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Avatar universal

Your thoughts please

Exposure: received unprotected fellatio (no noted lesions on or around mouth of female) - occurred 06/20 (now 14 d later) - otherwise STI status unknown
Testing: 6 d (post-exposure) G/C-NAAT urine analysis (results not known thus far, but no burning with urination or penile discharge whatsoever)
Possible Symptoms: 7 d (post-exposure) - found what appeared to be red bump under foreskin, although was not raised upon touching, just appeared this way, has not formed blister, opened up, scabbed in 7 d since (also not painful or itchy)
11-12 d (post) - noticed some aching in my back and abdomen, but engaged in rather rigorous physical activity day prior, so conceivably related to this (also, aching has improved since)
13 d - felt distinctive malaise/fatigue I would associate with flu-like symptoms all day long, but this has seemingly resolved overnight
13 d - noticed some very small red spots (3) on head of penis, not clustered, not painful, itching etc. and certainly not blister-like

1.) If the aching/fatigue/mallaise etc. were related to a primary HSV1 infection, would you absolutely expect overt penile lesions? Have you ever seen a case in which these sort of symptoms were occurring without the typical blister-like lesions?
2.) (note: answer will not be taken as gospel) Would these symptoms, independent of my suggestion, lead you to suspect HSV1?
3.) In a previous post, by HH I believe (could be EWH), one of you stated that a gentlemen who had received unprotected oral had nothing to worry about, in terms of HSV1, if he did not find overt penile lesions within 3 weeks of exposure.  I don't understand this suggestion, in light of the multiple remarks regarding just how mild a primary HSV infection can be.  Can you please elaborate a bit?
4.) Other than the 12 week HSV blood test, and my aforementioned G/C-NAAT urine analysis, is there any other testing you might prescribe?

Thank you
8 Responses
300980 tn?1194933000
You've had a single unprotected encounter in which you received oral sex.  You have taken the right steps to rule out gonorrhea, chlamydia and NGU but have lingering concerns that you might have acquired HSV-1.  From your story, I see little to worry about.  This is not because of a single observation but because of the additive impact of several points.

1.  You have had not symptoms. You sound as though you are vigilant about such things, making it unlikely that you would miss lesions if they occurred.  Most HSV that is missed is because of denial and attribution of lesions to some other cause. - I doubt that you would do that
2.  She had not obvious cold sores.  Transmission from lesions is much more likely than transmission from persons without lesions.
3.  While 60% of the population has HSV-1, this also means that 40% of people do not. That means that there is a greater than 4 out of 10 chance that she does not have HSV-1
4.  In fact. Most exposures to herpes do not lead to transmission of infection
5.  Your back ache, abdominal discomfort, etc are in no way suggestive of genital herpes of any sort
6.  The bump under/in your foreskin has not evolved.  If it were HSV it would have.  It sounds like a simple cyst.

I would not be concerned.  Hope you will not be.  EWH
Avatar universal
Wanted to clarify something.  I tested negative for HSV (not type specific) in April and have had no other unprotected sexual encounters since.  This is my reasoning for questioning the possibility of primary exposure, rather than recurrent.
Avatar universal
Thank you sir for the logical and reassuring explanation.  I only wish to clarify one thing, and ask one more question.  

You seemed to strongly imply it, so I hope you can simply confirm my suspicion.  In the entirety of your professional experiences, the systemic symptoms I mentioned (fatigue, aches) would not be occurring in the absence of overt (blister-like) penile lesions, correct?  

Second, as promised, a question.  Considering this exposure involved significantly more lip-lip contact (kissing) than fellatio, would it be proportionately more likely that the acquisition (however unlikely) of any HSV1 would be on my lips, rather than genitals?  (and from a completely inquisitive perspective, rather than a paranoid one, would it be possible to acquire HSV1 in both regions from this single exposure, considering my susceptibility from lack of past exposures?)

300980 tn?1194933000
Yes, you are correct- your risk would be highest for HSV-1 with predominantly oral contact

While theoretically it is possible that a single encounter invilving both genital and oral exposure could lead to infection at both sites, in practice it is extraordinarily rare.  EWH
Avatar universal
Hi Doctor.  Since I have had such difficulty getting an answer to an on-going question, even from in-person STD clinic workers (as I know you would wisely suggest), maybe you could offer some more insight.  I realize that I may have to eventually accept I will not get an answer, but I wanted to give it one last try.  I have remarked a few times about small clusters of bumps on my penis foreskin which fail to develop in the typical herpes fashion, and my concerns about the nature of these bumps.  Since I do not have the option of submitting a picture, I looked for a image on the web where I saw very similar bumps on a man's penis.  I eventually found such an image at:
This page is actually part of some sort of quiz for doctors's, and as you will see if you choose to quickly examine the image, the answer to the question ends up being PPP.  I also have PPP, and assume what they are referring to is the rim of white nodules.  However, what caught my eye is the small cluster of bumps left-of-centre on this man's penis, a few millimeters higher that the rim of nodules.  This is almost precisely what I have tried to describe in this forum, in terms of what I see on my own penis.  The only difference is that mine tend to get a little red from time to time, but never actually do anything else.  I suspect you will feel that a dermatologists opinion will be the gold standard in this case, but as I have already tried two, I am simply wondering if these strike you as a problem/pathological/STD related?  Thank you, thank you, thank you.  
300980 tn?1194933000
You're right.  As a matter of policy Dr. Handsfield and I do not look at pictures for diagnosis on this site.  Sorry.  Sometimes our collegaues on the MedHelp dermatology site will do this but as you know, we strongly believe that to be seen in person by a dermatologist or orther health professional is in your best interest. EWH
Avatar universal
Fair enough Dr.  A evenly applied and logical rule is fine and just in my eyes.  I have just one more question for this thread (or at least I sincerely hope so).  It is in regards to PCR or culture of a swab test for herpes.  Sites I have reviewed, and conversations with STD specialists in person would lead me to believe that actual blister fluid would have to be sampled for this sort of test.  However, you suggest sampling of even red rashes, without the appearance of, or opening of, blisters, to expose their contents for sampling.  Can a swab of some reddened skin or suspicious bump yield positive results for HSV in your experience, or do you need the typical open-blister type scenario for such a test?
300980 tn?1194933000
Both swabs and cultures can be positve if the virus is present.  We now know that the virus can be present on intact skin (asymptomatic shedding) and have known for some time that swab tests taken from ulcer bases or rashes indeed can yield herpes virus. So, in answer to your question, you do not need a fluid filled blister to get a postive herpes culture or PCR. Of the two tests, the PCR is more expensive but also more sensitive.  EWH
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