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Possible exposure and infection with STD

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I have been a bit worried about possible exposure and infection. My situation:

I'm male, 24. I saw two female escorts last month on separate occasions. Each was well reviewed by other people on forums dedicated to reviewing escorts. These were not street walkers but conscious service providers. And before them my last sexual experience was 5.5 years prior.

I saw the first escort (female, late 30's) about two and half weeks ago. She did not appear to have any cold sores or herpes sores on her mouth/face or genital areas as she was clean shaved down there. With her I did a bit of light kissing on the lips and french kissed only for a second. I received fellatio WITHOUT a condom for more than 10 minutes. I had protected vaginal sex WITH a condom.

I saw the next escort (female, mid 40's) just 3 days after, so exactly two weeks ago. Again she did not appear to have any cold sores or herpes sores on her mouth/face or genital areas as she was clean shaved down there. With her I just kissed her once or twice lightly on the lips; no french kissing. This time I received protected fellatio WITH a condom for more than 5 minutes. I had protected vaginal sex WITH a condom.

Since these experiences (so more than 2 weeks after) I have felt normal in terms of physical health aside from two days ago after masturbating a little aggressively I noticed a tiny red dot like bump (not really raised at all) on my penis glans' edge/rim. Its been there for two days now - hasn't gotten worse or better, no pain, just looks like a tiny red bump almost like a blood vessel inside was strained from masturbating.

And today I noticed a slight feeling of tingling (not sure if you can call it that because I've never experienced it before) and itchiness at the corners of my lips almost like its from ingrown hairs or something. I tried a home remedy of putting oils (sesame seed oil, mustard oil) on my lips just to keep them from drying in the cold weather.

Again I don't feel sick/flue like, no aching, no soar throat, no swollen glands, none of any of the herpes symptoms. I have also never had a cold sore in my life.

I am anxious to know whether I might be developing HSV1/cold sores/oral herpes with this recent lips concern? And if the single red dot like bump on my penis glans is anything significant?

I am looking to get blood tests for hsv, I live in Canada, so any recommendations on what test is best for me for detecting HSV antibodies?


Thank you.

Category: Sexually Transmitted Diseases(STD)Specialist

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Category: HIV- AIDS Specialist
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Thank you.

Hello and thankyou for approaching DoctorSpring. I have gone through you case in detail.
Your symptoms are not specific right now, but it can be the very initial stage of a Herpes infection.

Herpes Simplex Virus (HSV) are known to cause genital ulcers and infect the mouth ulcers. It can be transmitted from person to person even if the infected person does not seem to have any visible sores . It is spread through oral, vaginal or anal sex, but it can spread via direct contact like kissing also. So if one of those individuals were to have Herpesvirus in their system you could theoretically get a herpes infection.

But since there was no visible genital or lip lesions you are at a much lower risk.

Since you had protected sex, no STD testing are required at this stage. Testing for HSV will not be much useful either. Upto 50% of adults are already positive for HSV , so a test result still can come positive without a recent infection. The option here would be to wait for a week or so and see if there is any lesion in the lips. That will be the best approach for diagnosis in this scenario. If you really want to go for HSV testing you can go for a HSV antibody test.

The red dot like bump is non specific. Can you send me a picture of the lesion via followup ?

I hope this has helped, feel free to ask any further query.

Thankyou


Patient replied :

Thank you Doctor,

I have uploaded images. The red dot is on the glans edge to the left. I have also included an image of my lips/ mouth area.

Again there is neither irritation nor pain with the red dot. I first noticed it shortly after ejaculating from aggressive masturbation.

Also, after waking from sleep (6am here) the tingling/itchiness on my lips corners has subsided, but there is still some. I want to also mention that this feeling of slight irritation started last evening a half hour or so after I had applied some home made (by a family member) cream, which contained citrus extract, on my lips. Could this have been the cause?

Overall my lips are still clear of any lesions or rashes.

I have read online that herpes outbreaks (HSV1 or HSV2) usually happen within two weeks of exposure if infected. Because it has been two weeks for me and I have not experienced any outbreaks, can I assume there is a high chance I did not get infected?

You mention I had protected sex - I am sure when you say that you are still accounting for the unprotected oral sex I received during the first experience? Therefore in general is it unlikely to get infected with STD's from receiving oral sex?

Lastly, I will look to take the HSV antibody blood test. I have read that sometimes this test is not as reliable because along with HSV1 and HSV2 antibodies, it might also mistakenly detect other kinds of herpes viruses (such as chicken pox or mono). Therefore is this test still advisable for me. I would really like to get a peace of mind if this test can help.

Update (10:35 am eatern time, Feb. 9):
The feeling of irritation is back but only at the corners of my mouth. Now when I open my mouth to look at my lips corners I see small dots like Fordyce bumps, which I'm not sure if they were there before. They look exactly like in this picture (http://www.skinsight.com/images/dx/webAdult/fordyceSpots_2981_lg.jpg). Could it be Angular cheilitis? I put some mustard oil on my lips to keep them moist. I plan on seeing a clinic tomorrow.


Thank you very much for your time.


Hello,

Regarding this red dot in the penis, it is too early to comment. At first look it does not look like Herpes. It is most likely a mild abrasion from ?masturbation. There are NO oral lesions suggestive of HSV. Although tingling is mentioned as one of the first symptoms of HSV, most cases of tingling i find do not turn out to be HSV infection (cold sore). Many a times it is psychosomatic or made up by the mind. So that could be the reason in your case. The citrus might not cause this. And NO you won't get angular stomatitis just like that. It is possible that you had a dermatitis like irritation with all the local application. I would recommend you to apply nothing and just leave it alone.

Yes most HSV cases occur within 2-12 days, so again your risk is low. Regarding the unprotected sex - what I meant is that you need not go for a STD testing for now since you had protected sex. Oral sex is low risk exposure for transmission of HIV, Chlamydia, Gonorrhoea etc. So a standard STD tests might not be needed. However HSV ,as you know could be transferred via direct contact. A antibody test is not really required. I would not really recommend as I mentioned in the previous email.
Even if you are found positive (an unlikely scenario) there is nothing else to be done. There can be false positives too. Modern tests can differentiate HSV 1 and 2.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Thanks again Doctor, some of your words help in alleviating some of the anxiety I had.

I have again included some pictures of my actual rash-like tiny white dots I have developed on the inside corners of my lips. The area is burning/tingling where the dots are, and I also feel a little burning/numbing sensation on my mustache surrounding area.

I found a post by someone else on another medical help site describing similar conditions as mine: (http://www.medhelp.org/posts/Dermatology/Tiny-growing-rash-of-small-white-bumps-that-numb-and-burn/show/587186)

Basically these dots look like Fordyce Granules but they burn/tingle. I will still go show my problem to a clinic where maybe they can take a swab. Could this just simply be a skin rash/irritation rather than a developing cold sore? Is this how cold sores look when developing?



I also want to add that I spoke to both of the escorts, both said they have never had a cold sore.

Thank you very much.


Thank you for the images.

Yes, these look like Fordyce spots or sebaceous glands, which was probably inflamed or enlarged because of irritation. And no this does not look like Herpes sore or its initials stages.

I think you are really over worried about this. You need to relax and keep this thing of your mind. Do not apply anything on lips. I don't think you will be developing cold sore. You should carry on with your life, thinking about the possiblity of cold sore will only make this worse.

Hope this helps
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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