[Question #2030] hsv concerns

46 months ago

Hi Dr. Handsfield and Dr. Hook,

 

Several months ago I tested negative for HSV 1 & 2 IGG.  I have had no new partners since then.  8 days ago I had sex with a condom with a male in his early twenties who I do not know well.  Afterwards, he told me that he had been tested a while ago, but as we know that likely did not include a test for herpes, and also is only a snapshot of his sexual health several months prior.  I have heard of several occasions in which he has had unprotected sex with new partners.  I am very concerned about this exposure, as normally I am very careful with my sexual health.

 

Day 4 post exposure I developed a sore throat and a dry cough, which has persisted.  Day 6 I developed body aches which have also persisted, but no sensation of fever or chills.  Day 7&8 I have experienced sore eyes and a slight headache. 

 

During this time, I have felt tingling in different areas of my vagina.  Day 7, I felt burning on my buttocks.  I had no obvious lesions.  Today, I noticed three separate red lines on my inner thighs/buttocks very close to my vagina.  They are perpendicular to my leg and about 1 inch in length each.  They are not raised, but when I look very, very closely they appear to be many small circles close together.  I have also noticed an unusual vaginal odor.

 

I understand that my risk for any single exposure with a known carrier is 1/1000, and my use of a condom could potentially reduce this risk by up to 90%.  I know many people who have contracted herpes under such circumstances, so while I know it is irrational, I remain concerned.

 

My questions are:

Does this sound like a primary outbreak?  I understand that generally primary outbreaks are not “atypical” like what I am describing, but is there a possibility that there are in fact many people with “atypical” primary outbreaks who simply are not as hyper vigilant and write it off?  I am also curious if I have perhaps noticed a primary outbreak very early on?  I know that generally herpes starts with red bumps, but before that does it present as redness?  Also, I understand that it would be very unusual for an outbreak on the thigh without an outbreak in an area of maximum friction like the vulva and labia.  Is it possible that that will come later and, again, I am just noticing these symptoms first?  I am worried about what seems to be systemic symptoms and also perhaps a presentation of lesions that I am simply noticing before they reach the bump or vesicle stage.

 

Thanks so much for your assistance.  




Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
There are many people who experience atypical herpes outbreaks, yes, certainly.  Many confuse herpes symptoms with someone else, like a yeast infection or a UTI for women - friction burns or zipper catches for men.  Some experience recurrences on the buttocks or belly or thigh and don't associate these outbreaks with something genitally related, like herpes. 

When people first contract genital herpes, the first outbreak is almost always in the area infected - so in the case of a woman, the outbreaks would be vaginal or labial with vaginal intercourse or the anus for anal intercourse.  Condoms offer about 95% protection when worn by a male infected with HSV 2 (the study did not look at transmission reduction with genital or oral HSV 1 infection)

So for you, we would be looking for lesions in the genital area but knowing that your partner used a condom, I suspect your risk is really low for having contracted this infection

1) you have no lesions that sound anything like herpes to me
2) your partner used a condom
3) sore throat and cough are not signs of herpes - when people talk about flu symptoms, they are talking more about fever, achiness, sensitivity to light - that kind of thing, not upper respiratory symptoms
4) while redness may preceded a lesion, rarely would herpes appear as only a red area with no lesion.
5) the area where you do appear to have some symptom is the thigh, which is not where we would expect to see a first outbreak of herpes - perhaps a recurrence, but not first infection lesions.

Please let me know what other questions you might have on this topic.

Terri Warren
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46 months ago
Hi Terri,

Thanks very much for the reply.  Sorry if I wasn't clear on my symptoms: in addition to the cough I have experienced body aches and also achey eyes (light sensitivity).  My specific question is what is the likelihood that these red areas will turn into vesicles? Also what is the likelihood that there are more in my vagina that perhaps I'm not noticing or am unable to see? At this stage could they be painless still? Furthermore, given the condom use it seems that if I did contract it, it would need to be because he had an outbreak or was shedding in the area around the penis, rather than the penis itself.  If this was the case then it would make sense that I would have an outbreak not on my vagina but in an area of skin to skin contact during sex, like where I am noting the lines.  Are there any statistics on how present the virus is in this region as opposed to covered by the condom?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
I can't give you the likelihood that the red areas will turn into vesicles but I would say if they haven't in a couple of days and just stay red areas, they are unlikely to turn in to vesicles.  How long ago did you notice the redness?  I think if there were lesions in the vagina, there would likely also be lesions externally or you would have tenderness in the vagina

The reason condoms are so protective is that most shedding in men occurs from the shaft of the penis.  The skin of the lower abdomen, for example, is too thick to shed virus - the skin of the penis is very thin and the virus can get out but when you move more toward the body away from the genitals, the skin becomes thicker and shedding does not occur there unless there is an active lesion present.

If you are concerned about the lines on your thighs, you should be seen to have this evaluated.  As experts, we understand our topics very well but we cannot see you and don't accept pictures - that's where we suggest that you be seen for a more complete evaluation. 

Have you ever previously had a herpes antibody test?

Terri Warren
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46 months ago
Thanks for your response, I appreciate your help.  In response to your question about an antibody test, yes like I said in the first post I have had negative tests for 1&2 in the recent past and have not experienced any sort of symptoms so I am confident this wouldn't be from a prior infection. I noticed the red lines yesterday morning, but they are no longer there today so that's good.  Today I noticed a red bump about one inch above my clitorus though which has me concerned, and some slight anal itching/irritation.  It's possible the bump was present several days ago as well, and if so I havent noticed a change since then.  If it remains just a bump, that means is likely it isn't herpes, correct?  If I only had vaginal sex, a primary outbreak in either of these locations without a concurrent vaginal outbreak would be rare, correct?  I continue to feel ill (body aches and sore eyes) but my cough is now productive and I have been sneezing.  Do you think it's safe to say this is a cold? Or could my achiness be due to a systemic primary infection and the cough be a bug that happens to be occuring simultaneously? Thanks very much for explaining about why condoms work, thats really interesting and I appreciate the explanation.  I am confused because online it usually says condoms are only 30% effective, but on this forum I have read the 90/95% statistic multiple times.  Would you mind taking a moment to explain this discrepancy to me?  I do have an appointment booked with my doctor, but it is several days away and I'm very concerned. Thanks so much for your help.
46 months ago
Actually, the line is still there on one side only and next to it is another very small pink area. No bumps as of now.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
I do think this sounds like a cold.
The efficacy of condoms has been more thoroughly investigated lately and the research finds them to be far more effective than previously described when used every single time.  Here is the reference for that study: 

Clin Infect Dis. 2016 Feb 15;62(4):456-61. doi: 10.1093/cid/civ908. Epub 2015 Nov 17.Effect of Condom Use on Per-act HSV-2 Transmission Risk in HIV-1, HSV-2-discordant Couples.
Magaret AS1, Mujugira A2, Hughes JP3, Lingappa J4, Bukusi EA5, DeBruyn G6, Delany-Moretlwe S7, Fife KH8, Gray GE9, Kapiga S10, Karita E11, Mugo NR5, Rees H7, Ronald A12, Vwalika B13, Were E14, Celum C15, Wald A16; Partners in Prevention HSV/HIV Transmission Study Team.

Have you had the the red lines evaluated by a medical professional?  It's so difficult to know what to make of the lines when I cannot see them.  You can renew if you have more questions.  Thank you for using our forum to get accurate herpes information

Terri
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