[Question #3091] HSV 1 or something else

40 months ago
Dear Doctor, I am a 27 year old circumcised male. At the end of september I had unprotected sex with a female who was HSV-2 positive and on antiviral therapy. Even though a one time exposure risk is low I decided to monitor my status anyhow. a few days later test results were negative for chlamydia and gonorrhoeae. HSV-2 was negative and HSV-1 positive. I have had repeat HSV testing at 4,7 and 10 weeks. I plan on retesting at 12 weeks but due to no Lesions and no significant rise in IGG levels I feel confident I do not have HSV2. HSV 1 has been in the 3.8 to 4 range. I do recall having a painful blister on my lip last year 2016. Its vague but i think I have had blisters in that area before. Which if in fact was HSV I would have it orally. 
Going back a bit here on May 20th of this year I had unprotected sex with a female of unknown status. on June 17th about 4 weeks later, had red swelling of the left side of meatus or urethral opening. It did not hurt, did not hurt to urinate and did not turn into a blister. I think it went away within 3 to 7 days. Due to reading that herpes can manifest in different ways I'm worried that it may have been some mild HSV-1 outbreak. At the time I had chigger bites on my leg and thought it was due to that, and it may very well have been just that.  I realize now that was negligent and should have had it examined. My questions are 1) that I am correct in thinking that your body builds up antibodies that would potentially keep you from spreading the virus to other parts of your body and that genital to genital HSV1 transmission is rare. especially if you already have HSV-1. 2) any ideas on what could have caused such symptoms that I mentioned? NGU possibly? or bacteria? anything else I should test for? Thank you for your time Doctor, I truly believe this Forum is doing some good to help put peoples anxiety's at ease with answers with some experience behind them.  Thanks.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
1) you are correct, yes
2) are you asking about the symptom of a red swollen are on the side of the meatus, specifically?  That could have been trauma from the sexual encounter, irritation from a fingernail, too much suction with oral sex (if that was involved), lots of things. 
Your positive HSV 1 should be accurate 1) because it was >3 and 2) because you had a painful blister on your lip in 2016. 
Let me know what other questions you might have, OK?

Terri
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40 months ago
Yes ma'am. That area specifically. Left side of the meatus.  It was like there was a red lump there, or some sort of inflammation, but again no pain. I do recall by the third day it looked like swelling had gone down or it was starting to  heal. I'll admit after the encounter in September  I have obsessed over this matter probably in an unhealthy manner. Researching the internet  constantly. After reading things of how herpes could be mistaken for a bug bite that particular incident popped into my head. I have spoken to a few close friends who are nurses about the situation and they said that didn't sound like herpes. I'm just worried it was some atypical outbreak. Even though I'm certain I have HSV1 orally. which would be a good defense for other parts of the body.  No ma'am there was no oral sex in that encounter in May. I agree with you that it could have been anything. Does this sound like a Herpes manifestation? Would HSV not form into a blister in that particular location? I may be worrying a little excessively but just wanted some unbiased expert advice. Thanks for your reply Doctor.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
I do think that herpes would have presented much differently, yes.  I believe it might have been much more significant.  Add that to the fact that your HSV 2 tests have bee negative up until now (and I expect that to hold at 12 weeks) and I think it is extremely unlikely that you became infected at this encounter.  The other great thing?  She's on antiviral therapy.  All good things!

Terri
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40 months ago
Thank you so much for your time Nurse Warren. The redness and swelling was fairly significant, like the whole left side of meatus was inflamed. Again no pain and no blister.  My primary concern was that I may have autoinoculated or acquired HSV-1 genitally back in May and just didn't realize it. It definitely sounds like your of the opinion that whatever I had does not sound like herpes. Ill be sure and be more adamant about having any other irregularities checked, especially down there. Thanks again! Have a Merry Christmas!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
I doesn't sound herpetic to me.  But good, if you have something else weird show up like this again, get it swab tested or at least evaluated by a professional.  I still think it is highly unlikely that you would have either infected yourself genitally or got reinfected genitally through oral sex.  You mentioned recognizing your first cold sore about a year ago - I'm wondering - could  you have been infected both orally and genitally at that time?  That could happen but apparently you didn't have any symptoms back then genitally.  Just brainstorming here.  I would encourage you to assume for now that you are only infected orally with HSV 1 until proven otherwise.

Terri
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