[Question #3870] Genital Herpes Question

33 months ago

Hello Doctors,

22 yrold male, all sex happened at my university.

March 2017: Protected sex with woman of unknown status. Realized after that condom had broken but not sure for how long.

October: Unprotected vaginal sex with two different partners, both times was drunk and could not get erect so there was very little penetration, maybe none with one partner.

December and January: Unprotected sex multiple times with a friend who claimed she was tested, not sure if hsv included.

February: Unprotected sex once with another friend who said she was tested, not sure if hsv included.

April: Protected sex once and unprotected sex once with a girl who was tested for everything in January but had with three friends since.

 

The next day after last encounter I noticed a somewhat circular cut (sore?) about midway down shaft. It was red with dried blood around it white on the inside when I spread the skin, and it seemed to be a little bit wet (when I squeezed the skin a clear liquid came out). It was not crater-like or well-demarcated, but just like the top layer of skin was gone, and didn’t really look like the herpes ulcers online. I believe it scabbed up later that day, and was definitely scabbed up the next morning. I think it was gone by Friday or Saturday (Saw it on a Monday). When I went to my physician I described it and she said the white color on the inside could be layer of skin underneath or white blood cells, and the liquid was produced to clean wound.

Questions:

1.    Could this be a recurrent outbreak from one of the above encounters? Does the speed of healing and other symptoms match up?

2.    If it was a recurrent outbreak, could there have been a blister I didn’t notice that was opened during the intercourse the night before? I hadn’t inspected myself in the couple days leading up, but I likely did the week before, and I masturbate frequently so even if I am not inspecting my penis I get some pretty good looks while I do my business or use the bathroom. I also showered before the sex the bathroom was well lit and I didn’t seeing anything while I urinated, but I wasn’t looking closely.

3.    Could it be caused by friction (the cause my doctor guessed), and what other causes could there be that are not sexual? I have had circular cuts on my penis a couple of times before that have also scabbed up, one of which was three months before I was tested for hsv and everything came back clean. I should also mention that I did not wear underwear all weekend, only jeans, and I usually wear underwear, so irritation definitely could have occurred.

 

Thank you!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
This could be an outbreak related to one of the encounters that you describe, yes.  And if herpes, it could be HSV 1 or 2. 
Lesions on the thin skin of the genitals break pretty quickly after blistering.
My impression is that  true friction burns are rare and I don't think that they look like a cut. 
The thing is that the IgG test misses 30% of HSV 1 infections compared to the gold standard western blot.
Given what you've said, I think it might be worth considering the western blot to rule out HSV 1 more accurately. 
In addition,I would really encourage you to increase the frequency of your condom use if you do end up being negative for HSV and other STI's.
Please let me know what other questions you might have

Terri
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33 months ago
Thank you for the response. I gave blood for the IgG today (and HIV, I know it is very unlikely but I am a sexual hypochondriac and constantly overthink these things so I would rather get that out of the way), I will let you know the results when I receive them. I have a couple more questions if that's alright.

1. I guess I am just kind of confused about recurrent outbreaks. A recurrent outbreak could still be the first outbreak I experience? I definitely would have noticed if I had a primary outbreak with any of the encounters, as I look at my penis frequently. Would the blister have been so small that I would not have noticed it when looking down at my penis in the bathroom before the sex? Would it have began scabbing so quickly after an open sore was created? I guess I just need some more clarification on true primary first outbreak vs a first outbreak that does not happen a few weeks after infection.

2. The sore, or cut, was not indented and was not crater-like in any way, I have read that ulcers usually create a sort of crater in the skin. It was as if just the top layer was missing. The scab also rose above the skin kind of in the shape of a ball as opposed to being more deep into the skin like the crusting ulcers I saw online. Does this change things at all?

 You are completely right about condoms, and I will try harder in the future. I have allowed my depression, feelings of sexual-inadequacy, and issues with alcohol and other drugs to inhibit my judgement. Not an excuse at all, as I made those choices and it is no one else's fault. I should also mention that I was tested for chlamydia and gonorrhea a few weeks ago, both of which came back negative. 

Thank you for your help!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
1. Yes, that's correct.  The first outbreak could have been years before one that is recognized and this could be a recurrence but you don't seem to think so so if you are observing so closely, perhaps that's true.
2. Ulcers usually are indented yes.  But no, this doesn't help me too much, sorry

Glad to hear your other testing was negative, excellent

Terri
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33 months ago
I apologize I don’t think I was clear with what I was asking in #1, I may have worded it wrong.  If my symptoms were a recurrent outbreak, would there have been a true primary outbreak soon after I was infected? Or can an outbreak that appears months or years later truly be the first time a person exhibits symptoms, but still be called “recurrent” because the person was infected at some point months or years before, just never showed any symptoms? The literature I’ve read has really confused me on this concept.  I should add that I took an igG I’m December of 2016 and everything came back negative, so if my recent symptom was an outbreak it would have to be from one of the encounters I mentioned in my first post. I definitely would’ve noticed a primary outbreak in the days following any of those encounters, so since I didn’t could this still be a recurrent outbreak related to any of them? Please let me know if this does not make sense, as I know I am writing a lot, and I will try to condense it. I know we are allowed only two extra posts, but after you respond to this post, would you like me to post my results of the igG once I receive them? Thank you again!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
There likely was but many people miss a first infection or attribute the symptoms to something else entirely.  An outbreak that appears months or years after the first infection can definitely be the first time people exhibit symptoms, absolutely!
The thing is, since the IgG test misses 30% of HSV 1 and 8% of HSV 2, your first test in 2016 could have missed the infection.
And don't forget, we have no idea if this is actually herpes, correct?  You are a bit ahead of yourself with this assumption, I think
If you get any of these things again, please see a clinician right away and have a swab test done - preferably PCR, which is the most sensitive swab test.
If you want to renew, you can post your IgG results, yes

Terri

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