[Question #6014] HSV clarification from Dr.Handsfield

21 months ago
I am out of USA and I didn’t had any STD issues in the past or any sexual encounters. Dear Terry and Dr.Handsfield I would like to get both of your opinion as you are experts on this.

1st Incident 
On February  8th 2019, I went to a karaoke club and ,sat together on a sofa with a girl working there. She dressed with a short skirt and and t shirt. we sat together and drink alcohol and shared few cigars with each other .She also sat on my lap, hug me and I peg kiss her on the cheeks twice,then I  put arms around her back and shoulders, touch her lower thighs, stayed with her like this on the sofa around 2-3 hours. ( but no lip kissing or touching of genitals or sex , all the time clothes were on).
While I was with this girl, we had some shots with a platter of grapes. Few times she put grapes in my mouth. Also I rub her lower thighs with my hands and when having shots I ate grapes. Also we shared few cigarettes and she hold her cigarette for me to smoke. She may touch my lips and my fingers had touched my lips.
She used the wash room once in between.
Next day I had a continuous burning like sensation in lips and tongue but no visible blisters or sores. 
Then my GP checked me and put me on valtrex for 2 months from Feb 11th  (I dont know why, she thought burning could be due to oral hsv infection).
21 months ago
2nd incident (16th Feb 2nd visit to Doctor/ can this cause auto inoculation)

Still my lips were  burning and bit white tongue (no sores or blisters).
As I didn’t have any sexual encounter with others in past I was 100% sure I didn’t have genital hsv. On the second visit doctor checked my penis by lowering the penis pre skin and told its clear and my mouth was checked .  I hold my mouth upper lips with my fingers around a minute to show inside my lips to doctor. Within seconds without thinking I touch my penis with same hand (saliva contacted my fingers) to adjust pre-skin and adjust my trouser .
In the same evening I felt irritation in my penis head and I was more anxious.
After two days (19 Feb) I felt burn in my anal region and under Perineum. After next day my penis head was dry and felt like burning, also when peeing upper urethra was bit painful.
On 22nd Feb another practitioner checked my anal area and genitals told me no sores or blisters and put me on Doxycycline 100 mg for 7 days.Around week 25th March burning in the Penis was reduced and still had bit of Anal area burning (All this time anal burning was mainly under Perineum area ).

Feb 8th to March 31st – (51 days form initial encounter) I was on ACICLOVIR

Luckily I could talk to Terry Warren and From April 1st 2019  I am off valtrex and done IGG and Western bolt tests after 12 weeks off valtrex  and all test came NEGATIVE for HSV1 and 2. (Actually WB was done as I really wanted to do so).

21 months ago
I really want to agree with WB results ,But I am really worried because,

I get the recurring penile head burning and some times anal area irritation with bit swallowed area near anus and perineum.I never had penile burning conditions like this before. After the first penile burning incident 19th Feb it got repeated in mid April  , Mid May , early July and again in this week. Still no sores or blisters.
Also I met a Urologist and done a full urine analysis and prostate scan, but no infection or Inflammation of the prostate (prostatitis). he told this may be due to chronic non bacterial prostatitis (never had prostatitis in my life). 
Moreover, I thought it is due to stress/anxiety but few weeks back I was very depressed but this penile burning did not occur.I am sure this is really occurring and not just imagining.
This hot/burning/irritation mainly happen on penile head skin (in some occurrences also in the anal area near perineum). When penile burning starts it continue around 2 weeks in later occurrences . It starts with mild burning which comes and goes and while sitting and after pee I feel it more.Also area under pre skin become dry and bit painful to lower. After 2-3 days burning on the penile head become more intence and continuous.But not a unbearable severe pain. 

If I apply Candid cream (Clotrimazole Cream USP, 1% w/w, Antifungal Cream) burning/hot irritation on penile head become milder and faded away.

Could you please answer following

Is there any chances I am infected  but 3 monts off valrex WB and IGG tests miss the infection?

Do any of you think I was infected with Oral HSV 2 with incident 1 and  got infected in genitals (auto inoculation) due to 2nd incident ?

Is the recurring penile burning symptoms seems like a herpes infection ?

If so do I need more WB or IGG testing (now I am near 6 months off valtrex) ?
21 months ago
Really sorry for posting all the things if I violate posting guide lines. But I wanted to let you know whole thing.

Following are the results of my ELISA ANTI HSV 1& 2 IGG tests and WB

Test 1 -Feb 2019
(Index – Negative < 9.0 , Eq 9.0 – 11.0 , Positive > 11.0)
HSV 1 – Negative 1.86
HSV 2 – Negative 3.20

Test 2 : Mar 2019 – 3 weeks on valtrex
(Index – Negative < 9.0 , Eq 9.0 – 11.0 , Positive > 11.0)

HSV 1 – Negative 1.92
HSV 2 – Negative 2.89

Test 3 : Apr 2019 – 2 weeks off valtrex
(Index – Negative < 9.0 , Eq 9.0 – 11.0 , Positive > 11.0)

HSV 1 – Negative 2.07
HSV 2 – Negative 3.05

Test 4 :June 2019 – 9 weeks off valtrex
(Index – Normal < 0.9 , Eq 0.9 – 1.1 , Positive > 1.1)

HSV 1 – Negative 0.06
HSV 2 – Negative < 0.50 (they did not provide a exact value as it is less than 0.50)

Test 5: 12 weeks off valtrex
(Index – Negative < 9.0 , Eq 9.0 – 11.0 , Positive > 11.0)

HSV 1 – Negative 1.97
HSV 2 – Negative 4.27

WB HSV1/2 Negative - 13 weeks off valtrex 

Really sorry for posting all the things if I violate posting guide lines. But I wanted to let you know whole thing.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to our Forum.  Thanks for your confidence in our service.  On this occasion I will be answering your question as Dr. Handsfield and I share this portion of the Forum.  FYI, Dr. Handsfield and I have now worked together from more than 35 years.  While our verbal styles differ, we have NEVER differed in our assessments or patient advice.  I will also point out that normally all questions on this site related to herpes infections are answered by Ms. Warren who is a well known expert on herpes but whom I understand has already interacted with you on her Westover Heights site.  Before I get into detail on this subject, let me tell you that I agree with the advice that Ms. Warren has provided- the two events you describe are not events that would ever even put you at risk for acquisition of HSV-1 or -2 and in my opinion, you now have multiple negative tests which PROVE that you did not acquire HSV from your exposures of concern.  Other doctors may have done you a disservice by giving you medications, including valacyclovir, that you did not need.  

Is there any chances I am infected  but 3 monts off valrex WB and IGG tests miss the infection?
No, both test results agree with each other and each show that you did not acquire herpes.  If you had, despite taking valacyclovir that you did not need, your results at this time are entirely reliable and should be believed.  

Do any of you think I was infected with Oral HSV 2 with incident 1 and  got infected in genitals (auto inoculation) due to 2nd incident ?
HSV (1- or -2) is not transmitted by transfer from one infected site to anther site.  there is no evidence that you were infected.  

Is the recurring penile burning symptoms seems like a herpes infection ?
Your symptoms, including burning in the absence of lesions in no way suggest herpes infection.  When persons are worried about infection and focus their attention on one part of the body it is quite typical to become aware of normal sensations which are then experienced as burning or itching. I suspect that this is what you have experienced.  This is not at all suggestive of HSV

If so do I need more WB or IGG testing (now I am near 6 months off valtrex) ?
There is absolutely no reason for additional testing of any sort.  The events you describe are not associated with risk of HSV and your tests prove that you were not infected.  I urge you to believe your test results.  EWH

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21 months ago
Dear Dr. Hook really thank you for your valuable advice. I just asked for Dr. Hands field opinion, but never demand it. All of you are providing a valuable service and I know your expertise is really strong  and I would always accept your answers.
 I never doubt any of your answers as all of you are true expertise  in the field. 

I really wanted to believe wb results, but this recurring penile burning only occurred after this incident 2 is make things worse. 

I am sure I am not making that out due to anxiety, it really happens repeatedly. I never had such thing before. Why is this recurring penile burning is happening.?

I know asking this is not ethical, but please can Dr Hands field or Ms. Terry also go through this and answer my questions?  If so that would be a really nice thing and big help to let go this long term worries. 


Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
I cannot answer what is causing your penile burning.  There are many different health problems, including genitally focused anxiety which can cause unusual penile sensations.  What we do KNOW in your case however is that your symptoms are NOT due to herpes and that there is NO EVIDENCE that you have HSV.  I can assure you that both Dr. Handsfield and Ms. Warren are in agreement with me on this.  Time for you to move on and if this discomfort continues, to look for other causes.  EWH---