[Question #177] Herpes fear

97 months ago
3 months ago i had protected oral and vaginal sex with a csw from the dominican republic. (This was my first and only sexual experience. i have never had a cold sore in my life and know for a fact I do not have hsv 1.) Immediately following this incident I became extremely anxious and focused on my genitals. 4-5 days after the encounter I got a jock itch maybe from constantly touching my genital area looking for lesions. On day 8 I noticed a white speck on my penis and immediately went to the planned parenthood. The nurse checked the spot and jock itch and said it was nothing and wouldn't recommend a herpes blood test and the jock itch was caused by heat. I got another spot exactly like it maybe an inch away next day. They both look like whitehead pimples and the pimples would disappear when i rubbed the white substance off the top and both went away within 48 hours. They didn't itch, hurt, or burn. The nurse told me about some more herpes symptoms which aggravated my anxiety and I began to look for those things too. I began to check my groin lymph nodes repeatedly and eventually I think they became sore because of that. I got another whitehead pimple on day 16 with a hair sticking out of the middle which popped when i got an erection and white hard puss came out followed by some clear liquid. Disappeared within 48 hours but a scab was found a week later. Day 19 i got another red spot which I showed to my PCP and he said it was nothing and it also disappeared but scabbed 2 days later. Day 29 and Day 31 I got whitehead pimples similar to the first ones I had that had a white pus in the middle and went away within 48 hours. The white puss was rubbed off by me. All of the pimples appeared one by one. I tested negative for hsv 2 at 5 weeks post exposure and negative on the hiv duo also negative for syphillis. All the lesions/pimples I had happened one by one and were mostly on top of sebaceous glands which were visible once the pimple went down in size or went away. The only explanation I can think of is fordyce spots/sebaceous glands which became clogged and formed a whitehead. I have shown pictures of the pimples to many doctors and they agree the visual appearance does not look like herpes. I would like to also add that my face began to get huge cystic acne type pimples that would become painful and would bleed non stop if popped at the same time I was getting pimples on my penis. This situation put my body under a lot of stress so I think maybe sebum overproduction could be a cause of the pimples on my penis. I am planning on getting a herpes blood test soon but I can't find any justification for these pimples. Would a igg blood test for hsv 1 and hsv 2 be conclusive at 14 weeks post exposure? Should I get a western blot at 6 months to be extra certain I do not have herpes? Do my pimples sound like herpes to you and could it be signs of a mild outbreak? I am sorry for the long post but would really appreciate your response. Thanks
H. Hunter Handsfield, MD
97 months ago
Welcome to the forum. Although Terri Warren normally answers herpes related questions, we also endeavor to assure that all questions are answered within 24 hours. So you have me this time.

Your anxities come through loud and clear from the tone of your message and the nature of your concerns, even byond your statement about being "extremely anxious". Clearly you have some guilt or other regret over your first sexual experience. But some basic facts: 1) Even among the most sexually active persons, including female sex workers, at any point in time most have no active, transmissible STDs. 2) Even when infected, all STDs are inefficiently transmitted, i.e. most exposures don't result in infection. 3) Condoms work; whatever risk might have existed was markedly reduced by your wise decision to have safe sex. (Oral sex is safe even without condom protection -- not completely risk free, but much lower risk than unprotected vaginal or anal sex.)

As for your symptoms, they are not at all typical of herpes or any other STD. You clearly are examining yourself too closely out of anxiety, and almost certainly you are noticing mostly normal skin appearance or anomalies. Not only do the individual skin issues you describe not sound like herpes, but the pattern of their occurrence indicates herpes is not the cause. The fact that "many doctors...agree the visual appearance does not look like herpes" is additonal strong evidence. That you "can't find any justification for these pimples" means nothing. Pimples are not rare on the penis or elsewhere in the genital area, and the large majority of penile pimples aren't herpetic.

And we have your test results. Although 5 weeks is too soon to be definitive, most (probably around 80%) of newly infected persons would have positive IgG tests by that time. Based on all the information provided, I would have counseled against being tested for HSV. The chance of a false, misleading result was a lot higher than the possibility you were infected. However, now that you have started down that path, I recommend you have a final HSV IgG test; most likely the negative result will help reassure you more than anything I can advice based on symptoms, probabilities, and statistics. Instead of 14 weeks, do it at 16 (4 months), the definitive interval for conclusive results. Do have have a Western blot unless the IgG test is positive or equivocal -- which it will not be. 

And by the way, your HIV and syphilis test results also were conclusive. That doesn't seem to be your concern, but thought I'd mention it just to put those infections aside.

The bottom line is that you can be sure you acquired neither herpes, HIV, syphilis, nor any other STD from your single safe sexual exposure. Have the final HSV blood test at 4 months, but even without that result, you can relax and move on with no further worry about it.

I hope these comments have been helpful. Best wishes--   HHH, MD

H. Hunter Handsfield, MD
97 months ago
Do NOT have a Western blot test. Forgive the typo.

97 months ago
Doctor Handsfield I am so glad you replied. I have read all your posts on Medhelp on herpes and HIV and was hoping you would reply. I am on week 13 right now so I'll wait 3-4 weeks for the final blood test. I wanted to clarify that I had sex with a sex worker in the Dominican Republic while i was on vacation there. I know my symptoms and pimples don't look like herpes but I was just scared because I read articles online about atypical and mild herpes outbreaks that look just like pimples and are either never noticed or just mistaken for something else. My greatest fear is having herpes and not knowing that I actually have it and hearing from doctors that the blood test isn't very accurate didn't help my cause. Also I'd never had a jock itch or pimples like these on my penis before which scared me even more. I was monitoring my penis very closely and took pictures every time I saw something suspicious. I consulted a wide range of doctors consisting of Dermatologists, urologists, infectious diseases, and more on the healthtap app and all doctors agreed the lesions were not typical of herpes but said I should get a swab test if I get more in the future just to be sure. The only two pimples that scared me really were the ones I got on day 16 and day 19 and this was because I found scabs of them. The one that occurred on day 16 started with a red spot which got a whitehead in a couple hours or the next day and popped when I got an erection because the skin stretched and a white solid puss came out and some clear liquid. Overall most of my pimples occurred at the base of my penis where there is hair and some happened in the middle and one happened towards the top of the penis. Most pimples could not be popped. I just have some follow up questions.

1. If I test negative for both hsv 1 and hsv 2 at 16 weeks would I need to get another blood test at 6 months to be certain I don't have herpes or is the 16 week test enough? I ask because there is a lot of conflicting information online. 

2. What is the risk that I got HPV from this encounter? I know from your posts that most people get it and that most people don't develop warts. Is there any chance I would develop warts later on and any chance I got it?

3. Given the additional information about the pimple that occurred on Day 16 and day 19 is your opinion the same as before that this isn't herpes?

4. Would HSV 1 and HSV 2 come up in the blood test if it was dormant in your body or if you never had an outbreak before?

5. What would you put my risk at having acquired herpes from this encounter? This statistic/probability would keep me relaxed for the weeks I need to get through.

6. I still sometimes feel weird sensations around my genital area like random itching or crawling. Is this because of anxiety?

H. Hunter Handsfield, MD
97 months ago
This information doesn't change my analysis, opinions, or advice.

1) No. If negative at 16 weeks, as expected, do not have more testing at 6 months or any other time.

2) The chance of HPV from any single encounter undoubtedly is low, but I can't put a number to it. If you have HPV, you probably will never develop warts or any other abnormality. You're going to have HPV someday if you have anything like a normal sex life. Get vaccinated to prevent infection with the HPV types most likely to cause problems, then forget it.

3) Yes, no change in my opinion.

4) Yes. The blood tests are independent of symptoms.

5) Almost zero, certainly no more than one chance in many thousand.

6) Herpes doesn't cause such symptoms, and whenever someone suspects his or her own symptoms are due to anxiety, usually s/he is right. So that's probably the best bet.
97 months ago
Thanks for your response doctor. I really appreciate it. I just want to give you some final details about the pimples I just remembered. The pimples that occurred on Day 8 and Day 31 were on the exact same spot/hair gland. The pimples that occurred on Day 9 and Day 19 were also on the same spot/Hair gland. So two hair glands/spots had 2 recurring pimples. The other 2 pimples were on different locations. Also most of my pimples came up a couple hours after masturbating so maybe this had something to do with it. While I was masturbating on day 60 there was a firm lump on one of the hair glands on the shaft and it was not red but got rubbed off by me and white solid pus came out. There was a dimple there then which became black and scabbed but went away in 6-7 days after it healed completely. That was the last worrisome thing I had on my penis and since then there hasn't been anything. I've also had folliculitis on my thighs which I self diagnosed since there was a hair follicle and swelling underneath it. Overall I've been having many skin issues around my genital area and my face. I have a big beard on my face and I was getting huge cystic pimples there. 

1. Is it possible that there is a bacteria on my skin causing these issues like pimples on my face and genitals? 
2. How common is asymptomatic herpes infection and is this the only risk for me at this point seeing the atypical symptoms? 
3. The skin on my scrotum is red and has been ever since I started looking closely at my genital area 3 months ago. Is this normal?
4. Can masturbation aggravate the skin or spread some bacteria and cause pimples? 
5. Given the new information that 2 hair glands and 2 recurring pimples is your analysis/opinion the same that this is not herpes and is something else?
6. Does the day 60 pimple or lump sound like herpes to you? 

Once again doctor I really appreciate your help and your time. Seeing your response has definitely alleviated a lot of my anxiety. If this post is still open when I get my blood test results I'll definitely post it here for someone going through something similar. God bless you doctor. Best wishes.
H. Hunter Handsfield, MD
97 months ago
Your mind is really working overtime on this. Please re-read my prior replies carefully. Trust me on this: you don't have genital herpes.

1. It is conceivable you are colonized with staph, strep, or other bacteria that might be contriuting to your facial folliculitis and perhaps genital. This is much more likely for your genital symptoms than herpes is. Discuss this with your doctor, including the possibility of referral for consultation with an infectious diseases specialist.

2. Asymptomatic herpes is common. But that doesn't mean you have. If you will carefully read my replies, you will understand that my opinion you do not have herpes is based on several independent reasons. Could any one of them be faulty? Perhaps, but unlikely. But the chance that all factors (low risk exposure, no typical symptoms, negative blood test) would break the wrong way is astronoically low -- zero for practical purposes. Stop barking up the herpes tree!

3. My guess is that this is anxiety affecting your perceptions. Normal or not, herpes doesn't do this. 

4. No.

5. None of this change my opinions or advice.

6. No.

We've reached the limit of two follow-up comments/questions, so that ends this thread. Please do not start a new thread with the same questions. Repetative quesions are not permitted, and it would be deleted without reply (and without refund of the posting fee). Do your best to move on without worry about herpes or any other STD.

Best wishes and stay safe--