[Question #2225] 3 possibilities from question 2190

45 months ago
Doctors- I submitted several questions in the Herpes section that Terri has educated me on (question 2190).  However, in my constant state of worry and anxiety I thought of a few more details I thought were relevant.
- in lifetime 2 unprotected intercourse partners (spouses); numerous unprotected oral encounters.
- unprotected oral and protected sex with CSW one month ago
-  10 days after encounter developed conjunctivitis
-  12 days after encounter was put on doxycycline for conjunctivitis
-  14 days after encounter, after short unprotected  oral sex encounter, felt a pintching sensation on meatus/urethra.  Went to doctor that day.  Doctor noticed tiny abrasions/irritation/sore on meatus so small he had to use pen light to see it.  Called it "mild suspection" of std and ordered blood tests for hsv, chlaymidia, gonnorhea.  No swab/culture. Also did annual physical urine and serum lab tests
-   days 15-16 "pinching" turned to painful urination, not the worst pain I've ever felt but painful.  End of penis and urethra felt heavy
-  new detail:  day 16 when looking inside and opening urethra, i saw a thick discharge start to emerge out of penis, it disappeared back inside when i let go of penis.
- day 17 went back to doctor to discuss blood work results,  hsv1 IGG 31 (never had oral or genital sore), hsv2 negative, chlamydia and gonnorhea negative.  I told doctor I was worried about painful urination and he perscribed antivirals (which I quit taking on day 24 because terri said it could skew future hsv2 testing)
-  day 28 went back to doctor, all symptoms gone, did another hsv2 igg which came back negative.
Overall I'm so disappointed I didn't know to ask my doctor to do a swab/culture on day 14. My mind keeps convincing me and has me in a constant state of worry it's a new hsv2 infection .  I'm wondering of 3 possibilities Terri outlined what the risk is for new hsv2 vs recurrent genital hsv1 vs not herpes related.? Thanks for your time.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome back to the Forum.  I note that this is your 3rd post on that past 7 days.  I have reviewed your earlier interactions with Terri and agree with all that she has said- I too suspect that your HSV-1 infection is longstanding (in fact, most people who have HSV-1 do not get or remember cold sores or are unsure whether or not they do) and unrelated to your recent symptoms.  Assuming that your HSV-1 is longstanding, this makes it quite unlikely that your recent symptoms were due to HSV-1 because you are already immune to this virus and re-infection with HSV-1 would be very, very unusual (I have never seen a person with well established HSV-1 acquire HSV-1 infection at a new site following oral sex in the manner you describe).  Similarly, it would likewise be most unusual for you to acquire HSV-2 from receipt of oral sex.  On the other hand, your history of recent conjunctivitis and burning on urination may provide a clue to what is going on- adenovirus infections can cause conjunctivitis and the sorts of penile symptoms that you describe.  If your symptoms were due to adenovirus, we would expect your symptoms to resolve and to no t recur.  Adenovirus infections can be acquired both through receipt of oral sex but also through one's activities of daily living and are not a classical STI of concern in terms of risk for transmission to others or long term effects. 

Bottom line- my suspicion that your illness was HSV-2 is low and I would not worry further than to get a repeat blood test in the future (no less than 6 weeks after exposure and better yet at 3 months.  If these tests are negative, I would not worry about HSV-2 further.  Whatever caused this may well  have run its course and resolved.  It is not time for you to stop your apparently repetitive, intense self examination and to move forward.  Should symptoms recur, the should be obvious to you in your heightened sate of anxiety and if there are lesions at that time, you could have the swab test that you and Terri have discussed.  Personally, I doubt that this will occur.

I hope these comments are helpful.  EWH
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45 months ago
Thanks for your time and thoroughness Dr Hook- it is greatly appreciated.
A couple clarifications:
1.  You typed in your response "it is NOT time for you to stop your apparently repetitive, I test self examination..." I think you actually meant to type, "it is NOW time."  Just making sure..??
2.  I'm aware the risk is low and it's very rare to see HSV2 transmitted orally.  What was concerning me and has been keeping me up at night was the protected vaginal sex during the same encounter of the unprotected oral.  Do you also think that risk is low?

I will plan on getting another HSV2 IGG blood test after 6 weeks.

Thanks again, Dr.  I really want to move on but as you can tell have been paranoid about this.
45 months ago
Dr Hook- I also meant to ask how long I should wait to have sex again?  Thanks so much!
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
1,  correct, sorry for the typo.  I meant to write that it is NOW time to stop your self examination.
2.  Yes, I think the risk from your protected vaginal sex is very low.  HSV is spread by direct contact.  If you had acquired HSV and lesions from a episode of condom protected sex the lesions would occur at a spot not covered by the condom.

If I were you I would not worry about having unprotected sex at this time.  EWH

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45 months ago
Thanks for your insights and patience with me!
45 months ago
Dr Hook- one final question.  If this adenovirus is responsible for these symptoms, is it possible to spread/infect someone else with conjunctivitis but them have no other symptoms?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Good question. There are no good answers to your question.  Generically "conjunctivitis" is transmissible from person to person but there are many causes of conjunctivitis and how adenovirus is transmitted is unclear.  Irrespective however, this is not a major concern as an STI or in terms of long term risks from infection.  Time for you to move forward.

As you know this will end this thread which will be closed later today.  EWH
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