What is this?

[jaybird791]

Doc,

I am a 27 year old white male.  In late March, I had unprotected oral sex and protected sex with a stripper in Mexico.  (Protected sex was very short lived, and condom never broke, didn't insert my penis all the way)  The very next morning (7-8 hours after passing out very intoxicated) my penis and testicles were in mild to moderate pain--urethra hurt and my testicles were tender, but nothing unusual on my skin.  I freaked out and went to the CDC website to research what to take.  I then went to some pharmacies the next day in Mexico and took 2g of Zithromax.  The pain did not go away the third day so I took 400mg of cefixima? (Spanish) and started 100 mg twice a day of doxycycline for 7 days.  I also was sweating majorly (was very nervous) and had the chills.  The pain in my testicles and penis hurt a bit worse when I would sit for a long time.  When I returned back home, I went to the STD clinic.  The doctor there said it may be herpes and gave me a urethral culture (ouch).  The test came back negative for herpes and syphillis.  She did not bother to test for chlamydia and gonorrhea because she said the antibiotics I took would have cured it.   then went to family doc..still symptomatic..prescribed Vatrex and Cipro..took both and symptoms subsided..not entirely..week 3 developed rash around anus (stripper not near anus) and still taking Valtrex 1 g/day.  1 month after incident Elisa and Western Blot test while finishing up Valtrex..also got urine tested...just got test results..negative..rash still present...On 5th day of Famvir now, still discomfort in left testicle...Is this herpes?  What else could it be?  Worried about HIV, because of viral meds not working, but antibiotics not working either!...tested HIV negative 5 weeks ago at clinic..Too early for seroconversion?

Please help!  (trying to stay under character limit)

[Edward W Hook, MD]

The likelyhood that you have an STD or HIV is very, very low.  Let's break this down into several different facets:

1.  Your exposure was very low risk.  Your genital sex was protected and condoms work.  Your oral exposure was unprotected but few STDs are transmitted through oral sex.
2.  Your symptoms started 7-8 hours after your exposure.  There are no STDs that would start that quickly after exposure.  It typically takes 2-3 days, minimum for STDs to begin to cause symptoms.
3.  You have taken a lot of antibiotics  As a result, there is no way that you could have gonorrhea, chlamydia or syphilis.  The azithromycin you took is curative for gonorrhea and chlamydia.  The doxycycline would have cured chlamydia.  the cefixime would have also cured gonorrhea.  And all three antibiotics would have prevented syphilis from developing
4.  There is little reason think you have herpes.  You have not had lesions to suggest that you have herpes and therapy for herpes has not made your symptoms go away.  Furthermore, herpes does not cause pain in the testicles.  (BTW, valtrex and famciclovir work exactly the same way, if one did not work there is no reason to take the other- my advice would be not to waste you time taking either one)
5.  There is almost no chance you got HIV.   The chances of getting HIV from receipt of oral sex is less tan 1 in 10,000, if your partner was HIV infected -she was probably not.  Then you had a negative HIV test 4 weeks after your exposure - at that time 85-90% of HIV tests that are going to be positive would be.  Thus, working the math, at this time your chances of having HIV from this exposure are less than 1 in a million - you are more likely to get hit by lightening.  
6.  There is no plausible way that your rectal rash is related to your contact- there was not exposure.

You're behavior and the text of your post suggests that you are panicked by your exposure (I'm not accusing you of anything, just concerned).  I do not doubt that you have discomfort in your testicles or genitals but I can assure you, it is not due to STD or HIV.  I would suggest a two fold approach, working to try to calm yourself and your concerns and working through the symptoms you have with a health care professional. I hope this helps.  EWH

[Edward W Hook, MD]

Regarding the blood test, there are few data for the 4 week time point.  I would guess about half of tests would be positive.  At 6 weeks 60-70% of persons who have recently acquired herepes will have positive HerpeSelect blood tests.  There are fewer data for the Western blot.

My guess is that the "help" achieved by the valacyclovir is the natural history of your problem, not drug effect.

You have to decide who you wish to believe.,  I am not interested in arguing  and have no interest in debating with other sources.  

Please let us know how things come out.  EWH

[jaybird791]

Thanks for your comments Doc.  I appreciate them, and they have made me feel a bit better.  However, please understand where I am coming from.  I have been told by and STD clinic doctor that herpes can show up the following day.  She also said the lesions could be in urethra.  Also, the Valtrex did seem to help, but didn't cure the symptoms entirely.  Same with the Famvir.  Still mild pain...

Furthermore, my symptoms, sweating, chills, penile and testicular pain, burning during and after urination, and an anal rash, all point to herpes according to WebMD, and some other reputable sites.  Also, it seemed like the antibiotics did nothing.  

I've read that rashes can occur around untouched areas and can end up being herpes.  Is this true?  Is 4 weeks too early for seroconversion?  What are the chances the tests (ELISA and WB) are incorrect?

[Dallasfan]

You had very low to no risk sexual contact. I would relax and stop testing and treating something that is not there..You may be having some benign prostatitis unrelated to your contact that may give you your symptoms. I also never like anyone to self diagnose or self treat over the internet. A urologist may help your symptoms. Take care.