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primary outbreak and transmission questions
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primary outbreak and transmission questions

How do you know if you are having a primary outbreak or a recurrence? I've heard that in a primary outbreak, the symptoms are quite pronounced. However, being  a female and having had irritating yeast infections before, I'm wondering if what I thought was a yeast infection was actually an outbreak. However, I never had clusters of blisters before like I did just recently. Also, the subject of transmission is just so confusing. Some sources will tell you that you usually get your first outbreak within 2-14 days after transmission, others will tell you that you can get it months or years after transmission. If you have sex with somebody and have an outbreak a week later, is it safe to assume that that person transmitted the virus? Or should you also try to notify the person you had sex with three months back? This is all so confusing.
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First thing you need to do is get tested with an IGG Herpes Select Test and go from there. If you were recently infected, it will usually come out within a few weeks. It is possible to not show any signs forever or to get symptoms every month. The variation of this disease is different for everyone who has it so get tested and stop reading and from there we will work this out...
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101028_tn?1348750963
Studies have shown that about 1/2 of all presumed new herpes infections are actually just the first obvious recurrence of a prior infection. You really can't rely on the severity of symptoms or anything like that as to if it's a new infection or not. As slacker said - if you get a type specific herpes igg blood test at the same time as your symptoms you can better help narrow down if it's a newly acquired infection or not. Same as if you test + on the blood test but your partner doesn't then you know it's not a new infection for you.

so who do you tell?  Well really the only people who matter at this point is you and your partner.  All past partners are responsible for their own sexual health and should be requesting regular std testing to keep an eye on their own status.  If you want to tell past partners then by all means do so but you don't have to since there's no way to figure out who you got it from if you didn't get it from your current partner.  It's totally your choice.

grace
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Thnak you so much for your comments. I did recently test positive for HSV2 on a culture test about two weeks after having sex. Are you saying that I should now get ann IGG test too to see of it was a new infection?
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I should also say that I started having the severe symptoms a few days after having sex which is what prompted me to go to the DR.
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101028_tn?1348750963
The blood test needs to be done at the same time as the initial appointment for it to be helpful in determining if it's a newly acquired infection or not.  About 1/2 of folks will seroconvert to test + on the blood test by 2 weeks so at this point I recommend your current partner getting a blood test to see what his status is.

grace
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Thank you for your message. My partner is awaiting the results of a blood test. But, I have to tell you I was surprised by what his Dr. told him. He apparently checked him for symptoms, didn't see any, and told him he didn't think it was necessary to get a blood test since he had no symptoms. He did get one, but I thought the advice was strange since I just tested positive. I know if the tables were turned, I would get tested and would expect the Dr. to tell me it would be a good idea. I don't know. maybe I'm missing something. What do you think?
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101028_tn?1348750963
unfortunately some providers still think you can tell by looking at someone's genitals as to if they have herpes or not.  I think they also believe in santa and the easter bunny too.

grace
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Thanks again for responding, it means so much as I'm going through this. Am I to understand that even if my partner tests positive, it doesn't necessarily mean I acquired it from him?Also, I thought I heard that symptoms, like blisters, usually show up on one side of the genetalia during a recurrence, whereas during an initial outbreak, they can can show up on both sides? Any info. on this?
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101028_tn?1348750963
Yes it is possible that you both came into the relationship hsv2+ and never realized it.  You might never figure out who had it first at this point.  herpes is a tricky virus!

Usually recurrences are just one sided. There are exception to that rule but for the most part that's the way it goes. At the same time - initial ob's can be one sided too.  You really can't judge anything from the way an ob presents.

grace
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Thank you again. I can't tell you how much it means that you respond as I'm so confused and sad about this situation. My relationship with my partner was not stable at the time I got diagnosed and this is just placing more strain on it. I don't have many people to discuss it with as I have not told anyone except him. He is too freaked out to deal with it directly. I did speak to a person at the clinic where I went today and she told me that blood tests are pretty unreliable and that my partner could test negative for the virus, yet still have it. This, I know is going to be too much for him to handle. Are there no absolutes for this virus? Everything just seems so random.
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101028_tn?1348750963
Unfortunately many health care providers don't understand herpes testing.  At this point he needs a type specific herpes igg blood test to see what his baseline status is. If he's negative at this point it means you didn't get it from him if your own blood test is + for hsv2.  If he's been infected for more than 3 months - it will show up on the blood test.

grace
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Is it normal for herpes symptoms to last for approx. 4 weeks? I feel like I'm definitely healing, but still have irritation, discharge and sensitivity.
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101028_tn?1348750963
I'd return to your provider and get tested for yeast and bacterial infections. Don't guess and self treat - go be seen and get properly tested. Still having symptoms at this point means it's likely that something else is also going on and it sounds like it might be vaginitis for you.

grace
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Been reading a lot in this forum which is so helpful. Thanks to everyone who contributes. All my symptoms seem to have subsided, yet I am so tired all the time (have had a cold for the past two weeks, though). I am on suppressive therapy with Valtrex and am wondering if anyone has experienced lethargy and loss of appetite (lost 5 lbs.) due to this medication? I suppose it could also be due to the emotional roller coaster I've been on since being diagnosed. I'm also wondering about herpes and cervical cancer. Is there any link?
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Avatar_m_tn
Concerning the link of Herpes to cervical cancer. An interesting study of women with cervical cancer reported that 44% had cervicitis and an associated infection of HSV-2. However these data were reported by an epidemiologist in a small group of women.The importance of this is still uncertain.  It was also noted the women infected with Chlamydia or gonorrhea also had higher incidences of cervical cancer. It is also interesting to note that part of the HPV genome is being used to treat head and neck cancers and neuroblastoma tumors in children. Maybe there is some good to be found in the Herpes virus.
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101028_tn?1348750963
herpes has not really been associated with cervical cancer on its own. Hpv is more of the culprit there.  It's not unusual to have hpv and also hsv2 though.  

Have you had your hpv vaccines yet? Do you get regular paps?  

grace
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I had my last pap smear in Dec. and was diagnosed with HPV, however, I believe the Dr. said it was not a dangerous strain and that it would probably go away on its own. I have to get retested in June. So, I guess the vaccine is not an option. I'm 41 anyways. Not sure what age they suggest it for. Does the dual diagnosis pose a risk? Any thoughts on the tiredness and Valtrex? Maybe just a remnant of the virus?
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101028_tn?1348750963
Low risk hpv is not associated with cervical cancer anyways.

Currently the hpv vaccine is only approved for women 26 and under though by the end of the year that will probably change.  Hopefully by the end of next year it will be approved for males too.  

Some folks do feel tired when first diagnosed and on antivirals ( plus you seem to have that nasty cold that's going around right now too from the sounds of things ). It will get better.  

grace
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Thnak you for your comments. It seems I have a million scary thoughts running around in my head. This in addition to trying to accept that I've acquired this virus and how it will affect my life. I've heard it doesn't matter who gave it to me and I'm trying to accept that, however, part of me really wants to know. Especially since I don't feel my last partner waws honest with me about his test results. I suppose it's one day at a time. Thank you for being a sane source of support.
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I notice that you often mention that studies have shown that 1/2 of presumed new herpes infections are actually just the first obvious recurrence of a prior infection. I was wondering if you could list the names or titles of those studies. I'd be interested in reading them. Thanks for all your helpful knowledge.
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I have no idea at this point which particular study that stat came from. Just one of those stats that stuck in my head.   I've read way too many studies over the years to remember where each stat comes from specifically!

grace
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If you wanted to see a doctor who was an "expert" on herpes, would it be more beneficial to see an infectious disease doctor, ob/gyn or dermatologist?
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I'd check the westoverheights site and see if there are any doctors in your area on the lists they have there for other providers.  Those on the list usually are folks who have attended Terri's talks and hopefully aren't trapped in the older ways of thinking about herpes and are fairly up to date on it all.  There is also a doctors list on the herpes homepage too and I believe you can call asha's herpes hotline and they have lists too.  no guarantees you'll get superior care from anyone on those lists but it's a start.  Another option is to look for a herpes support group near you ( the asha help groups or even check out yahoo groups ) and ask them for recommendations.

I personally get all my herpes care from my regular doctor.  I've trained him well over the last 21 years I've been treated by him....he he he  Some obgyn's are much better than others - some of the worst herpes info I've gotten has been from obgyn's unfortunately. Makes no sense since 25% ( or more ) of their patients have genital herpes...sigh.  Fortunately herpes isn't that hard to deal with.  It's getting into the proper mindset that is the issue most times for providers - not being afraid of properly medicating your patients, not getting stuck in the "oh it's just your herpes, deal with it" mindset as well as remembering that just because something is going on in between the legs doesn't mean it's herpes so rule out everything. Also sometimes they have a hard time putting aside their own bias's and reminding themselves that just because someone has herpes doesn't mean that they must have every other std in the book.  Ok rant over!!

grace
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No family doctor is going to refer you out to an I.D. doc for herpes. That's overkill.  Like grace said, you should be dealing with your family doctor/ObG, or whoever does your regular routine care. A dermatologist is also a specialist, and you won't get referred out to them unless your family doctor can't figure out what it is you have. If you already know you have herpes, you'll be dealing  with your primary practitioner. (For a lot of women, that's an ObG; for others, it's a G.P.)

If you want medication, ask for it. If I were you, I'd just get up to speed as much as possible on the virus, how and when it's transmitted, using the medication, etc., and then just deal with your family doctor armed with your information. Frankly, all I need from my doctor is medication. I don't particularly care whether he's up on anything herpes because I don't really need him to be. This website (and the doctor's forum) gives me all the information I need. As long as I get medication when I want it, I could care less how much my doctor knows about it.
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Thanks for your suggestions. I will check them out. I don't think I need a referral to a specialist on my health plan, so that could be an option. I originally got treated at a PP, and got different information from the 2 providers I saw on 2 different occasions (different opinions on medication usage, one provider said my current partner at the time should get tested and the other provider said it didn't matter, one provider stated I would never know who I acquired it from and the other said, after listening to my history, that there was a good chance it was my partner at the time). I also called one time to speak to a provider (she was busy so the person who answered the phone said she would try to answer my questions) and again, I received different information. As I was in a state of shock at the time, it was difficult to sift through all the different opinions and make the best choices. Oh yeah, nobody ever called me with my results, so I called 1 1/2 wks later and the person who answered the phone said "No news is usually good news," put me on hold, then came back and told me I was HSV-2 positive. I honestly think they are all compassionate, intelligent people, but it was difficult to figure out which information was accurate at that crucial time.
I would really like to discuss the best course of action for my medication with a provider who is knowledgable. I'm currently using Valtrex for suppressive therapy, but have heard a lot of differing opinions about it. Transmission is not a concern at this time, but hopefully, could be in the future. I really want to avoid outbreaks as much as possible since the first was excruciating and caused me to miss work. In addition, 1 of the providers at PP said that there is no conclusive research that Valtrex cuts down on transmission after the first year of using it. Has anyone heard of this? That's a major bummer to me since I can't picture myself getting into an intimate relationship any time soon. But, I was hoping I'd eventually come to terms with it and be able to use suppressive therapy as a precaution.

Thanks also for the info. on the support groups. There is one in my state (about an hr. away) that meets once a month. I went this month and plan to go next month (if I can afford the gas, ha ha).
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Valtrex cuts transmission risk by at least 50% if taken properly. It could be even higher than that. But it's at least 50%. That is as long as you use it correctly. Once you stop using it on a daily basis, you lose the benefit of preventing transmission to a partner.

So the one provider who told you it doesn't work is wrong. If you don't mind taking medication every day to prevent outbreaks, you can keep taking it. There are no long-term issues with the suppressive drugs. The original medication from which Valtrex was designed has been on the market for a couple of decades at least, so we know it's safe.

For future dating, I would insist on full STD testing of both of you so that you both know where you stand. You know what you have, and you need to know what your partner has. I've never had a problem with a partner refusing to be tested. (Usually they are eager because it means we can get on with having sex!) Unfortunately, I'm always meeting HSV-negative guys. :( Given how much dating I've done, it surprises me I can't meet anyone who also has it - I only use medication if I have a negative partner since I don't have any symptoms.  But about 25% of people out there have it, so it's probable you may meet someone who has it already.
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101028_tn?1348750963
Valtrex when taken suppressively continues to protect your partner - not just for 1 year and then there isn't any benefits. I'm not sure where that provider got the info on that from unless they way they explained it was confusing and they only meant that they only have info on use for 1 year in discordant couples or something?

Feel free to ask any other questions about suppressive therapy you have too.  I'm not only suppressive therapy's #1 fan - I also know a thing or two about it ;)

grace
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Thanks for the info. Wish I had been smart enough to insist on STD testing prior to this. I was definitely in a state of temporary insanity over the last year and a half when it came to sex. I can't believe I was so careless about unprotected sex with the partner I was with. I mean, I was way more conscientious about that even with my ex-husband.

Maybe I was confused about the provider's explanation of Valtrex losing its effectiveness for reducing transmission after a year of usage, but I thought that's what I heard. Glad to hear differently. Could you recommend any websites, studies, etc. that I could get more information from?

I may become a huge fan of suppressive therapy too! Not that this is great news, but I think I am getting, or have gotten, a reocurring ob. Had some mild itchiness, irritation and discharge over the past couple days, but thought it was maybe due to my oncoming period. Checked down below today and thought I saw 2-3 tiny bumps on one side of my vaginal wall. Same place as original ob, but that was bilateral. If this is the only discomfort I'm going to get, I have to say, I'll be so relieved! I'm wondering if the difference in pain felt in my first ob compared to this one (if this in fact is an ob) is due to suppressive therapy with Valtrex or if this is just the way my obs will reocurr? Since my first ob ocurred at the beg. of Apr. and lasted until the beg. of May, isn't it unusual to have another so soon? I guess it's probably different for everybody, but you know, it would be nice to be average when it comes to this.  

Just a note: although I'm pleased about the level of discomfort felt during this supposed ob, I'm definitely not that happy about getting a reocurrence. I was still kind of hoping this was all a big mistake.



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101028_tn?1348750963
About half of folks have a recurrence within 2 months of the first one - pretty common.  It might not even be your herpes even.  If you still have symptoms or they get worse after your period - see your provider to get checked for yeast and bacterial infections.  When you think you have a recurrence - you increase your valtrex to 500mg 2x/day for 3 days.

The herpes handbook at www.westoverheights.com has terrific info as does the www.ashastd.org site.  Also the valtrex website itself has some wonderful information - especially if you go under the for healthcare providers section.  There are some instructional sections there that I think are really worthwhile for non-medical folks to watch and learn from.  

grace
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Thanks for the reply and the reminder about increasing my Valtrex. Those same directions are on my presciption bottle. However, since my brain has definitely not been thinking clearly lately, it didn't even occur to me. Guess I'm just surprised about the supposed ob. Do you think I should increase the Valtrex even though I'm not sure what it is? My symptoms are not horrendous and I just got my period today, but I want to take the medication correctly. I called my provider and scheduled an appt. for Friday. I wish I had remembered about increasing the Valtrex so I could have asked that question while I was on the phone with them today. I'm truly appreciative of your knowledge.
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If it's been more than 3 days - don't bother increasing your valtrex - the ob is almost over anyways then.  Just something to keep in mind for the future. I'm a fan of erring on the side of caution and increasing the meds anytime you think it might be an ob - sure beats waiting until you have a full blown ob that drives you nuts while you are waiting for it to heal.  

grace
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Thanks so much. I'll TRY to keep that in mind. Have a nice evening.
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Hello. Just wanted to try to clear some things up for myself. I went to my provider on Fri. and she could not find any evidence of a reoccurence, yeast, or anything. Stated that my symptoms could be hormonal due to my period. Thought I saw something a few days before, but she said it could just be the normal bumps present in the gential (genital) area. Hope I'm not going to become a freak about this. Anyways, I brought up the subject of Valtrex and it's ability to reduce transmission after a year of usage and she said that she usually weans patients off of Valtrex after a year because there have not been any studies done that prove its effectiveness with transmission after a year. She said that the risk of transmission a year after being diagnosed goes down anyways and outbreaks tend to decrease. I was just reading the Valtrex website and read the "For Healthcare Professionals" section. Under "Reducing Transmission Risk" at the bottom of the page, it stated "No data are available on the efficacy of treatment of more than 1 year's duration (for suppression)....." It also stated that the "safety and efficacy for Valtrex for reduction in the transmission of genital herpes have only been evaluated for 8 months." So, I'm confused. Am I misinterpreting the data and what the provider said to me? I certainly hope so. Any thoughts?
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101028_tn?1348750963
The statements on the website are known as cya statements.  In order to say anything different they would have to do more studies and go for additional FDA approval to say anything else. Not going to happen is the gist of that one.  

Terrific article by dr stephen tyring called valacyclovir, 20 years of acyclovir safety ( or something close to that ).  Your provider needs to read it.

The 8 months part is that the valtrex and reduction in transmission study was only conducted for 8 months.  They have not done long term discordant couple studies due to poor compliance in keeping people enrolled that long as well as cost.

The first year of infection we shed the virus about 3x more than we do after the first year or so on average. So yes during the first year the risk of transmission is highest.  Info from studies done has shown that couples are most likely to transmit the virus during the first 2 years of being infected but it also shows that you leave that relationship and move on to another later on - the risk is high again during the first 2 years of that relationship. Your providers reasoning is a little flawed but I certainly see where it's coming from.  

It's totally your choice what you wan tto do. I know I trust the herpes antivirals compleletely. I've been on suppressive therapy more than I haven't. I was on it for 12 years non-stop at one point - only stopped to participate in a research study.  I went right back on it when I was done.  I don't have time for ob's and I don't need to worry about my partner either.

grace
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I can't believe it, but I'm actually going on a date tonight. First one post herpes diagnosis, which was in April. At that point, I thought I was destined for celibacy. This situation just kind of fell into my lap. I've been getting to know him for almost a month due to work and it's progressed to this. However, I am honestly so scared about having the "talk." I know I don't have to jump right in and tell him my status and that I may not even want to sleep with him after getting to know him better. But, how have others dealt with their nerves when telling someone for the first time? I'm thinking I'll just feel so exposed.
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101028_tn?1348750963
It's the first date - why not just worry about what you are wearing and whether you'll be a klutz and end up wearing half your dinner ?  :)

grace

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You are sooo right. I'm kinda jumping the gun here. Thanks for bringing me down to earth. Anyway, just got in and had a good time. Herpes was not a topic of conversation. Ha ha. I appreciate the reality check.
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:o)  

I don't recall ever telling a guy on the first date. I just want the first date to be ... well, first datey. :)

He doesn't need to know about it until the two of you are ready to have sex. But you should also ask him if he's had anything and has he ever been tested.
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Thanks for the reply. It was good to be reminded that I still need to be worried about a guys STD status and not just worry about how mine might affect him. Does this dating thing ever get less complicated?
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Well I'm 106 and dating still isn't easy - and not for anything that has to do with my herpes!!!  I've been dating someone new for about 6 weeks now - our first date - I really was just meeting him to get it over with ( we had met online on a dating site ) and so I show up with my hair still damp for starters and I"m half asleep because I had only slept 3 hours after work that day and then I ordered a salad and broccoli. I'm sitting there with lettuce stuck in my teeth at one point and then I get freakin broccoli stuck in my teeth later on in the meal. I'm sitting there trying to keep my lips closed and suck all the produce out of my teeth without looking like a goof....lol.  I guess he didn't mind the green in my teeth - we are still going out :)  Of course up until the first face to face date I thought he had 2 kids, found out it's actually 4.  I might not be right in the head myself...he he he  Needless to say the 2nd date - I gussied myself up a bit better...he he he  

Glad your date went well :)

grace
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106?? Sounds biblical, though I can relate to the feeling. Oh the horror of eating greenery in front of a guy for the first time. There's just no good way. I guess your guy could be a keeper though as he seems to like his women au natural. Glad you got the chance to dazzle him again. Thanks for the story.

note to self: if and when there's a 2nd date, stay away from cruciferous vegetables.
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don't eat corn on the cob either on the first or 2nd dates - learned that lesson a few years ago...he he he

Yep even us old broads still have to deal with dating sometimes ;)  The older you get, the more baggage we all carry around. At least I can control my herpes with a pill or two a day - not that easy to control ex's and kids and bad habits and debt etc.  It's never as easy as boy meets girl, boy and girl fall head over heels and live happily ever after :(

grace
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I'm not looking for trouble, but I'm wondering if it's normal to not have had a recurrence since my initial outbreak in March of '08. I have been taking daily Valtrex since that time. I'm beginning to wonder if my culture was typed incorrectly (I was told the results were positive for HSV-2). Any thoughts?
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valtrex is why you aren't having ob's :)

If you read their prescribing info ( available on their website ) they break it down into what % of folks don't have an ob 6 months into suppressive therapy and how many are still ob free 1 yr into suppressive therapy.  Of course none of that really matters since only time will tell how it'll be for you.

and I know you aren't complaining about not having ob's right? lol

grace
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Thank you for your response. No, I'm certainly not complaining, but definitely hoping it stays this way. It sort of makes me afraid to ever go off of Valtrex.
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You will still get ob's while on suppressive therapy,  just way less which to me is always a good thing :)

grace
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Hello to all. I was so busy today that I forgot to pick up my Valtrex refill. My pharmacy is now closed.  Unfortunately, I am completely out and will not be able to take one today (I take it as supressive therapy). Does anyone know how this will affect/interfere with transmission reduction to a partner? I will pick them up tomorrow and begin taking them again. However, I will not be able to get them until around 4:30 or 5:00 p.m. Any help would be appreciated.
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Just missing a day every now and then isn't an issue.

grace
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Thank you so much Grace. I appreciate your help!
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I was wondering if anyone could help me. I recently developed what looks to be a pimple above my clitoris in the pubic hair area. Since I haven't had a recurrence since my diagnosis a year ago, I was wondering if this could be one? It's not painful or itchy and I have no other symptoms. Found it in the shower. I recently trimmed this area and was thinking it might be related. I've also been on suppressive therapy since my diagnosis. Also, I've been in a relationship for four months and wanted to make sure I was providing him with the correct info. He knows I'm on suppressive therapy and I told him that there is a 3% chance of contracting it using that alone. I informed him that used in conjunction with condoms, the risk is approx. 1%. Is this correct? He has expressed that he does not always want to use condoms and is okay with the risk. I find myself reminding him from time to time about the risks using both methods and condoms alone. Is this overkill?
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101028_tn?1348750963
It's a 2% risk/year of him contracting hsv2 from you if you just avoid sex during obvious symptoms and you are on daily suppressive therapy. If he's ok with that risk, let him be if you are ok with ditching the condoms too at this point.  

I'd avoid sex until this lesion is healed. Up your valtrex dose to 500mg 2x/day for 3 days just in case it is herpes.  If it's still there in a few days or gets bigger, see your provider.

grace
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Thank you so much for your prompt answer. I really appreciate it. I have upped my Valtrex dose just in case. The pimple has been there about four days. If it is a recurrence, how long should it last and how long will I be contagious? If it isn't, any ideas what it might be? I'm going to try to get seen on Thursday if it stays the same or gets worse. Thank you again for your input. Take care.
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If its an outbreak, then it might last a few days to a week, give or take, and you can have sex again when the skin is back to normal.

If it isn't herpes, then it could be staph, or you nicked it when you were trimming (been there, done that lol).

Aj
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Thank you so much for your answer. It's so helpful to have this board. Whoever thought grooming could be so dangerous.
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