[Question #6718] HSV Lesions

14 months ago
I saw a cut on my penis a couple days after a new sexual encounter (with a condom) but was traveling so I couldn't get it tested before it went away a couple days later. Does the fact that it healed so quickly rule out that it's a primary HSV outbreak? (I tested IgG negative five weeks later, so it's unlikely to be a recurrent outbreak) It seemed likely to be from friction because I had been rubbing that spot a lot in the days leading up, but I can't be sure...

In general, do I need to rush to a doctor for PCR testing and shut down my sex life for six months before getting blood tested every time anything shows up on my genitals, or are there better guidelines to follow?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
Normally, herpes lesions do not heal quite that quickly and a cut on a penis is unlikely to be herpes - we see that more often in women than men.  I do not think that you need to rush to the doctor for a PCR if you have no future lesions.  And the wait is 12 weeks, not 6 months for a final test if you decide to do that.  A negative IgG five weeks later is probably about 60-65% accurate (that is, that it will stay that way if you tested again at 12 weeks).  And the fact that you used a condom is also very protective against herpes.  No perfect, but very helpful.

Terri
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14 months ago
Thanks. So what sort of symptoms or lessons or circumstances would mean I should rush to get a PCR test? I understand they need to be done soon after the symptoms appear 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
I would say any blister or ulceration on the penis would benefit from an in-person evaluation.  It's difficult to know what a cut would look like or would be from but that might also warrant a visit.    I think you could re-do the IgG test in some weeks and go from there.  The IgG test missis about 8% of HSV 2 infections compared to the gold standard western blot.

Terri
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14 months ago
What do you mean by go from there? And what do I do until then?
14 months ago
What I saw looked like the skin had been pulled apart, it appeared inside of a fold of skin on my penis.  It was very subtle and I could only see it if I pulled the skin back to open it up.  It was like a linear crack, and red on the inside, but not oozing or anything like that.  It was gone as far as I could tell within 2-3 days, never scabbed over (aside from tiny little dots of scab that appeared inside it as it healed), never itched or burned.

I've seen Dr. HHH say on these and other Q&A forums that it's impossible for an HSV lesion to heal in less than a week, but then I see people here post stories that seem to conflict with that.  In the meantime, I don't want to put my girlfriend at risk.  I know the chances are low that I got HSV2 from receiving oral sex with a condom on, though she put it on with her mouth so I'm concerned there could have been brief contact or saliva could have gotten under the condom.  I also had sex with a condom with someone else the day before I noticed the cut, but since it takes at least two days after exposure for symptoms to appear, it seems I can rule that out as a source of this particular cut I noticed.

Do I need to abstain from sex until I hit the 12 week mark to protect my partner?  Is a negative IgG test at 12 weeks enough to reasonably say I'm safe?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
What I meant was you can decide what to do next if your IgG has changed.
I do think it is possible for herpes to heal in less than a week, most certainly, but that would be more likely a recurrence than a new infection. I think he was talking about a new infection taking longer than a week to heal and with that, I agree.  And you had a negative IgG so it seems unlikely that this would be a recurrence, right?
The risk of getting HSV 2 from receiving oral sex is just astronomically low.  Especially with a condom, even if she put it on with her mouth. 
The thing is, condoms reduce transmission from females to males by 65% so it's not perfect but pretty darn good.  The skin lesion is slightly concerning to me but not greatly so, given the condom use and the fact that it looked atypical. 
You could go to a middle ground which would be using a condom with your regular partner until you retest at 12 weeks and get a negative result.  At 12 weeks, the IgG test will miss 30% of HSV 1 and 8% of HSV 2, compared to the western blot
But with the addition of the condom, I think those numbers are actually much lower in your situation.  Good job with the condom use, for sure.

Terri
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