[Question #6661] HSV1 Genital Atypical

14 months ago
Background: Male. HSV1 oral since childhood. Ave 1 episode yearly stress, sun, etc. Now 60yo.  April 2019 new female partner. 1 week post oral/vaginal sex noticed prodrome/tingling lower lip.  Started Valacyclovir 1gm bid x 3 days.  Also noticed tingling head of penis approx 1 week after sex.  No sores in that area.  Maybe slight redness.  Also a few "pimples" below waistband of undershorts. Disappeared after a few days.  Dismissed as shaving irritations. No weeping vesicles.  IgG test May 40.8 HSV1.  HSV2 negative.  Continued Valacyclovir 1gm QD for 1 month.  Symptoms subside but don't disappear completely.  Test again August and 45.8 HSV1 HSV2 negative.  Symptoms pretty much disappear in September.  Late November symptoms recur-slight tingling lower lip AND head of penis.  Start back on Valacyclovir 1gm QD.  No SORES either lips or penis/groin area.  Here we are February 2020 and STILL have symptoms in genital area.  Symptoms are tingling on head of penis and recently chronic (varying intensities) "pinching" feeling in scrotal area.  In looking at Aug 2019 lab they also did a DNA PCR (?) test negative both HSV1 and HSV2...  

Question: What do you think the probability is of auto-inoculating myself genitally with oral/vaginal sexual play and intercourse?  I asked this partner about STDs and she said she tested "clean" after our episode.  And what is your experience with sub-clinical tingling with no classic blisters/sores?  Thirdly, I'm very anxious that I'm having these symptoms for MONTHS when I'm hearing most episodes last only days or weeks.  Comments please.  Thank you.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
Good questions.  I think the chances are exceedingly low that you would somehow acquire HSV 1 genitally after having it orally since childhood.  Also, HSV 1 genitally would never be symptomatic for months at a time - neither would HSV 2 for that matter.  I don't know what is going on with your penis but I don't believe it's herpes.  Was your contact with this person condom protected or not?  If not, have you been tested for other sexually transmitted infections?

Terri
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14 months ago
Thanks for the reply.  Yes I agree the symptoms are not typical, but the fact that I had the oral tingling I'm so familiar with and in conjunction had the sensations on my penis makes me think that it could be HSV1.  However, I'm hopeful that it's not genital HSV1.  The sex was not condom-protected.  I have not been tested for any other STDs, but the lack of discharge or any outward signs other than the "sensations" makes me wonder what type of STD would even be possible.  So...  To follow up, what type of physician should I consult - urologist? dermatologist? STD clinic? Otherwise?  I don't want to go on a wild goose chase as I am skeptical that I'll get a good answer from a GP.  And IF this is another type of STD with only "sensations" as described what might it be?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
I understand why you might think it could be HSV 1 and I certainly cannot promise you that this isn't HSV 1 but I seriously doubt it! 
Maybe an STD clinic as a start?  Or you can even order your own STD testing online without seeing a clinician as a starting point.  If everything comes up negative, I would take those results to a urologist.  Or you could start with the urologist.  You aren't describing concerning skin symptoms so I chose urology over dermatology

Terri
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