Unluckiest Man Alive? Help much appreciated

[superanon963]

I stupidly saw 8 escorts over two weeks. I'm getting help with a sex addiction. I received protected oral from all 8. Three gave me handjobs (minute amounts of vaginal secretions may have been on their hands?) and I may have shared a towel with two. Three of the escorts drooled on my scrotum, although their mouth never directly contacted my scrotum. My last contact was March 13. On April 3, I began to have some genital itching. I noticed about 7 red circles (mostly pencil eraser-sized) on my scrotum ONLY. Feeling anxious, I rubbed each of these red circular areas intensely. They were a little sore and itchy when I rubbed them. It seems that I rubbed the outer layer of skin off, and each of these red areas developed into open ulcers. Although they remained itchy, they didn't hurt too bad. Over the course of about 10 days these ulcers healed and vanished. No fluid-filled blisters of any kind developed. A couple of the ulcers developed into white circles on my scrotum that appeared kind of wet. I guess you could say it looked like a cold sore or canker sore, except on my scrotum. The day after I developed lesions, I went to a clinic and had a culture. I also had two more cultures done at doctor's offices over the course of a week. I went to see a dermatologist for the second culture and she told me I had genital herpes based on a visual diagnosis. All three cultures came up negative.

On March 16, I had IGg blood testing: HSV1 Positive 1.31, HSV2 Negative <0.90. I know for a fact that on a couple of occasions in the past, I have had a single, clear, fluid-filled blister on the inside of my mouth. So I probably have oral HSV1 already.

1) Considering I DID NOT HAVE VAGINAL SEX with any of the escorts, and I used a condom for oral sex, how did I contract herpes? As I mentioned, three of the escorts drooled saliva all over my scrotum, so is it possible their saliva alone could have given me herpes? If so, am I more likely to have genital HSV1 or HSV2 given my history?

[Edward W Hook, MD]

Welcome to the Forum.  While I cannot say what it is you have, I can tell you that neither your exposures nor the lesions you describe suggest herpes to me.  All too many clinicians have the mistaken idea that they can accurately diagnosis genital herpes through visual inspection.  This is just plain wrong. At least two major studies, including one that has not yet been published which I am a co-author on, indicate that when STD experts make a visual diagnosis of "herpes" they are worn 20% of the time.  Given your history or very low risk exposure, the time course of your lesions and your multiple negative cultures, I sincerely doubt that this is herpes.

If you already have HSV-1, your are almost certain not to get it again in another location.  Further, to get HSV-2 from oral contact is likewise most unusual.  

It is not clear to me if the lesions are still present and how they are evolving but I think you need another opinion.  This could be a drug reaction, an allergy, folliculitis irritated by your rubbing or something else.  It is unlikely to be HSV.

I hope that this comment is helpful to you. EWH

[superanon963]

Thank you very much for all your help, Dr. Hook. Your responses have really helped to ease my mind. I appreciate it. I will get testing at the six week mark and again at 3 months and just hope for the best. Take care and thanks again.

[Edward W Hook, MD]

At six weeks about 2/3rds of persons who acquire HSV will have positive HerpeSelect tests.

The majority of Aldara effects are local, occuring in the area where the drug is applied.

How many times should I repeat the STDs are not transmitted in saliva?  My answer will not change becuase you have repeated the question.   EWH

[superanon963]

Okay, thank you. A few final questions. Obviously, the dermatologist's diagnosis of genital herpes was frightening, so I'd want to get more blood testing to rule it out. But since my last contact was March 13, I'd have to wait until around June 13 to have a definitive test for HSV antibodies. The waiting process is torture. How accurate would it be if I had another HSV blood test in about a week or two? (about six weeks from my last exposure)

Also, could aldara cause red marks/lesions on other areas of the scrotum, but NOT on the area where I actually put the cream?

My other question is, if I had small cuts or scrapes on my scrotum at the time of contact, would it then be possible for the escort's saliva to cause herpes?

I appreciate your help, and I won't have any further questions after this. Thank you so much for your help Dr. Hook.

[Edward W Hook, MD]

These lesions still sound nothing like a typical STD, including HSV. STDs are not transmitted by "drool", even large quanitites of it.  On the other hand, ulcerative reactions can occur with Aldara use.  

You may never know what caused these lesions but I sincerely doubt that they represent an STD of any sort.  EWH

[superanon963]

Hi Dr. Hook,

Just to clarify, when I mentioned the "white circles" on my scrotum, which looked like canker sores (basically wet, white lesions in the middle of a red background), these sores were there during the course of the 10-12 day healing process after I rubbed off my skin. Only two of the seven lesions seemed to develop into these "canker sore appearing" sores during the healing process. The other ulcers were open skin that just scabbed over eventually. In any case, all the lesions are now gone completely...no scabs or anything else. Only mild redness and white scar tissue in one area. Thanks again!

[superanon963]

Thank you so much for your prompt response. I appreciate the work that you and the other doctors/nurses do. The lesions have resolved. One of them is still mildly red, and there appears to be some white scar tissue there. But from the time I noticed the 7 red areas (April 3), rubbed them and they became open wounds, and they disappeared was about 10-12 days. I have also been using aldara for a genital wart on my scrotum. I placed the whole packet on the wart because it didn't seem to be doing anything. I used aldara for about 4 days straight near the time of the outbreak. The red areas on my scrotum were nowhere near where I put the aldara though. Other thoughts: I did lay in bed with my boxers on with one of the escorts and she was naked and cuddling with me. Another one was naked and we masturbated each other simultaneously. Maybe those caused it? Also, is it possible that drool (saliva) alone, which landed directly on my scrotum in large quantities, could have caused herpes? I put rubbing alcohol on my scrotum after each encounter and I showered. Thanks for the help again.