Herpes advice

[bullethead]

Dear Dr,
A bit of background:
Sex with my wife has been very rare in recent years and in July ’07 I regret I had an encounter with another woman who I subsequently (18 months later) found out had genital herpes. She’d had it for sometime but supposedly hasn’t had an outbreak since 2004.
The main encounter involved mutual oral sex and genital to genital contact (unprotected but no penetration took place). There were a couple of other very brief occasions where she started to perform oral on me but I quickly stopped it.
Since finding out about the other woman’s herpes I have become somewhat obsessed about the condition and I do seem to get a lot of genital issues; burning sensation at the tip of the penis and general balanitis type symptoms (have never had noticeable blisters or lesions)
I have noticed that the balanitis type symptoms seem to be triggered by ejaculation, most recently when I had a ‘wet dream’ during the night (so no manual rubbing had taken place). The burning sensation lasts for quite a few days afterwards. Because I have read that herpes is a common cause of balanitis this has stressed me greatly.
I have seen my GP on many occasions and I have had swabs for STDs all of which are negative.
I have asked about blood tests but they are not generally done in the UK and she also says that it would be pretty pointless as both myself and my wife get facial cold sores and have done for some time. There would be no way of knowing if any positive result would be due to oral or genital infection?
She thinks anxiety is causing me to notice my genital problems that have probably always happened but previously I’d have thought nothing of.

My questions:
1.Would you concur with what my GP has told me about testing and about anxiety being an issue?
2.Was my exposure as low a risk as I’d like to think?
3.Does having had oral cold sores offer some protection from getting HSV2?
4.Is ejaculation a ‘trigger’ for a herpes outbreak?

Thanks for your time.

[Edward W Hook, MD]

Welcome to the Forum.  I have reviewed your earlier interactions on the HSV Community site as well. It is apparent that you are having trouble shaking this concern.  You did not have penetrative sex, just rubbing ("frottage") with a partner who was not having an outbreak during contact.  The chances of transmission are miniscule and without a subsequent outbreak you should be confident that you did not get HSV-2 from the encounters you describe.   I hope my comments below, confirming the responses you have already head will help you to move on.

1.  Testing is taking a chance.  You have no reason for testing and with a history of cold sores you have a substantial chance of having a falsely positive HSV-2 test result.  I would not recommend it.  There is no reason to think you have HSV-2- I would urge you to accept that you did not get HSV-2 through the encounters you described.  .

2.  Yes, the risk was infinitesimal.

3.  It is debated however my reading of the data is that having HSV-1 does reduce your risk for HSV-2 acquisition somewhat. Dr. Handsfield agrees with me.

4.  No.  And the symptoms you describe are not suggestive of HSV.

As I said, I hope these comments will help you to move forward and stop perseverating. EWH

[bullethead]

A related discussion, paper cut was started.

[Edward W Hook, MD]

Yes, as I said above, I agree with the positve you- I said this.  It is now time for this thread to end. Take care. EWH

[bullethead]

Thanks again Dr Hook, can I just clarify something, when you say you "agree with all of the statements I have made", can i assume you mean the statements made by the 'positive me' and not the one made by the 'frightened me'?
Apologies for keep pestering you, just want to be 100% sure on what you meant so I can finally put this thing out of my mind once and for all (so that this is the last time you hear from me).
You have been a great help, keep up the good work.

[Edward W Hook, MD]

Thanks for the follow-up. I agree with the "positive you" and all of the statments that you have made. I would also add that given the sensitivity of the skin at the head of the penis, there is a possiblity that the soap you are using may also be contributing to this problem.  I certainly would not be worried about  HSV.  Take care. EWH

[bullethead]

Dear Dr,
Not sure if I can still  get your feedback so long after the original questions but I I would like to  follow up with what I thik might 'trigger' the balanitis type symptoms that I mentioned previously. Rather than ejaculation I think it is actually washing under the foreskin that may be causing the problem.
The reason I have come to this conclusion is that twice in the last 2 weeks I have washed the area a little more thouroughly than usual, when I say thouroughly I mean gentle rubbing of the glans rather than just a rinse off (never used soap, just water). On the first occasion I started feeling irritation within an hour that progressed as the day went on to a more general burning feeling, soreness, red patches and spottiness on the skin (not blisters or raised).This all settled down within 2-3 days and I went back to normal and either didn't wash under the foreskin or just had a quick rinse. Nine days after the previous 'thourough wash' I did the same thing again and exactly the same thing happened.
Thinking back over the past couple of years this has happened quite regularly and I think it probably always is associated with washing. The 'frightened me' makes the following assumption:
1. Friction to the skin is a trigger for a GH outbreak and GH is one cause for balanitis so these issues I am having must be GH outbreaks.
The more 'positive me' makes these assumptions:
1. The skin in that area is very sensitive and the  gentle rubbing when washing exposes it to any number of irritants that cause me problems for a few days.
2. The problems are probably very minor but I notice them more because I am so anxious about any sensation in this area.
3. GH outbreaks wouldn't be so frequent  (e.g. twice in 9 days)?
If it's not too late I would very much appreciate your opinion on which 'me' is the one to believe and get your views on the assumptions I have made.

[Edward W Hook, MD]

Glad to help. I agree, it sounds like your GP is right on target.  Take care.  EWH

[bullethead]

Thankyou so much for your response, it has really helped to have someone with a lot of knowledge in this area give me reassurance. I guess my 'symptoms' could be down to any number of things and anxiety is no doubt a factor.
I really hope I can now accept what you and my own GP (who has been fantastic by the way) have told me and get on with devoting myself to my wife and child, put this mistake behind me and enjoy my life.
Thanks again.