[Question #2462] Follow Up to #2358 Please help!

43 months ago
Dr. HHH

Please read my original post to re familiarize yourself with my stupid mistakes.
 
I checked with the dermatologist on what hsv 1 and 2 test were used when taken at 6 weeks.  He said IGM which i found out is useless.

During our last correspondence i have experienced additional symptoms: dull pain in my lower stomach like a bladder infection coming and now have blistering feeling/burning in my feet.  I know you said my exposure (scrotum sucked/licked) is no risk. 

Last week i called my primary doctor to get IGG for hsv 1 and 2 which is 11.5 weeks from exposure.  Today i got results of hsv 1 positive (2.8) and hsv 2 negative (<.9).  I always thought i already had hsv 1 since all 3 off my kids clearly have sores outside on their lips that look obvious and we share drinks all the time regardless of their sores (all three had it in the last 3 weeks).  I just dont recall getting sores.

Based on my test results I have the following questions:

1.  Is the result of 2.8 mean this is a recent infection?  If it is then must be genital with all the symptoms? 
2.  Based on all my symptoms i have experienced (not all at one time) do you still think my exposure (scrotum sucked/licked) was no risk and my positive hsv 1 is oral?
3.  So if i have any outbreak in my genitals you recommend i get swabbed to see if ghsv 1?  If positive then i need to tell wife?  But that would mean i have been exposing her during sex. 
4.  Do i continue having sex with wife hoping she has hsv 1 oral?
5.  Is there anything else i need to get tested for?
6.  If it is g hsv -1 would the outbreak appear and shedding only happen where the pimple was found which is at the bottom of the scrotum?  I cannot see this scrotum area getting in contact during sex.

Im scared and dont know what to do.  I feel like im doomed.  Please help!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome back. But I'm sorry you remain concerned. There is no realistic chance you have herpes and I'm sorry you didn't follow my advice to just drop it.

It was a mistake to have an HSV blood test, especially since you had past symptoms suggesting you already knew you probably had HSV1. That means you could not have acquired it again from the oral sex event; and HSV2 is almost never transmitted by oral sex.

1. The numerical result is totally unrelated to when infection was acquired. You had HSV1 in rhe past and still have it. So what?

2. You cannot acquire a new HSV1 infection if you already had it. And as discussed last time, your symptoms are NOT AT ALL suggestive of genital herpes.

3. You won't have an "outbreak" in the genital area. But if you do, then yes, you should have it tested immediately. I'm sure this won't happen.

4. You should continue sex with your wfie regardless of whether or not she has HSV1. Half of all adults have HSV1, and most have no idea whether or not their wives are infected. Would you advise half of all married couples to avoid sex because of this? Of course not. We don't expect much of forum users, but we do expect rational thinking.

5. No additional testing is recommended or necessary, for either you or your wife.

6. You probably do not have gential HSV1. If you do, it is not from the oral sex event that is dominating your thinking. And if you do, it probably will never be transmitted. Sexual transmission of genital HSV1 to partners is rare, never something to worry about!

In response to "Im scared and dont know what to do.  I feel like im doomed." This is absolute nonsense. Resume a loving, romantic relationship with your wife. Put aside a sexual decision you regret and your irrelevant symptoms. Move on with your life. Nothing bad will happen. If you continue to be so concerned, get professional counseling. I suggest it from compassion, not criticism. But it simply is not normal to remain so fearful and anxious after the reasoned, science based reassurance you have had.

I hope this information is helpful, but I am not confident. I believe you will not get beyond this without counseling. Or 'fess up to your wife and rely on her common sense and understanding. Good luck.

HHH, MD
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43 months ago
Thanks again for your response. 

I assumed i had hsv 1 oral because i thought canker sores in the mouth were hsv.  You mentioned in first question that its not.  I dont remember having any mouth sores.  Plus i assumed since my kids have clear hsv mouth sores, that i would have it too.  So maybe i  didnt have oral hsv1 symptoms in the past.  This wasnt discussed in the first question.  So if i didnt have oral hsv 1 symptoms in the past do you think i might have genital hsv1 based on my situation?

You are probably right i shouldnt have gotten tested for hsv 1 and 2.  I just dont want to give my wife something for life.  But i will never know if hsv1 is gential or oral unless i have a visible sore.  We have been together for 20 years so is it possible no visible outbreaks or symptoms for both of us in all these years?  Only now i had a pimple on scrotum and various symptoms?

In the first post you mentioned sucking/licking scrotum is no risk.  Do you still feel that way based on my ongoing symptoms?  Currently i still have constant dull pains in lower stomach area (bladder area) and having to urinate more often especially at night, plus burning/sore feet.  My scrotum being sweaty, sticky, icy hot sensation, and cold testicles off and on for the past 2-1/2 months has gone away for the past 4 days.  Can symptoms that i have linger for this long if its hsv1 genital?

Having these symptoms is hard to overcome the fear of losing everything over a stupid mistake.  Please respond again to my questions and situation.   Thanks



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Thanks for the clarifications. Even if your past symptoms are more like canker sores than herpes, that your kids have had HSV1 is certainly consistent with the possibility you have had it (orally) for a long time. However, there is no way to know the site of infection from the blood test. In the absence of symptoms, most positive HSV1 tests reflect oral and not genital infections. But even if your infection was genital, your wife probably isn't at risk. Genital HSV1 usually recurs infrequently, and viral shedding in the absence of symptoms is uncommon, unlike HSV2. Genital to genital HSV1 transmission therefore is rare. (I've never seen a case in my 40+ years in the STD buisiness:  all genital HSV1 I have ever seen were acquired by oral sex.) 

As for your symptoms, you have made the mistake of reading symptoms of genital herpes, seeing things like "itch" and "tingle", then assumed you might be infected. What such lists typically don't clarify is that herpes lesions and outbreaks may itch or tingle; but those symptoms alone almost never are due to herpes. And certainly herpes would never cuase "sweaty, sticky, icy hot sensation, and cold testicles", and herpes never causes off/on symptoms for weeks on end. There's no way those symptoms are herpes.

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43 months ago
Just a few more questions since this is my last follow up:

1.  If someone has genital hsv 1 is genital to oral rare too (since you have never seen genital to genital in your 40+ years)?  Has Dr. Hook or Ms Warren seen a case of genital to genital?

2.  Since i was tested and confirmed to have hsv1 but dont know which hsv type i have, is the correct thing to do is tell my wife and then ask her to get tested?  Would really suck if we already had hsv1 or she gave it to me and i am the one confessing and lose everything.

3.  Would it be reasonable to be together for 20 years and only now groin symptoms show up for me?  Seems very unlikely.  So could this prove to be recent infection i got?  I never had these symptoms before (except testicle dull pain years ago).

4.  I know its bad to google stuff on the internet but the symptoms i have seem to be listed in websites as symptoms for genital hsv 1, especially bladder pain, burning/sweaty/sticky/shiny scrotum, sensitive lymph nodes, sore testicles, etc.  And in forums people with genital herpes experience some of these symptoms for months without sores.  Are these symptoms normally before an outbreak of sores?  Even when i google burning feet and herpes a bunch of herpes articles pop up including HIV being possible symptom.

5.  Last night had a hard time sleeping with the lower stomach bladder pains and having to wake up and urinate 4 times, plus the burning feet feeling.  Did you ever see this problem in your patients with ghsv?  These symptoms have been on/off for the last 2 weeks.

6.  I noticed you didnt really answer my question regarding scrotum sucking/licking  if you still feel i had no risk with all my symptoms.  Do you still feel it was no risk?

7. I cannot see all my symptoms being anxiety or stress related.  Could i have possibly got something else? Could this be gono or chlam if somehow she touched my penis opening with saliva or fluids prior to putting on the condom?   What else could this be?  Could girl being naked and sitting on me to massage my back, legs, etc.  have any risk for something?

I admit im having a very difficult time dealing with what to do and how to move on.  I fear my wife will have similar symptoms then i will feel guilty as hell that i gave her something.   Im so stupid.  Thanks again for your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
1) I have no idea whether or not they have seen such a case. Rare things happen, so they might have, even though I haven't. But this is irrelevant:  does it make a difference in your chance of being struck by lightning if any of the three of us has ever treated a struck patient?

2,3) People with HSV for 20 years or more can still get outbreaks; it's not unlikely at all. Many people with known HSV1 or 2 would inform their spouses, but there's no hard and fast rule. If you decide to do so,  you don't have to "confess" anything, unless you want to tell a white lie about having a cold sore and deciding to get tested. No need to mention your sexual indiscrtion, which probably is entirely unrelated to your positive test result.

4) The very worst resource for worried people to seek information about symptoms they are worried about is website designed for people with that particular problem -- whether it's herpes, cancer, HIV, or a hundred other chronic medical conditions. Some with such symptoms don't put them in context; and many infected people have loads of symptoms that in fact are coincidental. I stand by my comments above:  if you came to my clinic with the symptoms you describe, herpes would not enter my mind (except to reassure you if you were already worried about having herpes) -- i.e. just as I have tried to do here.

5) Nope, not this symptom either.

6) Oral contact with scrotum is not likely to transmit HSV. If it had done so, the main symptoms you would have had would be blisters/sores at the sites of contact. Not elsewhere.

7, and your closing comment) You may not see these symptosm as anxiety or stress related, but I do. If I had to teach med students or residents about anxiety symptoms, all yours would be on the list (FAR before herpes!). You clearly have genitally focused anxiety related to a sexual decision you deeply regret. Maybe you in fact should consider discussing all this frankly with your wife:  she may be more understanding and less judgmental than you fear. Many men in your situation would consider it. Alternatively, the only suggest I have is to seek professional counseling. I doubt you're going to get over this until you talk it through, whether with your wife or a mental health professional. I'm not a psychologist, but I've seen an awful lot of men with genitally focused anxiety. Anyway, I suggest this from compassion, not criticism.

As you know, that concludes the two follow-up comments and replies included with each thread, and so ends this one. I'm afraid this is going to have to be your last question on these topics; the forum does not permit repeated questions on the same topic or exposure. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, continued answers tend to prolong users' anxieties. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you for your understanding.


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43 months ago
Dr. H,

Sorry just one last comment regarding item. 6.  I had a pimple in a hair follicle (with long pubic hair) at the bottom of the scrotum where it was sucked/licked.  It wasnt anywhere else.  This is where the area was clammy as well after putting on pimple cream from dermatologist.  Does this change your opinion?  Sorry for last question.  Just want to make sure we on the same page with my question.
43 months ago
Sorry please ask my question 1 regarding genital to oral for genital hsv 1.  Is this rare too?  Or is only genital to genital rare?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
No, none of this changes my opinions or advice. Pimples or folliculitis are not rare on the scrotum. You repeatedly refer to "clammy" skin, but of course the scrotum is in a warm part of the body and sweats a lot. You are noticing normal body sensations, not symptoms. None of this has anything to do with the oral sex exposure, except emotionally. 

HSV1 is rarely transmitted to any body site from the genital area. The large majority of HSV1 infections are acquired from infected persons' oral infections.

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