Genital HSV-1

[dchanel]

Hi Doctor,

I'm a 27 year old male. Approximately two months ago, I had protected sexual intercourse with a friend of mine. However, right before engaging in sexual intercourse, she informed me that she contracted genital HSV-1 in graduate school. That was approximately five years ago, and she only had that one initial outbreak. She has been outbreak free ever since. Given that I used to want to be an epidemiologist, I knew the risk was almost zero when using a condom and considering the transmission rate of genital HSV-1.  But my concern started this past Saturday. After performing an intense cardio workout at CrossFit, which I just started last week, I noticed right above my penis in the pubic region that I had what looked like several ingrown hairs or severe irritation. Ever since then, I have been observing the area constantly. I realize that an initial outbreak never occurs almost two months after possible exposure, but some of the bumps have turned into little scabs. I never noticed any blisters. It just looks like a large irritated/pink area with a few bumps (at least almost 2 inches across from right to left). There was no localization of the bright pink irritation/bumps.

My question is should I be concerned and consult a doctor for testing, even though there is no blisters? Also, before that interaction I was tested for HSV-2 via blood serum antibody and my result was negative. I would just like to put my wondering mind at ease.

Thanks again for all the help you Doctor's provide us here on this website.

[Edward W Hook, MD]

I think your plan to move forward without concern is a good one.  EWH

[dchanel]

Thanks Doctor Hook. I mostly just needed some reassurance. As of now, there is hardly any pinkness or irritation that could even possibly be cultured or tested. Therefore, unless you disagree, I'm not going to worry about getting tested. With the area healing within a few days, there is just nothing to suggest genital HSV-1, much less the constant worry I've been going through.  

[Edward W Hook, MD]

Welcome back to our Forum.  Having reviewed our past interactions before answering these questions, it is my impression that you are doing a good job of talking about previous STDs with your partners- good job!  Now let's move on to your questions.

The odds of the lesions you describe being an initial outbreak of HSV acquired from your contact two months ago are small. As someone with an interest in epidemiology you know that all we can do is weight the evidence and make a prediction as to what is or is not going on.  In your case, the evidence makes this quite unlikely to be genital HSV-1.  the reason I say this are:
1.  Your partner had a single episode of genital HSV- and no known recurrences.  Further we know that the probability of transmission of genital HSV-1 is low.

2.  The timing is off. Typically initial episodes of HSV occur within two weeks of an exposure.

3.  The description you provide sounds more like chaffing or perhaps folliculitis than genital herpes.

4.  The lesions are in a location where HSV is not common. Over 85% of genital herpes in the male occurs on the penis.  

Putting all of this together.  The odds that this is genital HSV-1 are quite low.  I do know from our prior interactions and get the impression from this post however that you have been worrying about these lesions and repeatedly examining yourself.   If that is the case, it might be best to see your doctor and get a PCR or culture test for HSV at your earliest convenience.

I hope this helps. EWH