[Question #11791] Herpes without classic symptoms

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12 months ago
Today is day 8 after hand-genital contact in massage. Reading this site, that was a no/theoretical-only risk scenario. Some sources online disagree. I have not had any big lesions, but minor symptoms: a) a small line of redness along the corona of the penis. There are normal whitish small bumps always there that go around the entire corona, but on one side these have some red, irritated skin underneath, but no broken skin that I can tell; b) an on/off tender, tingling, pricking, stinging sensation in the same place; c) last night (day 7), I barely slept and was sick with intense nausea (anxiety?). Of course am concerned for myself, but more for my partner and baby, who I would not want to risk transmitting this to.
1. Can there be a HSV2 infection without true lesions, but with other mild symptoms? An Australian government resource says it can "appear as a small area of rash, cracked skin, or some other skin condition on the genitals," which may explain what I have.
2. I read some primary infections are "asymptomatic," but are they truly asymptomatic or are people just not noticing minor evidence of an infection like what I've described? 
3. Can the virus ever cause subsurface irritation that never actually breaks the skin?
4. I have had HSV1 for 20yrs, could my antibodies have lessened the severity of a primary HSV2 outbreak?
5. If someone has a shedding sore(s) on their hand and touches another person's genitals, wouldn't that present a significant risk of infection? The usual assumptions are that this person would not touch another (because it's "bad for business") or it would not be allowed by the touchee (because the sores would be obvious); what if we assumed the opposite, which may have happened here?
6. What antiviral would help suppress the infection and prevent transmission until conclusive testing can be done? Again, my most important concern is not spreading further.
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Terri Warren, RN, Nurse Practitioner
12 months ago
The resources that you read that say that hand to genitals is not a method of transmission of HSV were correct.
1. Can there be a HSV2 infection without true lesions, but with other mild symptoms? An Australian government resource says it can "appear as a small area of rash, cracked skin, or some other skin condition on the genitals," which may explain what I have.
Your symptoms do not sound like HSV at all to me, especially with the kind of contact that you had

2. I read some primary infections are "asymptomatic," but are they truly asymptomatic or are people just not noticing minor evidence of an infection like what I've described? 
Some are truly without symptoms, primarily in people who have prior HSV 1 infection, and some misattribute their symptoms to something else entirely

3. Can the virus ever cause subsurface irritation that never actually breaks the skin?
That is possible, yes, but far less likely with a primary infection

4. I have had HSV1 for 20yrs, could my antibodies have lessened the severity of a primary HSV2 outbreak?
Yes

5. If someone has a shedding sore(s) on their hand and touches another person's genitals, wouldn't that present a significant risk of infection? The usual assumptions are that this person would not touch another (because it's "bad for business") or it would not be allowed by the touchee (because the sores would be obvious); what if we assumed the opposite, which may have happened here?
It could have happened here, but herpes whitlow is generally quite painful and somewhat unsightly so I doubt this occured.  Of all the people who have worried about transmission of HSV through hands, I've not seen one test positive on the gold standard western blot if that has been their only contact.

6. What antiviral would help suppress the infection and prevent transmission until conclusive testing can be done? Again, my most important concern is not spreading further.
I understand your concern, I really do, but if you really think you could have HSV, then taking antivirals early in an infection can yield a false negative on an antibody test.  Better to observe carefully for unusual skin changes and have anything that fits that description swab tested right away when it shows up.

Terri
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12 months ago
Thanks, good info. The consensus here with the experts seems to be that getting HSV2 from the brief touching is essentially impossible. The redness I mentioned earlier, which lasted a day or two, has all but gone away but I feel very ill today, a general malaise, diarrhea, and "flu-like" symptoms. The follow up questions would be:
1. How much longer should I look for unusual skin changes or lesions before I can assume they won't show up? I am on day 8 now.
2. Can I have the dry skin swabbed for presence of the virus in the place it was a little reddish, or would that not work without an actual lesion?
3. Is it possible for malaise and flu-like symptoms to be the only physical manifestation of the virus, or would this always be accompanied by some kind of skin issue?
4. Assuming I contracted it from the brief hand contact (I know this would be a first for the experts here), how long before I become less infectious? Is it mostly transmitted by open sores (which I don't have)?
5. Is it recommended to avoid contact with my partner indefinitely?
6. How soon can the western blot test be done accurately?

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Terri Warren, RN, Nurse Practitioner
12 months ago
1. How much longer should I look for unusual skin changes or lesions before I can assume they won't show up? I am on day 8 now.
Day 14
2. Can I have the dry skin swabbed for presence of the virus in the place it was a little reddish, or would that not work without an actual lesion?
Yes, if you can find a clinican to swab it - some are reluctant when they are certain it isn't herpes in their opinion

3. Is it possible for malaise and flu-like symptoms to be the only physical manifestation of the virus, or would this always be accompanied by some kind of skin issue?
There are so many reasons one might have malaise and flu symptoms - they can't be definitive without skin lesions

4. Assuming I contracted it from the brief hand contact (I know this would be a first for the experts here), how long before I become less infectious? Is it mostly transmitted by open sores (which I don't have)?
You would be infectious right away, essentially.

5. Is it recommended to avoid contact with my partner indefinitely?
I don't recommend you avoiding contact with your regular partner if your only contact was someone masturbating you

6. How soon can the western blot test be done accurately?
12 weeks from the encounter

Terri
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12 months ago
I visited a clinician to see if I could be swabbed, and you were correct they refused to do it as they saw no reason to for several reasons. They examined the area and said there was no evidence of a current, healed, or emerging infection and their evaluation was consistent with everything I have read here, that a practitioner can't truly say "never," but there is nothing to be concerned about. I will do my best to move on. Is it worth it to test after 3 months anyway to be sure, or does the risk of a false positive make this unwise?
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12 months ago
And does it make a difference whether its the IGG test or western blot for likelihood of a false positive? 
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Terri Warren, RN, Nurse Practitioner
12 months ago
There are no false positives on the western blot, not possible. But in the lower positive range on the IgG, about 50% are false positive.  If you want the best test, do the blot for sure.
Terri
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