[Question #616] Genital Herpes - Risk assessment

42 months ago

Timeline/info:


July 2015: Had protected sex (condom), one night stand

Nov 10: Received unprotected oral only, one night stand

Dec 30: Received/gave unprotected oral only, one night stand

Dec 31: Noticed a small reddish mark under foreskin


After the oral on Dec 30, I masturbated 3 or 4 times that day. The following day, the red mark appeared and through early january, got worse, became like horizontal red cuts/marks under my foreskin. No blister, liquid, pain etc. I went to my doctor who said "it didn't look like herpes". He gave me canestan cream which didn't help.


I followed up with an STI check around Jan 12th. The doctor at the STI clinic said my symptoms sounded nothing like herpes and said "it didn't look like herpes", i recall her saying "im not worried about you". We then tested for the main sti's and she took a swab on the marks for herpes. Tests all came back clear.


Cuts remained and thinking they were maybe abrasions from masturbating, I used E45 cream and they healed quickly.


Then on March 2nd, a slight red mark appeared again under my foreskin, not as bad as before! I had masturbated maybe once a day in the week leading up. I again put E45 cream on, and the marks vanished within 2-3 days. No flu/pain, blisters, scabs, liquid, pimples etc. A week later, i met a girl who performed a handjob on me. The next day, this brought a red mark back again slightly on one side under the foreskin, but healed with a slight touch of E45 cream once again by the next day or so. Since then, no problems.


I do recall possibly having a cold sore like 20 years ago, i'm 33 now.


I have had a few long term girlfriends in the past and neither myself or them have had any symptoms of anything.


** Due to my anxiety, and my potential for a progressing relationship with a girl I recently met (who gets cold sores on the mouth herself actually), I'd like to know your thoughts on how likely I've picked up genital herpes from these 3 encounters (1x condom protected sex in Aug and the 2x unprotected oral in Nov/Dec). And should I do any further testing or anything!?!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
I don't know what E45 medication is so it's a little harder for me to know how to answer your question.  But I will say that if E45 has steroids in it, that steroids most often will make herpes outbreaks worse, not better.  It's very good that the clinician who saw you didn't think it was herpes and also that the swab test was negative.  Also, your exposures have been so limited infection is also unlikely statistically.  However, if you are getting into a relationship with someone who has cold sores (almost always HSV 1), it might not be a bad idea to get an IgG herpes antibody test to see your status to know if you and she are the same or different in the herpes department. 

Terri
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41 months ago
Hi Terri,

Thanks for the reply. E45 cream is a common cream used in the UK for dry, flakey, itchy skin etc, the ingredients are here (i don't think it contains steroids): www.boots.com/en/E45-Cream-for-Dry-Skin-Eczema-350g_981170/

The first cream the doctor prescribed was Canesten HC which contains Clotrimazole and Hydrocortisone corticosteroid. That didn't seem to help and changing to the basic E45 seemed to help, especially the 2nd time in March when the redness only lasted a day or two upon applying E45 only.

I will look into tests, i'm guessing she is HSV1 (coldsores from childhood) and as I said, sure I've had them before too although not for 20 years.

1) Here in the UK, we can order herpes screens online from a reputable firm in London. Do you advise doing their test, which they describe as "A laboratory based test for Herpes using PCR technology. Our PCR screen can distinguish between Herpes Simplex I and II."? I'm pretty sure the STI clinic here said they DON'T do blood tests for herpes, and of course, she thought I didn't have it anyway but 1 or 2 other online firms do blood tests by post for it.

2) Thanks for your opinion on how unlikely this exposure is. Can you put a rough figure on it, trying to put my mind at ease and move on from this :)

Thanks Terri.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
PCR is a swab test (or at lea).t should be although I have seen clinicians mistakenly order it as a blood test.  A PCR is NOT a screening test for herpes - if you do a swab test of the genitals when there is no sore present, even if the person is infected, they may well not be shedding virus on that particular day.  So it is quite useless if negative, do you see what I mean?  And it is useless as a blood test because people who have herpes rarely - with the exception PERHAPS of first infection - have herpes in the blood stream.  What you would want as a screening test for herpes is an ANTIBODY test - IgG to be specific.  And since you've already had and have HSV 1 (which I missed earlier) there is little need, just in my opinion, for you to test for HSV 2 given your only possible genital exposure, aside from giving oral sex which is very low risk for HSV 2 acquisition, was one episode of protected intercourse.  The odds of acquiring herpes through that is very very low - well under 1 in 100.

Terri
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41 months ago
Hi Terri,

Thanks for all your info and advice!

My final question then is - should I now continue on with life and forget about all of this and the constant worrying in your opinion?



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
What I can certainly is that your risks are very low for acquisition of HSV 2 in the situations that you describe.  I don't know what your previous sex life is like nor if you were at risk previously.  If these are  your only sexual experiences in your lifetime, then I think the need to test further just isn't there.

Terri
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