Confusion about Herpes/Testing

[whoknows979]

Doctor,

I've been suffering from a bit of anxiety after an unprotected oral sex exposure (I received) that happened about 10 weeks ago. Since then, I've been waiting to get tested for HSV-1. Exactly 10 days after exposure, I noticed a small bump on my testicle that became red, as well as the area around it. After about a week, it lessened in physical appearance and turned more into just a red area, not so much a bump anymore. There was no pain at any point. I don't remember ever having an irritation that looked like this. Though this isn't a typical description of a Herpes outbreak, I know outbreaks can sometimes be very mild and even go unnoticed. This is what originally got me concerned.

I went to visit my local clinic today, but soon found out that they do not do IgG blood tests for HSV, instead they only do culture swabs. When I asked why, the nurse explained that even after a positive HSV-1 result comes back, what does it prove? Only exposure to the virus, it doesn't mean that the person will ever have an outbreak. She mentioned it just brings about unnecessary stress and anxiety to those who get a positive result.

I understand it's dumb and immature to be so anxious about herpes. Afterall, millions of people have it. However, I personally struggle with it mentally, and know that the only way I'll be able to think clearly is if I get tested. At this point, I'm not even sure what my question is. I'm looking for a bit of advice as to what to do next and how I should deal with this. Thanks very much.

[Edward W Hook, MD]

Your comment (I agree, not sure that there was a question there) elicits several comments which will, I hope, be helpful to you.  

For starters, even if your partner had HSV-1, the chances of your getting infected from a single exposure are low.  Most exposures do not lead to infection.  

In addition, I think the perspective of the nurse you spoke to was correct in many ways.  If you get tested and are negative, it would certainly provide further evidence that whatever caused the area of redness (which was not typical of herpes) indeed, was not herpes.  A far more likely result however is that if you get tested, you will find that you had antibodies to HSV-1.  I'm not sure how it would help you. The antibody test tells you nothing about the location of infection.  Over 60% of adults have HSV-1 antibodies with most of them having the antibodies because they have had oral herpes.  Of  those with HSV antibodies, about 90% have never had an outbreak and therefore would be unaware if they had not been tested.  Finally, if you have genital HSV-1, which is very unlikely, both the chance of having a recurrence4 and the chance of giving it to a sex partner are very low and far, far lower than if you had HSV-2.

Putting all of this together, I too see little benefit to getting testing.  I hope my comments help you in sorting out your dilemma.  EWH

[whoknows979]

Thanks so much. I appreciate your quick response, I'm happy you were able to clear that up for me. Just a follow up: For my own understanding, why is it that the chances are low for contracting HSV-1 genitally from a single exposure of oral sex? If acquiring HSV-1 orally is so common and so contagious, wouldn't it be just as easy to get it genitally from someone shedding it orally?

And one more: I mentioned that I noticed the small irritation on my testicle, which her mouth never touch what-so-ever. Would it be more likely that something would show up on my penis, since that was the area of focus?

Thank you in advance.

[Edward W Hook, MD]

The idea that infections are highly contagious is incorrect. My statement regarding the low risk of infection following a single exposure is based on numerous observations and studies but does not have a simple answer.  It turns out that most persons exposed to infections, whether STDs or even the flu do not get infected.  How contagious something is varies from person to person and is modified by a long list of things which include both the characteristics of the virus or bacteria and the both characteristics of the infected person and the person who is uninfected but exposed.  

Yes, if you were to get HSV, it would show up at a site of exposure, not an un-exposed site.  EWH

[whoknows979]

Once again, thank you for such a quick and concise answer. This will be my last post here.

For clarification -- I noticed on another post that Dr. HHH mentioned that the herpes virus (on most occasions), needs to be "massaged" into the skin in order for it to infect that area. As I said before, the bump and area of redness I spoke about following my sexual encounter was located on a part of my genitals where the female who was giving oral sex never actually touched with her mouth, I am sure of this. Her mouth only made contact with my penis itself. Would it be impossible for HSV to be transmitted to my genitals, (the scrotum area) if there was never any physical contact with the site where the irritation occured? Your previous post mentioned it would show up only at the site of exposure -- I'd like to make sure I'm understanding that correctly.

Thanks again.

[Edward W Hook, MD]

It is time for you to stop worryng about this.  There really is no reason for you to think that you have herpes or that your lesion was herpes.  Herpes IS transmitted by direct contact and by your report, your partner did not contact your scrotum.  As far as Dr. Handsfield's comment is concerned, he is correct, friction clearly and definitely increases the risk of HSV transmission.  That said, it still is infrequently transmitted even with the friction supplied by intercourse and other sexual activities..

Once again, time for you to move on.  To help you do that, I will move on too.  This thread is ending.  EWH