[Question #2888] Herpes at base of penis with condom?

42 months ago
Hello,
About 8 weeks ago, I had unprotected oral sex and brief (10min) protected vaginal sex without a condom with a new partner. Three days later I noticed a small area of redness on one side of the base of my penis in an area that may not have been protected by the condom.  It never hurt (even when washed) and I only noticed it because I looked. I saw an urgent care doctor the next day. It already looked like it was starting to heal like a skin abrasion does. The doctor wasn’t sure it was herpes and verbally ran it by a dermatologist who also wasn’t sure but thought likely not.  I was scheduled to see the dermatologist but it healed completely in about 3 days. Unfortunately the doctor didn’t swab it and started me on 10 days of Valtrex. It completely healed after just three doses. My IgGs were negative though I’m pretty sure I’ve had cold sores.  There was never any pain, blisters, ulcers. When it was there it was completely linear and fit the shape and size of the inseam of underwear I wore that was tight fitting and bunching for a very intense run the day it developed. 
I’ve been a nervous wreck since. I’ve been checking every few hours and have never seen anything else. I have had almost constant symptoms of irritation  in different places. 
I was convinced it was herpes because of where it was and the timing. But I’ve read posts on medhelp by Dr Handsfield and Hook that said that initial infections don’t get better that fast, Valtrex doesn’t make syx improve that quickly and that symptoms are usually related to lesions and shouldn’t be constant  
My questions:
1. How likely is the story for herpes?
2. Am I correctly interpreting Drs Hook and Handsfield that lesions in the initial outbreak don’t heal that quickly, that Valtrex wouldn’t have worked that quickly and that symptoms of pain shouldn’t be constant and should be related to lesions?
42 months ago
Sorry.  Just to clarify. I had unprotected oral sex and completely protected brief vaginal sex. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
Hello,
So here' the deal about your situation.  The most likely STI you might get from receiving unprotected oral sex is HSV 1 (someone with the virus orally transmitting it to you).  But you already have HSV 1 so it is extremely unlikely that you would subsequently get the same type (HSV 1) genitally.  I'm no saying it is impossible - I have seen it once in 33 years of practice and read about it once through an online forum, but that makes it extremely rare.  It didn't last long enough for a new infection, the presentation of a linear area is not consistent with new herpes lesions, it was painless and Valtrex just doesn't work that quickly as you describe.  But the best thing going for you here is your previous history of cold sores.  The IgG test misses 30% of HSV 1 infections so I'm not very surprised that your IgG was negative.  I believe that you are very unlikely, given all of this, that you acquired HSV 1 from this encounter.  And I also don't think that you acquired HSV 2, given all of the above that we already discussed.

Terri
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42 months ago
That’s tremendously reassuring. My worry was that since most people don’t realize they have genital HSV maybe it was because their initial infection was as brief and not noticeable as mine. I have certainly never seen an ulcer or blister. And I had trouble getting past the location and timing. But I’m going to accept that it would be very unusual for me to have contracted GHSV1 and that this would also have been atypical for primary HSV2 infection.  I’m going to move on. Thank you for your help. 
42 months ago
Hi Terri. Thank you again. One more question. 
There’s a lot on the net that suggests that herpes doesn’t present in a typical way. But it’s been really helpful to read what you and Dr. H write. And I only trust what I read from the two of you or Dr Hook. 
My sense from those more reputable posts is that if someone is paying attention primary genital herpes usually presents with genital blisters/vesicles and ulcers/sores that take a week or a few to heal and may be less severe if you already have HSV1. Recurrences also usually have lesions of some sort but fewer and shorter in duration. 
Is that all somewhat accurate?
I’ve never had a vesicle or ulcer now 9 weeks out. Just the linear abrasion rash that cleared in 3 days and a couple of red bumps that cleared completely in less than a day. 
I’m also reassured by that despite having lots of genital discomfort that comes and goes. Am I off base in being reassured by not ever seeing vesicles or ulcers?
I tend not to be an anxious or obsessive person.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
I'm so sorry, this post slipped past me.
Yes, all that you said is accurate.  I think if people are observing very carefully, they may well notice a new infection. That isn't always true but I think often true.  And yes, having HSV 1 first makes HSV 2 less likely to be symptomatic. 
I know you are still concerned about this contact and we can never say never of course, but I think genital herpes is really unlikely in your situation. If you cannot get past your worry or simply want more reassurance, I would suggest that you consider getting the herpes western blot to be more certain.I'm going to leave this open for one more question since I missed your last one for a few days. My apologies.


Terri
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42 months ago
Thanks Terri. And no worries. I’ll likely wait and get a IgG at 12 weeks. If that’s negative, I’ll move on. If I have another question after that, I’ll be in touch. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
That sounds like an excellent plan.  I'll leave this post open for 30 days.  Do let me know if you have more questions.

Terri
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42 months ago
Hi Terri. Thanks again for your help. Tested negative at just under 11 weeks. I’m going to have a final ELISA tomorrow at 12.5 weeks. My understanding is that the test catches 92-96% of HSV2 infections and has a negative predictive value of close to 99%. My primary care  doctor is also pretty certain that I’m negative and he discussed things with an ID doc who suggested not even getting the 12.5 week IgG. He said there’s no way it’s herpes. I’m still having trouble getting past. My doc won’t order the Western. Scheduled an eVisit with you for Tuesday. Just want to make sure- my appt is listed for EST specifically.  Any way to make sure that I’ve got the right time zone? Anything need to be ready before the visit? Sounds like with the negative test at 11 weeks there’s almost no chance it’s herpes?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
You are correct that the IgG test misses about 8% of HSV 2 infections and 30% of HSV 1 infections.  Evisit will give you the time in your zone but it should fit with my schedule.  If you have any questions about that, contact the HELP desk at evisit - they are incredibly helpful.  If we do the blot, and it is negative, you must let that be your final answer on the herpes question.  I am happy to arrange this test for you for your peace of mind - sometimes nothing is more valuable than peace of mind so why not get it?

Terri
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