Concerned about herpes exposure

[hopefullyparanoid]

Is it possible to have recurrent hsv2 that produces only mild prodrome-like symptoms but never any visible lesions?  I was with a woman who had HSV2 a few times.  She was on valtrex and we always used condoms (but during sex she would grind her pubic bone into mine).  A few days later, I noticed soreness/tingling in groin— in particular where my groin meets my left inner thigh.  Skin on left inner thigh was rougher with raised bumpiness that I could see and feel.  Saw a doctor a week after that- he couldn’t see anything and said that if I had been feeling tingling for more than a few days I should have seen a blister or lesion, which I never did.  That tingling/roughness persisted on and off for a few weeks but never produced a blister that I could see, and finally it went away.  Now, a month later, it feels like it’s back and this time I also have a throbbing/tingling in my lower back (between where the two pelvic bones stick out).  I’d chalk this up to continued hypochondria, but I’m still concerned about being with a new partner.  If one does have such mildly symptomatic hsv, when is it theoretically ok to have sex?  Ie, if one's "outbreak" is minimal and doesn't produce blisters that can heal, then how do you know if it's over?  Thanks so much for any help!

[H. Hunter Handsfield, M.D.]

Both the location of your symptoms (groin/thigh area) and their nature are against herpes.  When herpes causes soreness and tingling, it almost always is in association with over, recognizable blisters/sores.  And on/off 'for a few weeks' is not typical timing:  herpes symptoms almost always last for a few days (only 1-3 days for the tingling), then go away entirely, until recurring again--and such recurrences always are at least a month apart.  Certainly 'throbbing/tingling' in the lower back isn't a herpes symptom.  On top of all that, the chance you got infected having sex 'only a few times' with a partner on Valtrex is very low.

Still, since you have been exposed to a partner with HSV-2, it would be reasonable for you to have a blood test.  Wait until 3-4 months after your last sex with her.  Almost certainly the result will be negative (or if positive, it won't necessarily explain your symptoms).  Until then, I don't think you are a risk to your future partner(s).  But to be even more safe, use condoms until you get the negative blood test result.

Having said all that, asymptomatic or mildly symptomatic HSV-2 infection is just as easily transmitted to partners as overt, symptomatic genital herpes. In some ways, it's actually higher risk for transmission.

Best wishes--  HHH, MD

[hopefullyparanoid]

Thanks very much, Doctor H.  As I said, I'm hoping this is all just my paranoia (I was definitely freaking out when I first started feeling stuff, and was only reassured after seeing the doctor). It's frustrating bc I can't tell if a lot of these feelings were just always there and I never noticed them before and am only noticing now because I'm hypersensitive.  I realize that I can only be fully certain if I get a blood test (I had actually previously tested negative and had only been in one monogamous relationship in the interim though), so what I was most concerned about was in the meantime, if the "symptoms" I was feeling meant that I was having an (albeit mild) outbreak and should therefore definitely abstain from sex.    (Btw, the lower back thing concerned me because all the literature talks about the virus being in the nerves at the base of the spine, so I wasn't sure if you could actually feel it there).
Either way, your answer was reassuring on that front.  Happy Fourth and thanks again.

[hopefullyparanoid]

(To clarify, my previous negative-result test was over a year before this more recent incident)