Atypical, but alarming symptoms regarding herpes exposure from a one-night stand

Dear Dr. Handsfield,
23 days ago, I regrettably had a 1 night stand with a friend.  I performed unprotected (fairly rough) oral sex on him and engaged in protected vaginal sex. Wasn't in best frame of mind, so unsure of each act's duration.  2 days later, his friend told me he's had genital herpes for 6 months.  He felt he didn't need to tell me b/c he was taking daily suppressive therapy, unsure if he's really taking it daily.

Been a nervous wreck since.
Symptoms:
1. 3 days after exposure, my lips/area around lips began to swell/tingle -  started taking l-lysine. Lips have sand-like bumps on outer ridge.  Had 2 bumps on both edges of lower lip that have come and gone.
2 Had diarrhea/loose stool for 5 days, but have IBS history from anxiety
3 Intermittent tingling/soreness around genital region/groin (esp. right)/hip flexors/armpits, but no sores/bumps
4 Scariest: intermittent facial swelling/numbness for the past 3 weeks. Started around mouth, progressed to nose/nostrils, chin, cheeks, eyes, above eyebrows, neck. Antihistamines don't seem to help, but oddly exercising does.
5 Slight swelling of labia majora (gone away)
6 No temperature, but feel achy
Went to the UW clinic 2 weeks post exposure.  Nurse said face/genitals/uterus looked normal. HIV, Syphilis, Gonorrhea, Chlamydia, Pap Smear: all negative. Western blot test showed "No evidence of previous infection with type I or type II herpes." The nurse referred me to allergist, said to get another herpes test in 6 months.
Questions
1 What are the chances my symptoms are attributable to HSV-2?
Read Herpes can rarely cause full blown swelling/hives. Could I have somehow gotten the virus into my bloodstream to cause this facial reaction?
2 If I have no lesions, do you think I need to be retested for herpes?
3 When is the earliest I can put my mind to rest? Unsure what to tell future partner regarding chances of having HSV.

Thank you so much.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

Shame on your partner for not telling you about his herpes until after the event.  Your risk was low (details below), but even so, it isn't fair to put someone through the sort of anxiety and worry you now are having.  I hope you'll show him this thread -- perhaps it will help him learn to not put future partners in the same position.

That said, the average transmission risk for HSV-2 transmission is once for every few hundred exposures, and lower still when taking suppressive therapy.  The risk is higher in the first 6 months after a new infection, but still low.  (If his herpes is from HSV-1, your risk is even lower -- probably under one chance in a few thousand.)

As for your symptoms, none are typical for new HSV infection.  All your various tingling sensations aren't worrisome -- recurrent HSV can be associated with such symptoms, but not generally the initial infection.  Diarrhea for sure isn't caused by herpes.  Further, if "UW" means the University of Washington, you can be confident you have received very high quality care; the knowledge about herpes is very high in Seattle in general and in the UW cinics in particular.  (It's also a good bet they're up to speed on herpes at the U. of Wisconsin!)  Your negative blood test, including Western blot, doesn't mean much by itself; it takes more than 3 weeks for positive results.

To your numbered questions:

1) I'm sure your symptoms are not due to herpes.

2) Re-testing is optional from a medical standpoint. However, from an emotional standpoint, I would recommend it.  My guess is you'll continue to worry until you have a definitive test result.

3) You don't really have to wait 6 months.  If you have another negative standard HSV test (IgG, not Western blot) at 3-4 months, it would be virtually 100% proof you weren't infected.

I hope this has been helpful. Best wishes--  HHH, MD

[koro537]

Sorry doctors.  This is koro 537.  I forgot to mention that I did develop a bump on the roof of my mouth (the hard palette)  and felt bumps on the inside of my lower lip.  However, the bumps on the inside of my lower lip have no erupted and I'm unsure if I might've caused them from constantly checking/touching and biting my lips. None of these bumps on the inside of my mouth hurt or burn or itch.  Thank you so much again!

[koro537]

Lastly: because of my strange sensations around my lips/mouth, I applied Neosporin a few times, as well as Aquaphor.  Do you think the small bumps could simply be pimples, as I do have oily skin? Sorry, this is my last comment. I  really do apologize.

[H. Hunter Handsfield, M.D.]

No need for apology -- clarifying comments aren't a problem.  Howeber, I saw these comments before replying above.  They don't change my opinion or advice.

[koro537]

Then I will get the standard HSV test around the 3-4 month marking.  Thank you so much for the prompt and informative response. I truly appreciate it.

[koro537]

Hi Dr. Handsfield.

I'm sorry to trouble you again. I'm not sure if I have to ask a similar, but new Question in a new formal Question box. If I do, I shall re-post.  I spoke with the man I slept with, who informed me that his outbreak was not on his genitals, but rather above, between his genitals and belly button.  Does this change the chances I got HSV-2, since the skin above the genitals is less thin than the skin on the genitals?
Thank you again.

[H. Hunter Handsfield, M.D.]

This might slightly reduce the chance you were infected, but not because of differences in the skin.  But your risk was so low anyway that it probably makes no important difference.

Go ahead with plans for later testing.  In the meantime, try to put this out of your mind.  It is exceedingly unlikely you were infected and you can expect the last blood test to remain negative.  Until then, there aren't any circumstances you can think up that would change my opinion or advice -- so I won't have any further comments or advice until the blood test is done.

[koro537]

Thank you so much for the informative response. As always, I really appreciate your expert and timely advice. This forum provides an unparalleled service for people like me.  Thanks!