Really want to find answers for my mistake

[Tonysinger]

I’m 31 male and had several sex encounters in May.  All vaginal sex condom protected and not broken, unprotected oral twice.

3 days later, tingling/itchy in lower pubic area, scratched without taking a look, then it’s gone and didn’t feel anything else. 7 days later felt the same itchy then tried to scratch again. Found a round-shape brown or black patch ~ half inch above penis base. Size is ~ 1 cent coin.  No obvious pain/no ulceration but oozing. It healed w/o. drug 6 days later, skin was back to normal but round brown pigmentation patch left. Another symptom is nerve pain in pubic area near the lesion. No penis discharge, no swollen lymph, no fever, no rash but feel very stressed/fatigued.

Went to two drs. GP didn’t order culture test even with active lesion, said maybe herpes but unexpected location. Dermatologist said maybe anything coz lesion healed when seeing him. They ordered blood test for me though.

The tests have been done are

1. 11 days
HSV 2 Herpeselect IGG 0.04 neg

2. 30 days
RPR-Syphilis/HIV ab/ HIV RNA/ gonorreah/Chlamydia,        all neg
HSV1 IGG 0.09  neg
HSV2 IGG 0.28  neg

3. 53 days
RPR-Syphilis/HIV ab, all neg
HSV1  IGG 0.09 neg
HSV2  IGG 0.16 neg

Feel very guilty and want to find out what it really is.  Based on test result I can only rule out Gonorreah/Chlamyida/probably HIV but nothing else. My questions are,

1, For HIV do I need one more antibody test 3 month to be 100% sure?
2, For Syphilis RPR do I need other type of tests like EIA after 3 month to be 100% sure? Coz RPR may generate false negative
3) For HSV2 my biggest concern, I know need to wait 3~4 months to be sure.  But does my declining index ratio mean anything? Can I still seroconvert positive later? Do you recommend WB test at 3 month to be 100% sure? Coz 5% never generates antibody even if carrying it.

I made mistakes and deserve penalties on my own if any. But don’t want to contract anything bad later to my wife. She is innocent and I feel so guilty for her now.

[Edward W Hook, MD]

Welcome to the Forum. The exposures you describe was quite low risk for ALL STDs, including HIV, the symptoms you describe including your transient skin lesions, and your test are all negative.  Further testing really is incredibly unlikely to be positive.  

1, For HIV do I need one more antibody test 3 month to be 100% sure?

No, your only risk at all was from the oral sex and that risk is so low that we typically often do not suggest testing.  Your results will not change and further testing is not needed, despite the overly cautious "official" recommendations you can find on some sites including from the CDC.

2, For Syphilis RPR do I need other type of tests like EIA after 3 month to be 100% sure? Coz RPR may generate false negative

No further syphilis testing is needed. The RPR is highly reliable- believe your results.

3) For HSV2 my biggest concern, I know need to wait 3~4 months to be sure.  But does my declining index ratio mean anything? Can I still seroconvert positive later? Do you recommend WB test at 3 month to be 100% sure? Coz 5% never generates antibody even if carrying it.

Your risk for HSV is also quite low, even before you tested. Further, your lesions in no way suggest HSV. The changing index values reflect day-to-day variation in the test, nothing more.

My sense from your test is that your problem in not STD but that you are guilt ridden as a result of your behavior. Further testing will not help this.  Please consider discussing your guilt with a confidential counselor or trusted advisor.  EWH

[Tonysinger]

Dear Dr. Hook,

Thanks alone are way not enough to express my sincere gratitude to you and your help. I have no more question and will happily accept what you educate me.

May the best to you and your work.

Thanks a million!

[Edward W Hook, MD]

Last answer- you can't seem to let this go.

Their uncertainly was due to the fact that the lesion did not suggest HSV. herefore you were tested repeatedly, with negative results and over a period when there were no typical recurrences.  You seem to want to test more, so go on and do it. I am confident that no matter how much you test or what test you use to test, you will get the same answer- you did not get HSV for the low risk exposures that you have described.  EWH

[Tonysinger]

Dear Dr. Hook,

Thanks again for your reassurance. I feel really grateful and will move on.

The last question, my GP actually told me during his diagnosis for my ACTIVE pubic lesions, it's not like a yeast, etc. other regular infection and although not very sure, herpes probably is still the major reason. Then he told me to consult with dermatologist.

My dermatologist looks less convinced by the lesions though. But he couldn't rule out herpes either.

Their uncertain diagnosis and initial concern for herpes infection makes me worried. Do you think GP's initial diagnosis as herpes would affect your judgement about my case? Can I move on with my negative HSV2 result confidently?

This will be the last question and thanks for your answer again.

[Edward W Hook, MD]

In your questions about the possibility of either syphilis or HSV, you are taking things out of context.  In the link about syphilis you provide above, the clinical suspicion of syphilis had been (possibly) raised by the client’s doctor, hence the discussion of further testing.  This is not the case for you- you had low risk exposures and have nothing in your clinical or laboratory results to suggest either HSV or syphilis.  Tests are part of the entire fabric thorough which we make our assessments, not the sole determinant.  When one test or clinical observation does fit or make sense then other tests are needed.  On the other hand, in cases such as yours when there is nothing objective to suggest the presence of an STD such as HSV or syphilis, there is no reason to keep testing.  At this time, you really need to believe your tests and deal with your guilt, not waste time doing further unnecessary testing.  Really.   EWH

[Edward W Hook, MD]

In your questions about the possibility of either syphilis or HSV, you are taking things out of context.  In the link about syphilis you provide above, the clinical suspicion of syphilis had been (possibly) raised by the client’s doctor, hence the discussion of further testing.  This is not the case for you- you had low risk exposures and have nothing in your clinical or laboratory results to suggest either HSV or syphilis.  Tests are part of the entire fabric thorough which we make our assessments, not the sole determinant.  When one test or clinical observation does fit or make sense then other tests are needed.  On the other hand, in cases such as yours when there is nothing objective to suggest the presence of an STD such as HSV or syphilis, there is no reason to keep testing.  At this time, you really need to believe your tests and deal with your guilt, not waste time doing further unnecessary testing.  Really.   EWH

[Tonysinger]

Dear Dr. Hook,

Thanks a lot for your timely reply. It does relieve my stress a lot.

I agree my own guilt makes the anxiety worse but I'm probably not the kind of person who do not trust test result. Actually I feel quite confident regarding my HIV negative result just because reading your post and knowing "combination of PCR and antibody at 4 weeks provides 100% conclusive result" And that's why I'm taking them at 30 days. Thanks again, Dr. Hook, for educating me regarding that.  However, my real questions are from syphilis and HSV2 result.

For syphilis, why I cannot have full confidence about RPR is because Dr. HHH's mentioned in his post,
http://www.medhelp.org/posts/STDs/RPR-Test/show/1431601
RPR may not provide conclusive result sometimes. Do you think I need to take into account if I want to 100% sure? Or  you think I'm overly worried and should just trust my negative result at 53 days as conclusive?

For HSV2, I read from STD/Herpes forums quite often and learned a lot knowledge about herpes from the experts like you. And knowing at 8 weeks, around 80% infections will be detected by Herpeselect test. So that's why it raises the question to me, if want to purse conclusive result, should I resort to test again at 3 month with regular Igg or a WB test? Or I don't need retest any more and just take 53 days negative result as conclusive?

Thanks again for your help.