[Question #1138] Followup Questions #927 #986

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91 months ago
Hello Terri,

Recap: About 10 weeks ago, I engaged in a mutual masturbation and I found lesions on my penis glans 10 days later. I went to see a NP right away. The viral cultural came back negative and I'm high positive for HSV1. The lesions started to improve before I began taking Valtrex, and healed completely within 5 days without scabs and pain. I saw an urologist for the lasting rash and bladder pain about 4 weeks after the initial symptom. I was told I had yeast infection and bladder spasm due to stress. Clotrimazole cream and Flomax worked really well.

I am seeing a new person recently, and I told him about what I had experienced. I'm glad I did, and he seems fine about it. When I'm about to leave the excessive worries behind, I noticed tingling/burning cold sores on my lip which I've never experienced. The PA I was able to find last minutes put me on Valtrex, and I didn't bother to have another swap cause it's neither PCR nor type-specific. I feel down again and have many questions on my mind.

1. What is it more likely to happen to me? Could I have both OHSV1 and GHSV1 from 10 weeks ago or could the cold sores be my initial HSV1 outbreak?
2. I read gay men have more OHSV2. We had deep kisses during last 2 weeks. Is another IgG test still redundant?
3.  I read you said antibodies prevent one to get same type of infection at another location and I also read elsewhere only an established (6m-1yr) infection does. Assumed I caught HSV1 10 weeks ago, would IgG > 5.0 prevent me from getting it at another location or HSV2 at the same location?
4. If I was your patient, will you recommend suppressive therapy or you would give it more time?
5. I asked the person I’m seeing to get tested. If he also has HSV1 and doesn't know the site of infection, what precautions shall we take for oral and anal sex?

I can’t imagine going through this without you and I really look forward to hearing your insights again. Thank you.

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Terri Warren, RN, Nurse Practitioner
91 months ago
Sorry, this got lost in the older posts.
You have a high HSV 1 antibody level, right, so we know that this isn't a new infection with HSV 1 causing the cold sore rather it is likely a recurrence.
1.The cold sores could be your first outbreak but not your first infection because you already had HSV 1 antibody
2.I'm not clear that gay men have more HSV 2 - I suppose that's possible- but I don't think it is necessary to retest for HSV 2, given your previously described sexual situation.  Has the new partner had herpes antibody testing?
3.  Yes, your previous HSV 1 infection would be very protective against you getting HSV 1 in a new location.
4  Your suppressive therapy would be for HSV 1 - you might have a discussion with your new partner about their cold sore history or previous history of herpes testing to see where to go with this.  If you have a partner who is negative for HSV 1 and 2, then you may want to consider suppression.
5  OK, just saw this statement.  If you are both infected with the same type, I don't think you need to take precautions against new infection as this is so unlikely but I can't tell you that it is impossible just very unlikely.