[Question #1719] HSV-2 and HPV Questions

45 months ago
1.) First of all, in regard to HSV-2 testing, when is it appropriate to be tested? I have never had any symptoms (to my knowledge), nor have I ever (to my knowledge) been exposed to the virus, but all the same have been very paranoid about this. Also I'm 25 and my lifetime sexual partners is around 14 and I have had mostly unprotected sex with most of them (some of them were really promiscuous and never used condoms). Does this warrant an HSV-2 test? Obviously I am going to be more careful hereafter given the recent anxiety.

2.) Secondly, in regard to HPV, when I was a kid (before I had any sexual encounters, although as a child I always had warts on my hands), I think I had a wart on my scrotum.  Could this be from my hands?  Much later, when I was 20 years old I began to stress about this (I hadn't had many sexual encounters at this point), and constantly search on my genitals for warts. I had them at my hands at said time, and soon after discovered one on the shaft of my penis. I went to the doctor in horror and he told me it looked like a wart but not like a typical genital wart and I asked if it could be from my hands and he said maybe.  If it is true that these warts were just from my hands, does that make me less likely to transmit them to someone else's genitals? For instance, if the warts were caused by HPV-1, HPV-2, or HPV-3, say.  I haven't had any warts like that since and I'm 25 years old now and would like to just forget the whole thing, but I freak out if I should disclose this to people or not.  And lastly, I've read a lot from Dr. Handsfield on disclosure, and I'm curious if it's okay to have unprotected sex with people and not tell them about this whole thing (monogamous or non-monogamous). I also have OCD issues and it's hard for me to distinguish between what I ought to worry about and what I shouldn't. Thank you for your attention and I look forward to reading your response.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

Welcome to the Forum.  Although Ms. Warren usually answers questions on herpes, given the more general theme of your question, I will do so today.  Taking your questions in order:

1.  herpes testing.  Given your history (i.e. no suspicious outbreaks) I would recommend against blood tests for herpes.  I would add that my recommendation against testing in your case is in agreement with the recommendations of the U.S. Preventative Services Task Force and the CDC.  The reasons for this recommendation are multiple and revolve around problems with the test.  In persons such as yourself, false problems are rather common (some would estimate up to 50%) and about 5% of persons who get herpes will not have positive blood tests at all.  Thus the information you might get from a blood test would not be particularly helpful and very well could be wrong.  The herpes blood test is useful for persons who may be infected or have suspicious lesions but not in your case.

2.  Warts.  I'm afraid that he information your doctor gave you long ago did not reflect current thinking about warts and HPV infections.  There are more than 100 different types of HPV and interestingly while related, different types of warts tend to infect different types of tissue.  Thus it is most unlikely (in medicine one can never say never) that you transmitted warts from your hand to your scrotum or penis.  Far more likely that this was acquired sexually.  Now that the wart is gone, it is behind you and I would not worry further.  Our experience and that of others is that once warts have resolved, either with treatment or by themselves if they do not recur in 3-6 months, they will not and the person should not consider themselves infected or feel a need to disclose to sexual partners.  Warts and HPV are widely mis-understood and while in a well-informed, trusting relationship disclose is always a good thing, the fact is that there are frequent misunderstandings and for those reason we do not recommend routine disclosure of past, resolved warts or HPV infections.


I hope you find my comments helpful.  EWH


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45 months ago
Wow. What a huge relief. Thank you so much for your response. It just made my day. I do have one follow up question, however:

Since I've been freaking out about HSV-2 I do tend to notice bumps in my inner thigh/genital area that might be folliculitis etc. One time I had one red bump that was full of clear liquid and blood, and maybe pus? (can't remember) but it seemed to come from under the skin.  When I tried to squeeze it, afterwards walking in my jeans burned pretty bad. If there were only blood and clear-liquid coming out of a lesion, would this be indicative of herpes? Or does herpes simply have clear-fluid? Should I stop worrying about this? Thanks again.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Typically the fluid in herpes lesions is clear.  In addition, the location of the lesion you describe is NOT typical of herpes and is more typical of folliculitis, the infection that can occur when hair follicles get infected.  I wouldn't worry about this.  Should the lesion recur, I would suggest keeping it clean with soap and water and to not squeeze it.  EWH
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45 months ago
Thank you very much for your replies. And finally, for my last follow up question I was curious about shaving cuts. I'm not very good at shaving and before sex I usually shave. Does this increase my risk enough to warrant an HSV-2 test? Recently I also cut myself pretty deep before having unprotected sex with a really promiscuous girl. Does any of this increase my risk enough to warrant an HSV-2 test? I keep thinking of things that might increase my risk more than average and I just want to be at peace. Thank you Dr. Hook and I won't be asking anymore questions after this.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago

I'll comment your question about shaving and follow up a little bit regarding your question on herpes testing as well, having seen that you raised the question of testing with Dr. Handsfield and Ms. Warren as well.

Regarding shaving, in scientific studies in which experimental animals are infected with herpes viruses, to facilitate infection, the skin which is about to be infected is often slightly abraded/scraped to make the likelihood of infection more likely.  Thus, at lest from a theoretical perspective a close shave or nicks could increase your risk of acquiring herpes is you were directly exposed.  If you then caught herpes, we would expect that infection to be a typical herpes infection.

Regarding testing, I think Dr. Handsfield has laid out the issues pretty well.  None of the lesions you have described are suggestive of herpes to me although admitted, I have not examined you and HSV lesions can be variable in appearance.  On the other hand the locations of your lesions, that they have not recurred, and the description of the ones you have described are not typical of HSV.  As a man in North America with more than 10 sex partners, your average risk of having had HSV is about 1 in 3 or 4.  Your risk of having a falsely positive test is about 1  in 25-30.  Given your concerns, perhaps testing will be helpful but, before you test, I would urge you to consider whether the results of the test, whether positive of negative will give you peace.  If testing will help you in this way, then test.  As Terri and Dr. Handsfield have indicated, this is a difficult area and decisions about testing need to be made from an informed perspective.  I hope my comments, along with those of my colleagues will help you.

As you know, this is my third response to your question and therefore this thread will be closed later this morning  I hope this information will be helpful.  EWH


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