Could it be HSV? - Looking for general advice.

[Amy4589]

My BF and I have been together for 3 years. For the past 4 months, our relationship has been long distance. I visited him from 10/30 to 11/1. During the visit, we had sex once before I noticed some red bumps in the middle of his penis. He shaved some of the hair so that we could get a better look. There were about 3 bumps, they looked like zits but significantly different from the bumps I get when I shave. He said that he had not noticed them. I told him I didn't want to have sex again while the bumps were there; we did not have vaginal or oral sex for the rest of the weekend. He scheduled a doctor's appointment for this Tues (11/10) but he says that the bumps were gone by this past Tues (11/3).
Also on Tuesday 11/3, I noticed a minor red spot on my top lip (mouth lip). After about 3 days of observing no change in the spot, I felt that it was probably not caused by HSV because I read that HSV outbreaks "erupt" within 24 hours of the first sign of one. It has now been 5 days since I first noticed the spot and I now feel it has become larger. Originally, I couldn't see it unless I was standing within 6" from the mirror. Now it is noticeable from more than a foot away. It's not raised, it doesn't hurt, you might call it a discoloration.
Here are my specific questions related to this situation: 1) What are some indicators that a rash is caused by HSV and not something else? 2) If my boyfriend's bumps are truly gone, how do you feel about him having a blood test? Based on some of the things that I have read on this forum, I think this might only cause us more stress: it seems like a lot of people are experiencing conflicting, confusing results. If we have both had HSV-1 since we were 5, I think I'd rather not find out now - just seems like unnecessary stress. Could he demand to be tested for only HSV-2? 3) Should I be worried about what I am describing on my lip?
Thanks in advance, I truly appreciate it.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.

In general, herpes is the most common cause of penile blisters, sores, or ulcers.  It's not possible to be certain from your description. I'm confused by the location, hwoever. On the one hand, location on the penile shaft is more like herpes than folliculitis, razor burn, etc.  On the other hand, apparently they were in an area that required shaving for a close look -- and herpes tends to be uncommon in hair-bearing areas.

To the specific questions:

1) See above.  Also, most herpes lesions occur in clusters, and each recurrence is in more or less the same place (within an inch or so).  A blister-like appearance is typical.  Herpes lesions are superficial (think of them as being "on" the skin, whereas folliculitis, acne, etc are deeper, like "in" the skin. Herpes lesions take 10-14 days to heal completely; folliculitis often is faster.  But all these are only clues, not definitive.

2) A blood test is a good idea.  You should have one too; if he has herpes, you could have been the source, at least in theory.  It would be reassuring if both your results are negative for HSV-2.  Don't be too frightened about confusing results.  The large proportion of people with straightforward results obviously don't post questions as often as those with uncertain outcomes.

3) A simple "discoloration" doen't sound like herpes.  Most likely the lip lesion is something other than herpes.

I hope this helps.  Best wishes--  HHH, MD

[Amy4589]

For clarity's sake I should have said that I did not perform oral sex on my boyfriend at all during this last visit.

[H. Hunter Handsfield, M.D.]

To clarify one point:  In recommending blood testing, what I really think you should do is see a herpes-knowledgeable health care provider (go together), ideally while you still have the lip lesion and before your partner's penile lesions heal completely.  Either a dermatologist or your local health dept STD clinic would be a good choice.  Then follow that person's advice about testing for HSV.

[Amy4589]

Hi Doctor, thanks for your quick response.

These bumps were definitely covered by hair but they were not at the base of his penis where the hair is extremely thick. They were at least 2 inches above that where the hair is getting somewhat thinner. When I first spotted them, I thought they were in grown hairs but upon further inspection, I felt they weren't. I googled pictures of herpes on the penis and I did notice that almost all of the results pictured lesions on the final third of the penis. Obviously I can't (and haven't) ruled out HSV based on this alone but it is somewhat reassuring to hear you say that the location of my boyfriend's bumps seems atypical because I had been thinking the same thing.

I felt, as you seem to, that my boyfriend's best bet was to go to an STD clinic while the rash could still be looked at. Unfortunately, he was equally sure that he would rather see a general practitioner and apparently (I don't know this for sure as we currently live 300 miles apart) the rash is now gone although he is planning to keep his appt tomorrow. I guess at this point blood testing will be necessary for our mutual peace of mind - I am just frustrated because I feel that this matter could have been resolved more easily and more quickly if he had listened to me and gone to see a health care provider ASAP. Typical girlfriend complaint lol.

A final question if you have time: we have been together for 3 years and stopped using condoms 2.5 years ago when I went on the pill. Until now, I have never seen a rash on him and I have never had a worrisome rash either. For the past 4 months our relationship has been long distance and we see each other once every 2-3 weeks. If he tests positive for HSV-2, should I assume that he cheated?

Thanks again for your input. I will keep the board posted on the results just in case it helps anyone else make a decision in regards to their personal lives.

[H. Hunter Handsfield, M.D.]

Even the world's top herpes experts often cannot accurately distinguish herpes from other skin lesions, and certainly I cannot advise any further based on a written description.

If one partner has undiagnosed genital herpes, the infection is is very frequently (and I mean VERY frequently) transmitted only after several years.  So, no -- definitely not:  you should not assume your partner has had other partners if this turns out to be herpes.