[Question #11476] HSV2 risk assessment - follow up to Question #11474
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14 months ago
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Hi Terri,
I apologize I did not make my question clear and you misunderstood me.
1) Nobody looked at my bump and made any assessment. I meant the photos found on the verywellhealth.com. You are the first and only expert I directedly reached out for a response.
2) This was NOT due to oral sex but protected vaginal sex w/ CSW.
3) My question was asking if my current symptoms indicate or raise any concerns of potential HSV2 infection. I understand the general statistics (4% transmission rate, 2/3 reduction if condom used for vaginal) and wanted a specific response to my situation.
So summary of my symptoms and kindly asking for your input:
1) itchy glans and anus that lasts only a few seconds but disappears, to return again in 1-2 hours.
2) Area just under glans, near frenulum, turning red with a new tiny white bump appearing (smaller than fordyce spot) at day 16. Hence only a single/singular bump that may or may not be blistering.
3) None of these areas are painful nor sensitive to touch.
Please be kind...
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Terri Warren, RN, Nurse Practitioner
14 months ago
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Sorry, I misunderstood that you were no longer concerned about the unprotected oral sex in April. Good that that is not now a concern for you. And I don't know what verywellhealth is so didn't know if someone told you it resembled HSV 2 or you came to that conclusion on your own. BTW, HSV 1 and HSV 2 look identical and by looking, one could tell which type a herpes lesion is. That's important to understand, I think, in terms of thinking about the tiny white bump. Is it something that you think would benefit from swab testing?
Something that lasts only a few seconds is really unlikely to be HSV, either HSV 1 or HSV 2. And something that is smaller than a fordyce spot is also unlikely to be HSV 2.
Also, the transmission rates that you give are correct. The 4% is doing nothing - no condom, no meds, and this is the rate in established couples who participated in research studies of discordant couples. And this is having sex about twice per week for a year. You add condoms, it cuts the risk by 65%. Your contact was considerably less than that, right? So I think the risk is even lower for you. And it is also good that the are of the bump is not tender or painful. Not all herpes lesions hurt but they are often at least tender.
It is common to see small bumps near the frenulum on the penis, BTW. Something truly new is slightly concerning. I still think you may want to have it swab tested. You could look back and wish you had.
All and all, I think HSV 2 is quite unlikely here. You did a good job with condom use for your contact in May both for oral sex and intercourse. You aren't describing symptoms that I would normally associate with HSV either.
If you decide that you want to consider doing an antibody test for HSV 2, I would discourage that due to the very high rate of false positives on this test. OR you could do it, if you decide you want to, but be prepared to do a herpes western blot if it is positive, as a confirmation. But honestly, you should think about that pretty carefully if you decide to go that route. Don't know if you were even thinking about that.
Terri
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14 months ago
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1) If, hypothetically, this was an intial HSV2 outbreak (I've never had cold cores ever, only canker sores. Neg HSV1 result via blood this month), would the appearance change in, say, 2 days?
2) I have so many spider veins and my skins is very glossy. So being anxious and scared, certain areas catch my attention but I think the spider veins just seemingly form "shapes" that make it look like a concerning spot. So my question: I am stretching out my skin to see that the surface is smooth. Is this the wrong approach? i.e. if I had HSV2 blister forming, and I stretch out the skin, would it still be obvious, or make it look "normal" even though it isnt?
3) Hypothetically speaking, if a woman was recently infected and is not yet aware (asymptomatic or pre-prodromal), what would the transmission rate be like if she were to have vaginal sex w/ a man? Would this rate be similar or comparable to a woman who is having an outbreak?
4)Is it possible for an ulcer-like (or open sore like) areas to appear (i.e. slightly indented or very shallow crater like) without ever blistering first? And would such open sore or ulcer like area be tender and potentially painful?
Thank you so much for your kind and thoughtful response, Terri. I will log in later this weekend for my final question to follow up.
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Terri Warren, RN, Nurse Practitioner
14 months ago
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The IgG test misses 30% of HSV 1 infections, compared to the gold standard western blot, just so you know.
Herpes lesions do change their appearance over a period of time, yes, but if you are asking would be it there one day and gone in another day or two, that is very unlikely. usually HSV lesions last longer than that.
I think if you didn't stretch out the skin at all, you would see a herpes lesion. Stretching out the skin could be distorting it and making it look abnormal in some way that it really isn't. When observing, I would recommend that you simply look at your penis and see if it looks normal to you.
People who have new herpes infections shed quite a lot more often than people who are, for example, infected for a couple of years, yes. and so the transmission rate might be higher for that person, yes
An ulcer could be viewed first as sometimes blisters break before they noticed as blisters, and most often those blisters would be at least tender, yes
You are welcome
Terri
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14 months ago
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Thank you for your response, Terri.
What I meant to ask is - if the appearance does not change for 2 days, then would I be more inclined to assume that this is not hsv2?
If I do a swab test on this area, and it comes out negative, is that conclusive post 3 weeks from the sexual event?
Would someone who is shedding virus because they recently got infected, be transmitting the virus at same or higher rate than a person who is having an outbreak?
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Terri Warren, RN, Nurse Practitioner
14 months ago
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oh, now I understand your question. If it is herpes, it might take a little longer to change. If it is not changing in a week, I doubt that it is herpes
If you do a swab test, be sure it is PCR, not culture, and a negative would be informative but not definitive.
People can shed virus asymptomatically in very large volumes, as much as during an outbreak.
Terri
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