[Question #2444] G-HSV Question

43 months ago
Here are my facts - I have been in a committed relationship for 7 months.  I have never had any sign of an OB in my life and I very frequently check.  I went abroad and did not have any intercourse for about 8 days and out of nowhere I saw what appeared to be a single circular lesion or sore high on my penis shaft.  It did not have any vesicles - just one opening, for lack of a better word.  No other symptoms.  It gradually healed.  Initially I believed it to b friction from masturbation. I know you cannot diagnose online - My question is, how likely would it be for a primary/recurrent outbreak to present as one single lesion/sore?  If it is not G-HSV, what could it be? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
So would you describe this as an ulceration? 
The timing of the appearance of the lesion at 8 days out from intercourse could still fit within the definition of new infection, yes.  Do you know anything about the herpes status of your regular partner?  Are they the giver of oral sex to you?  Do they have a history of cold sores? Do you?  Given that this is a committed relationship, I'm assuming that means you have no other partners?  How long did it take to heal?
I think an open sore from masturbation is extremely unlikely. 
Have you ever been tested for herpes in the past? 

Terri
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43 months ago
Hi Terri - to answer your questions, it's hard to say if it was ulcerated or not.  I am as certain as one can be that i have never had a cold sore anywhere on my body and she is certain she has never had genital cold sores, not sure about oral.  We have had no other partners during this time, but have in our past.  It has for the most part healed, but 32 days later there is still a faint white-reddish small circle present.

Now for some more background: years ago I was tested for herpes (which started my anxiety about herpes) and my results came back high positive for HSV-1 and 1.17 for HSV-2.  Again I had never had  cold sore and still have not to my knowledge anywhere.  I got a new test knowing it as a low positive about a week later and the HSV-2 number was the same.  At the time I was in another long-term committed relationship, so I know it was not a new infection.  I understand that from that 1.17 we can't really tell what's going on.  What are your thoughts?

Also, a follow up question:  If the sore was indeed, GHSV-1, given the location, wouldn't it be safe to use a condom, since it would cover the area infected?

Thanks
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
I think it would be good to clear up whether you have HSV 2 or not.  That requires a herpes western blot.  With a 1.17 index value, there is greater than an 85% chance that this is a false positive.  Also, if you have never had a cold sore that you recall, nor has your partner, but you have a high HSV 1 index value, you've got HSV 1 somewhere on your body - it could be genital and this lesion could have been HSV 1 or 2 - without a swab test, we cannot know.  Should I assume that you've not had a swab test of this lesion?

Terri
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43 months ago
I have not had a swab done.  I don't want to have another blood test just to come back equivocal again.  Western Blot is almost impossible to do if you can't gt to UW.  I guess aside from another blood test, the best bet would be to see if another lesion appears and have it swabbed?

But since this is the last e-mail I believe I am allowed could you answer these questions for me?  1.  How likely is G-HSV to present as one single lesion?  I seem to see some places like Dr. Handsfield say it is possible but not the most likely  2.  Wouldn't sex be safe with a condom, since it covers the area, even if there is asymptomatic shedding?  and 3.  If one has a break out and it heals, isn't it safe to assume that when it is healed there is no possibility of transmission (at least for a short time), since a breakout JUST occurred?

thanks
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
1.Genital herpes can show up as a single lesion, yes.  Especially if it is a recurrence and you missed the first infection. 
2. Yes, quite safe.  Condoms reduce transmission from an infected male to an uninfected female 96%. 
3.  No, one cannot make that assumption. 50% of viral shedding happens before or after an outbreak and 50% occurs randomly in between outbreaks.

The western blot is not almost impossible to get outside of UW. I order them for people all the time, today I have nine patients on my schedule, almost all of whom want western blots and I can order them for them in the cities in which they live, they then ship the samples to UW.  If you are interested in this, please visit my research website at westoverheights.com and schedule a video consult.  If you want the greatest clarity about your herpes situation this is the test to do.  And absolutely, if another lesion appears do have a swab test right away. 

Terri
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