Sexually Transmitted Diseases/fear of std/hiv

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Question
Herpes or Warts or HIV Rash
Herpes or Warts or HIV  
Dear doctor, on 3 August 2014 (around 5 weeks ago) i received several minutes of unprotected oral sex and several attempt of protected vaginal sex (but just stuck at the entrance as heavy alcohol intake made me cant erect). I was very worried and got the girl for test, negative for Ag/Ab hiv test, but positive for both herpes strain. All the way, i did not faced any obvious symptoms just slightly fatigue, cold feet and weakness in legs. I had tested for hiv combo test on day 19 and day 30 which got back negative as well. Around few days ago(on 5th week), my hands started to pop up several separate tiny red bumps (just like bed bug bites) and several very very tiny spots on the glans of penis. Consulted a physician, he doubt to be some sort of allergic or dermatitis and prescribed me with those anti inflammatory medication. Today i had some very very mild sore throat, dont know whether its due to heavy alcohol intake yesterday night.

According to your expertise, was my case is HIV related or herpes related or just merely some dermatitis? And the 4th generation ELISA combo test on 28 days post exposure indicative or conclusive enough for oral sex?

Hope to get back from you asap, was nervous.

KeithS

Answer
Hello KeithS,
You seem to be very worried. Unprotected oral sex is a very inefficient way of transmitting HIV. It almost never  happens that way. You should be much more concerned about your over indulgence in alcohol use. Your fatigue, cold feet, and weakness red bumps sound very much like anxiety, and the tiny white spots on your glans (head) are probably related to a mild irritation, possibly from yeast or another fungus, or possibly human papilloma virus-- the photo suggests both!  It definitely does NOT suggest HIV or herpes.

Good luck!
--mark

Sexually Transmitted Diseases

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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