 tn?1263660809
It won't have enough impact to change test results.  
Yes, I would recommend a baseline herpes antibody test.  If you have high index value for HSV 1, then I would suspect that you've had it a while, and are not very vulnerable to getting it a new location.  
As to sex with your wife, I just can't answer that for you.  I'm a wife, and if you asked me would I rather take an unknown risk of getting an STD from my husband or hear that he had got a blow job from a stripper, I would have to say I would rather hear the later than have someone take a risk with my health without my knowing it.  But that's just me.  The thing is, herpes isn't the only risk.  Were you tested for the other STDs, gonorrhea, chlamydia?  Its too early to test for other STDs like hepatitis and HIV, but the problem is that the mouths of commercial sex workers are not very safe because of the frequency of their partner change.  And although oral sex is certainly less risky than vaginal or anal intercourse, it isn't risk free.  

You have some difficult decisions to make here, I don't envy you.  I"m sorry this is all quite difficult, and I wish there were some easier answers.  

Please feel free to ask additional questions.

Terri
Avatar universal
At this point I have been tested for Chlamydia and Gonorreha but have not rec'd the results.  For my understanding from previous posts to Dr. Handsfield Chlamydia is not a risk in my circumstance.  I do have some additional questions.

HSV 2 transmission is rare from oral to genital contact.  How rare?  What needs to take place for transmission to occur?

If she had HSV 1 on mouth but no sores present what is the possibility of transmitted HSV 1 to my genitals?  Wht has to occur for this to happen?

If I am HSV 1 & 2 negative from my baseline test and I contracted HSV 1 from receiving the oral does that mean I will have HSV 1 on my genitals?

Will it be recurring?

If I was symptom free for 16 days (two of which I did take a Valtrex) nd my wife was symptom free for 14 days (no open sores, discharges, discomfort unirinating) what is the likelihood I am infected with either 1 or 2?  In the majority of the posts it seems 2-10 ays is when an initial outbreak should occur.

Thank you so much for your help.
55646 tn?1263660809
I would agree that contract chlamydia from oral sex is very uncommon, but when it comes to professional sex workers, we have seen chlamydia in the throat, so I'm glad you were tested, good job.

I can't quantify the risks that you ask about exactly in the way that you ask them.  The rate of shedding virus from the mouth of someone who has HSV 2 orally is about 3 days out of the year, so giving off the virus is uncommon from the mouth.  In order for transmission to occur from the mouth of someone with HSV 1, virus has to be shed at the time, and viral shedding of HSV 1 from the mouth is more common - somewhere between 9-18% of days.  Did you kiss her?  If you are HSV 1 positive when you test a few months down the line after being HSV 1 negative at baseline (which we don't know), then you could have contracted it either orally or genitally.  And if you get it genitally, it certainly could recur, though infrequently; from the mouth, more often.  

Yes, if one were to experience an initial outbreak, it would be within 2-10 days, most likely.  However, not everyone experiences an initial outbreak, though I suspect you are being more observant that some people, given your situation.

A baseline antibody test is essential, in my mind, and the sooner the better. The longer you wait, the less clear it will be if you contracted herpes long ago or just recently.

Terri
Avatar universal
I am going in for a baseline screening on Tuesday.  May I share my results with you?  If both 1 and 2 are negative would it be beneficial to screened again at 6 weeks and see what degree of change has taken place and then again for certainty at 12 weeks?  Or is the 6 week screening not necessary?
55646 tn?1263660809
Yes, of course you can share your results with me, I want you to!  The 6 week screening, if you are negative for both now and then, will be good news, but no definitive news.  A final screen would be done at 16 weeks post exposure.

Terri
Avatar universal
Terri, over the weekend I read countless posts from the expert forum regarding HSV risk from my type of exposure and have another question.  It appeared to me that both Dr. Handsfield and Dr. Hook were consistent in their advice that if you had a low risk exposure like mine and no symptoms w/in the first 14 days (initial outbreak) that they did not recommend testing.  I certainly do not want this to come acrss as questionning your advice because you advice has been tremendous.  Would you please clarify?
55646 tn?1263660809
I don't think you are fully understanding my advice on this situation.  I'm not suggesting that you get tested because the situation is high risk, I'm suggesting that you may want to get a baseline antibody test to see if you ALREADY have HSV 1 infection, making you at very low risk for acquiring HSV 1 from this new encounter.  It might help you worry less, and if, in the future, you get any symptoms of HSV 1, then you would know that you already had it at this encounter, didn't acquire it from this encounter.  At this point, it may be a little late in the process to get a test that accurately reflects your antibody status prior to the encounter.  I hope this clarifies my thoughts about this a little better than I articulated earlier.  

Terri
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