[Question #9984] Did I give myself HSV?

27 months ago

In the middle of an OCD flare, I got worried about a couple of encounters I had 3 years ago and the relationship with my ex that ended 18 months ago (my last sexual contact). I never had symptoms. I got a quest HSV2 IGG test on 4/26, and it was negative. (I have HSV-1 since childhood with an index of 55.1 and confirmed swab on my lips).

On 4/28 I was at a bar and was invited to sit with a group of people. An older lady was in my face, very close contact flirting with me, etc. They provided me with drinks that I stupidly took. Likely glasses and food was shared. I don’t think she kissed me, but my memory is hazy and wonder if I was drugged. I definitely left alone.

The next week I thought I had a razor bump on my lip. I was constantly picking at it then likely masturbated immediately after. I then realized it was more like a cold sore. Not the ones I usually get. Smaller and less painful. Different this time.

On 5/8 I noticed a red area on my penis shaft. On 5/9 there was a single tiny bump in this area. On 5/10 it had evolved into a small oval raw spot. Over the next week the red skin flaked away around it leaving a linear cut that healed from the outside in. This was above the hair area, so not folliculitis. It’s also exactly where the finger I was picking at my lip would have touched. There was never any pain even when touched.

I had a swab done on 5/10 (still waiting on results) and repeat IGG, this time with Roche’s Elecsys, also negative. On 5/11 I had a Vikor swab done (multiorganism PCR), negative for all herpes viruses. Unfortunately I had been washing the area with Hibiclens (4% CHG), which would have killed any virus on the skin, but would the PCR still pick up the dead virus, or would the biofilm from Hibiclens make the swab totally useless?

Terri Warren, RN, Nurse Practitioner

27 months ago

Before we get into talking about the testing, the experience that you had does not present a risk for herpes acquisition. Even if you kissed her, which you don't recall, you already have HSV 1 because you have your own cold sore history, right? So the presentation of what was on your lip is not important.

Once you have HSV 1 in one location on your body, it is extremely unlikely that you would subsequently get it in a new location on your body.

So when you talk about negatively testing on the IgG, you're talking about negative for HSV 2, correct? There is nothing in the experience that you describe that would put you at risk for HSV 2.

I fee like I might be missing something in this post, can you clarify?

Terri

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27 months ago

Correct. I tested negative for HSV2 just prior and just post to the bar encounter. My worry is my unusual cold sore after this was actually HSV2 spread to me from an active oral HSV2 infection (I know, rare, but any scenario here is rare) as it showed up 4-5 days later, then my penile lesion 4-5 days after that. The entire situation was bizarre. I found out one was a sex offender, and there are lots of crazy people. I'm almost positive I did not leave the table at any point as I can see the motion activity record on my phone. There is no reason I should have memory gaps based on the amount I drank (3? beers). Did they contaminate my drink intentionally? Did the person who got it for me rub a genital lesion on it as a sick joke? Part of this is my OCD, I know. But as I have never had symptoms and developed them the week after this, I am struggling to make an explanation work.

With regards to the testing, can Hibiclens affect the PCR result? The VIkor swab I think only picked up skin as the raw spot was very tiny at that point (day 3), although she did swab the area thoroughly. The swab on day 2 was just a quick up and down and sent for viral culture but changed to Aptima TMA assay (claim 2-3x more sensitive than PCR). I would like to believe these results, which hopefully I will get today. This was done about 10 hours after Hibiclens and the same day the bump evolved into a raw spot. I did not see it clearly develop a fluid filled blister on top and pop as I was at work during the day and it could have without me noticing.

Have you ever seen someone have a single red bump higher up on the shaft that turned into an area of raw skin and healed within a week that was definitively ruled out as herpes? My understanding is that that is basically all this can be, correct? It was not a friction burn as it started as a raised bump.

27 months ago

Part of the reason I think this is a new infection despite no sexual contact in 18 months, as crazy at it sounds, is because after the oral cold sore healed, I had rhythmic buzzing on another part of my lip for a few days, and now that the penile lesion (it was on the left side of the shaft) is gone, I have been have rhythmic buzzing/tingling in small specific areas down my left leg (above left ankle, left calf, left frontal thigh, left buttock), as well as pretty significant muscle in a specific spot on my upper right sacrum. The muscle pain is consistent, and the nerve pulsing episodes last about 15 minutes and come and go at the different spots for the past few days. My understanding is that herpes does things like this when newly infected after healing when the virus travels back to infect the nerve roots, correct? I don't remember having these nerve sensations before.

Terri Warren, RN, Nurse Practitioner

27 months ago

Honestly, the scenario that you present as a possibility here is so remote. I'm not aware that a sign of herpes is rhythmic buzzing on the leg.

How would you get a new infection if you haven't had sex in 18 months? If any of this is herpes, which I doubt, this would be a recurrence, not a new infection. But I doubt that it is either.

NAAT testing is very similar to PCR - both look for genetic material of the virus rather than growing is, like a culture. NAAT testing is definitely superior to culture.

I am concerned that your OCD (self described) has taken you places that you really don't need to go in terms of worry.

Terri

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27 months ago

Terri,

What is throwing me for a loop are the two different negative IGG tests in the setting of a very concerning symptom. Honestly, if it weren't for the symptom, I would have believed the tests and let this go. Can you review photos in a consult? I would love an expert opinion on what it looked like.

I have another theory. Tell me if this makes any sense. By far, the highest risk partner I had was a one night stand 3 years ago (before my last relationship). I performed oral on her, immediately kissed her, then she performed oral on me. I found out she was sleeping with multiple people at the same time and never saw her again. At first I was worried I had acquired GH from her from fluid transfer to the mouth then back to me. But that would not explain my negative IGG tests.

My theory is this: I acquired an oral HSV2 infection ONLY from her. Because oral HSV2 is very inactive, even in 3 years my immune system didn't get to experience it enough to build up detectable antibodies. During a period of extreme stress (ironically over STDs) I developed an oral HSV2 recurrence. I then auto-inoculated myself genitally, which would have been possible due to my low antibody level. I would expect I will now soon test positive and have genital recurrences as the virus will be more active now. From what is known about oral HSV2 infections, shedding, and antibody development, does this make any sense? Without shedding, you never get sufficient antibody buildup, even 3 years later? It would also explain why my ex never had any symptoms (b/c I never gave it to her since it was oral only).

So, it's new genitally, which explains the post-herpetic left leg tingling, which is still going on, mainly above my ankle and very annoying.

Thanks

27 months ago

I also came across this recently published Indian study, which suggests oral HSV2 is commonly shed (more than HSV1) and the authors seem to think it can be spread by things like spit talking. So...... yeah, I'm confused and upset as this is all coming from the fact I was picking at an unusual cold sore on my lip then touched myself and developed something herpes-like there. I am told my HSV1 antibody level would make that impossible to have been HSV1.

https://journals.lww.com/aomr/Fulltext/2021/33010/Asymptomatic_Shedding_of_Herpes_Simplex_Virus_in.6.aspx

26 months ago

Terri,

The area above my left ankle (S1) that's been tingling for the past few weeks became painful so I checked the skin and there is a new scabbed/crusty lesion there (no recent friction or trauma there). I wiped the crust off and it's a raw spot. In the exact spot where the tingling is (still) occuring.

So, in summary:

4/26: Negative IGG test

4/28: Bar encounter. I believe woman may have put her hand on my lower back down into my gluteal cleft. I asked around the bar and they said she is known to due this to men. I am worried she may have purposely scratched me after touching herself.

5/1: Notice bright red rash into gluteal cleft. Think intertrigo. Put steroids and antifungal on, it gets worse.

5/2: Weird oral cold sore I am constantly picking at.

5/8: Linear ulcer 1-2 inches along in gluteal cleft with surrounding redness and blistery-like lesions. Viral culture negative. PCR swab rejected. Repeat HSV2 igg negative.

5/9: Small bump on left penis shaft.

5/10: Bump turned into raw spot, not painful. PCR swab negative, but no vesicle fluid.

5/11: Repeat penile swab negative, again really just a swab of skin, but skin cleaned with chlorhexidine.

5/14: Penile lesion just a small cut and mostly closed up

After this, tingling along left leg, mostly above left ankle.

5/25: Now have a sore above left ankle where tingling is. You've said you've seen recurrent HSV2 at the ankle.

What do you think is going on? Unless this is a weird zoster presentation due to stress, I think it has to be a new HSV2 infection either from primary infection in gluteal cleft from a scratch (it was a nasty rash) or auto-inoculation from an old oral-only HSV2 infection. Again, no sex in 18 months and never had any below the belt symptoms since then.

Any clue?

26 months ago

Also, it's probably important to note that everyone that looked at the skin crack in the gluteal cleft and surrounding splotchy red rash said it did not look like herpes. Although on some photos I took, there are some vesicle-like bumps and ulcers. It was extensive throughout the entire crack. I would be surprised if a recurrence would present like this, which makes me think primary site. I know you say that is not a possible entry point, but the skin in the cleft was not intact from frequent moisture/sweating.

A hypothetical question: If someone wanted to purposely infect someone with HSV, if they were to scratch a lesion on themselves, then put their finger down below the belt of the person sitting next to them and scratch the skin in the cleft, how successful would this be at transmitting? I know I'm reaching but I don't know how else to reconcile all these symptoms and the timing. Alternatively, I auto-innoculated myself at this area by picking at my oral cold sore then constantly examining the intertrigo-like rash in the cleft.

If someone did develop a new infection in the gluteal cleft, how likely is it that they would develop a penile lesion a week later then an ankle lesion 3 weeks later? Obviously direct spread is not possible to those sites, so it would have to be recurrent through the nerves. Can it recur in a different area that fast after the primary infection?

Terri Warren, RN, Nurse Practitioner

26 months ago

You are way past the amount of posting that we allow here. If you had HSV 2, whether you had symptomatic disease or not, you would have antibody.

I asked another herpes professional to review the study that you presented and they agreed that it was not well done and should not be believed at this point.

You concerned about someone intentionally infecting another person is so unlikely, I don't believe that it is necessary to respond.

Your negative swab tests, negative physical exam finding and negative IgG tests should be sufficient to reassure you. I hope that you can accept them

Terri

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