Aa
Genital HSV1 Concerns
Hello Doctor,
I noticed a mark on the shaft of my penis. To me it looked like a cut or irritation of some sort from vigorous sex or masturbation. No blister but it did scab. Once it had scabbed up and healed almost completely (at most a week after I initially saw it) I had unprotected vaginal sex with my long-term girlfriend on Friday. By Sunday I had developed blisters on and around the same site as the original cut and lymph node swelling. My GP cultured it on the Monday and it came back as HSV-1.
1a) What is the most probable explanation for how I contracted HSV-1 genitally?
1b) Is it possible that I transferred it to myself through masturbation with my own saliva? Would that be more possible if I did it while I had that cut on my penis?
1c) Since we have abstained from oral sex since the primary OB, what are the chances of her or I getting oral HSV-1 from unprotected oral sex? As far as we know, she does not have genital HSV-1 (or any symptomatic HSV-1) and both of us will be getting an HSV blood test done as soon as she finishes work in a week.
2) I am still extremely paranoid about getting HSV-1 in my eyes/mouth even months after the primary OB. I wear contacts and though I wash my hands thoroughly with soap before and frequently every day, what are my chances of getting it in my eye?
3) I have read many people's dissent about your assurance of a near/practical inability to transfer HSV-1 to other parts of your body past the primary OB and the possibility of transmission to partners with seropositive HSV-1. What is the final consensus on HSV-1 transfer for unprotected vaginal and oral sex between monogamous long-term partners?
I have more Q but the limit...
Thanks
I noticed a mark on the shaft of my penis. To me it looked like a cut or irritation of some sort from vigorous sex or masturbation. No blister but it did scab. Once it had scabbed up and healed almost completely (at most a week after I initially saw it) I had unprotected vaginal sex with my long-term girlfriend on Friday. By Sunday I had developed blisters on and around the same site as the original cut and lymph node swelling. My GP cultured it on the Monday and it came back as HSV-1.
1a) What is the most probable explanation for how I contracted HSV-1 genitally?
1b) Is it possible that I transferred it to myself through masturbation with my own saliva? Would that be more possible if I did it while I had that cut on my penis?
1c) Since we have abstained from oral sex since the primary OB, what are the chances of her or I getting oral HSV-1 from unprotected oral sex? As far as we know, she does not have genital HSV-1 (or any symptomatic HSV-1) and both of us will be getting an HSV blood test done as soon as she finishes work in a week.
2) I am still extremely paranoid about getting HSV-1 in my eyes/mouth even months after the primary OB. I wear contacts and though I wash my hands thoroughly with soap before and frequently every day, what are my chances of getting it in my eye?
3) I have read many people's dissent about your assurance of a near/practical inability to transfer HSV-1 to other parts of your body past the primary OB and the possibility of transmission to partners with seropositive HSV-1. What is the final consensus on HSV-1 transfer for unprotected vaginal and oral sex between monogamous long-term partners?
I have more Q but the limit...
Thanks
MEDICAL PROFESSIONAL
Culture is just fine, no different than PCR.
You are worrying too much. Try to let it go and move on with your life. Please don't post anything more until the blood test result is available. I will be happy to make a final comment at that time -- but will have nothing more to say until then.
You are worrying too much. Try to let it go and move on with your life. Please don't post anything more until the blood test result is available. I will be happy to make a final comment at that time -- but will have nothing more to say until then.
I saw my GP today and she confirmed that it was a positive culture, not a PCR. Does that mean anything?
What do you think the preexisting scab could have been? I feel like I cut or pinched the skin there and didn't give it enough time to heal and resulted in it scabbing over after continued irritation?
We will be getting blood tests done next week and I will post the results. However, for some reason, I cannot shake the anxiety that it could come back as positive for HSV-2. I am terrified that it might and could not possibly cope with having that type along with HSV-1. Am I out of my mind for worrying? I practiced safe sex before my current relationship.
Thank you for your help!
What do you think the preexisting scab could have been? I feel like I cut or pinched the skin there and didn't give it enough time to heal and resulted in it scabbing over after continued irritation?
We will be getting blood tests done next week and I will post the results. However, for some reason, I cannot shake the anxiety that it could come back as positive for HSV-2. I am terrified that it might and could not possibly cope with having that type along with HSV-1. Am I out of my mind for worrying? I practiced safe sex before my current relationship.
Thank you for your help!
MEDICAL PROFESSIONAL
It sounds like you indeed had a true primary infection; the preexisting scab probably wasn't due to herpes.
Initial/primary herpes often has a stuttering course, i.e. with lesions healing as new ones form, for a couple of weeks. This doesn't count as a second outbreak, just a somewhat prolonged initial infection. That's why treatment of initial herpes should always be given for a full 10 days.
It is true that herpes can mimic UTI, and that a small percentage of NGU cases in men are caused by HSV, but more like 3-5%; 10% is too high. But your symptoms don't sound like NGU, and NGU by definition occurs only in men. It sounds like your partner had a real bacterial UTI that responded to antibiotics -- which pretty much rules out herpes. And recurrent UTIs are common in women. Conceivably she had both a UTI and a recurrent outbreak of genital herpes due to HSV-1, but not likely. The most probable explanation for your herpes is that your girlfriend has oral herpes and you acquired it from oral sex. I anticipate that her blood test will be positive for HSV-1. So will yours -- but if you had been tested early, the initial blood test would have been negative.
So don't over-analyze all this. Feel free to report your partner's blood test results, and your own if blood testing is done.
Initial/primary herpes often has a stuttering course, i.e. with lesions healing as new ones form, for a couple of weeks. This doesn't count as a second outbreak, just a somewhat prolonged initial infection. That's why treatment of initial herpes should always be given for a full 10 days.
It is true that herpes can mimic UTI, and that a small percentage of NGU cases in men are caused by HSV, but more like 3-5%; 10% is too high. But your symptoms don't sound like NGU, and NGU by definition occurs only in men. It sounds like your partner had a real bacterial UTI that responded to antibiotics -- which pretty much rules out herpes. And recurrent UTIs are common in women. Conceivably she had both a UTI and a recurrent outbreak of genital herpes due to HSV-1, but not likely. The most probable explanation for your herpes is that your girlfriend has oral herpes and you acquired it from oral sex. I anticipate that her blood test will be positive for HSV-1. So will yours -- but if you had been tested early, the initial blood test would have been negative.
So don't over-analyze all this. Feel free to report your partner's blood test results, and your own if blood testing is done.
Thank you very much Dr. Handsfield, you have certainly helped appease my concerns and anxiety a considerable amount.
That initial scab (the week leading up to infection, before the full blown blisters) was the very first time, to my knowledge, I had ever had something scab over on my penis. I have had single pimples on the shaft of my penis (different locations, lasting only a few days, and never scabbing) but never anything that looked remotely similar to the blisters a few months ago.
When the blisters developed, I had pretty bad fatigue, felt generally unwell, exhausted, very tired driving home and very little energy. The night before and that night I almost fainted when going pee in the middle of the night. By Sunday night I had VERY noticeable swelling of the lymph nodes in my groin. They continued swelling for the next week and I could feel 2 swollen nodes on each side of my groin. The swelling lasted for over a month, very slowly decreasing. Cannot remember if I had a headache, very possible though.
A blister formed where the previous scab was, another formed to the right and one to the left, about the size of a pea. I'd say 3 blisters total and a bright red dot on the head of my penis.
Not sure if the preexisting lesion was herpes or not, doesn't seem consistent with the way the blisters developed concurrently with the swelling and fever.
My doctor prescribed Valtrex with dosing according to HSV-2 (due to that being most probable) while awaiting the test results. I am seeing my GP tomorrow and will ask about the test, whether or not it was a culture or PCR. She burst a blister and swabbed it with a Q tip and that went to the lab. I finished up the medicine according to the dosing over 3 days I believe but the following weekend the blisters came back following an intense feeling of prodrome (severe tingling in the butt and back of legs, lasting several hours/half a day) and she put me on Valtrex dosing for HSV-1 after the culture came back positive for HSV-1. When the blisters came back, the occurred in the same vicinity of my penis as the original blisters.
Overall, have not experienced any pain during those initial 2 OBs, aside from clothing rubbing the sores.
I also became concerned today after reading a WebMD article about NGU/NSU. The WebMD article scared me because it mentioned something about HSV-1 causing NGU/NSU in 10% of cases or something. Do I have any reason to be worried?
Thank you so much!
That initial scab (the week leading up to infection, before the full blown blisters) was the very first time, to my knowledge, I had ever had something scab over on my penis. I have had single pimples on the shaft of my penis (different locations, lasting only a few days, and never scabbing) but never anything that looked remotely similar to the blisters a few months ago.
When the blisters developed, I had pretty bad fatigue, felt generally unwell, exhausted, very tired driving home and very little energy. The night before and that night I almost fainted when going pee in the middle of the night. By Sunday night I had VERY noticeable swelling of the lymph nodes in my groin. They continued swelling for the next week and I could feel 2 swollen nodes on each side of my groin. The swelling lasted for over a month, very slowly decreasing. Cannot remember if I had a headache, very possible though.
A blister formed where the previous scab was, another formed to the right and one to the left, about the size of a pea. I'd say 3 blisters total and a bright red dot on the head of my penis.
Not sure if the preexisting lesion was herpes or not, doesn't seem consistent with the way the blisters developed concurrently with the swelling and fever.
My doctor prescribed Valtrex with dosing according to HSV-2 (due to that being most probable) while awaiting the test results. I am seeing my GP tomorrow and will ask about the test, whether or not it was a culture or PCR. She burst a blister and swabbed it with a Q tip and that went to the lab. I finished up the medicine according to the dosing over 3 days I believe but the following weekend the blisters came back following an intense feeling of prodrome (severe tingling in the butt and back of legs, lasting several hours/half a day) and she put me on Valtrex dosing for HSV-1 after the culture came back positive for HSV-1. When the blisters came back, the occurred in the same vicinity of my penis as the original blisters.
Overall, have not experienced any pain during those initial 2 OBs, aside from clothing rubbing the sores.
I also became concerned today after reading a WebMD article about NGU/NSU. The WebMD article scared me because it mentioned something about HSV-1 causing NGU/NSU in 10% of cases or something. Do I have any reason to be worried?
Thank you so much!
MEDICAL PROFESSIONAL
Thanks for the compressed version! The answers to the specific questions are below, based on the assumption that your first recognized genital HSV-1 outbreak was indeed a primary infection. Can you say just a bit more about it? Number of lesions, other symptoms like fever, headache, inflamed lymph nodes in the groin, etc; and how the diagnosis was made, i.e. positive culture or PCR test? Have you had similar scabbed lesions of the penis before this? In other words, it is certain that the preexisting lesion wasn't herpes?
1 a-c) Almost all new genital herpes is sexually acquired from a partner, not the result of autoinoculation (i.e., self-infection from another part of the body). Autoinoculation is rare in people with longstanding HSV infections. A preexisting nonherpetic sore on your penis migh increase that risk, but still it is more likely your partner has an oral HSV-1 infection and you were infected by oral sex. (It could be she has a genital HSV-1 infection, but oral is more likely.) Once someone is infected with HSV anywhere on the body, s/he is immune -- or at least very high resistant -- to catching a new infection with the same virus type, anywhere on the body. That's why autoinoculation is rare, and why couples do not "ping pong" their mutual HSV infections back and forth. Assuming your partner has oral HSV-1 and is the source of your genital infection, there is no risk she will be reinfected again from you.
2) As suggested above, autoinoculation is most common during or soon after an initial infection. If you were going to tranfer your genital infection to your eyes, it probably would have happened by now. At 2 months, you probably have substantial immunity/resistance to autoinoculation. It's still a good idea to wash your hands with soap and water after using the toilet or otherwise handling your genital area. Otherwise I wouldn't worry about it. And once 3 months have passed, there probably will be no risk at all.
3) The "some people" who disagree on this do not include genuine herpes/STD experts; or in some cases there might be confusion over "zero risk" versus "very low risk". The clear consensus of the experts is discussed above: no risk of repeated mutual reinfection.
4) There has been no research on the effectiveness of suppressive therapy for genital HSV-1, either for prevention of oubreaks, suppression of shedding, or prevention of transmission. However, most people with genital HSV-1 have few or no recurrent episodes, asymptomatic shedding is much less common than for genital HSV-2, and genital-to-genital HSV-1 transmission appears to be rare. Therefore, suppressive therapy rarely is necessary for genital herpes due to HSV-1. For HSV-2, there is no "rebound" effect when antiherpetic therapy is stopped -- no increased outbreaks, no increased asymptomatic shedding or transmission. Probably it's the same for HSV-1.
5) This happens all the time. HSV is transmissible only intermittently, and many couples in which one person is infected go for an entire sexual lifetime without transmission occurring. A two year delay is nothing unusual. It's just a question of when luck ran out and your partner happened to have active viral shedding at the time you had sex.
I hope this helps. I look forward to hearing more detail about your initial infection 2 months ago, as well as the results of your and your partner's blood test results.
Regards-- HHH, MD
1 a-c) Almost all new genital herpes is sexually acquired from a partner, not the result of autoinoculation (i.e., self-infection from another part of the body). Autoinoculation is rare in people with longstanding HSV infections. A preexisting nonherpetic sore on your penis migh increase that risk, but still it is more likely your partner has an oral HSV-1 infection and you were infected by oral sex. (It could be she has a genital HSV-1 infection, but oral is more likely.) Once someone is infected with HSV anywhere on the body, s/he is immune -- or at least very high resistant -- to catching a new infection with the same virus type, anywhere on the body. That's why autoinoculation is rare, and why couples do not "ping pong" their mutual HSV infections back and forth. Assuming your partner has oral HSV-1 and is the source of your genital infection, there is no risk she will be reinfected again from you.
2) As suggested above, autoinoculation is most common during or soon after an initial infection. If you were going to tranfer your genital infection to your eyes, it probably would have happened by now. At 2 months, you probably have substantial immunity/resistance to autoinoculation. It's still a good idea to wash your hands with soap and water after using the toilet or otherwise handling your genital area. Otherwise I wouldn't worry about it. And once 3 months have passed, there probably will be no risk at all.
3) The "some people" who disagree on this do not include genuine herpes/STD experts; or in some cases there might be confusion over "zero risk" versus "very low risk". The clear consensus of the experts is discussed above: no risk of repeated mutual reinfection.
4) There has been no research on the effectiveness of suppressive therapy for genital HSV-1, either for prevention of oubreaks, suppression of shedding, or prevention of transmission. However, most people with genital HSV-1 have few or no recurrent episodes, asymptomatic shedding is much less common than for genital HSV-2, and genital-to-genital HSV-1 transmission appears to be rare. Therefore, suppressive therapy rarely is necessary for genital herpes due to HSV-1. For HSV-2, there is no "rebound" effect when antiherpetic therapy is stopped -- no increased outbreaks, no increased asymptomatic shedding or transmission. Probably it's the same for HSV-1.
5) This happens all the time. HSV is transmissible only intermittently, and many couples in which one person is infected go for an entire sexual lifetime without transmission occurring. A two year delay is nothing unusual. It's just a question of when luck ran out and your partner happened to have active viral shedding at the time you had sex.
I hope this helps. I look forward to hearing more detail about your initial infection 2 months ago, as well as the results of your and your partner's blood test results.
Regards-- HHH, MD
My apologies,
Had a primary OB of Genital HSV1, 2 months ago. Had a cut or mark on shaft of penis for a week before OB, looked like skin was pinched somehow, scabbed over. Sex w/ GF on Friday. Blisters and lymph swelling by Sunday. Cultured positive for HSV-1.
1a) What is the most probable explanation for how I contracted HSV-1 genitally?
1b) Is it possible that I transferred it to myself through masturbation with my own saliva? Would that be more possible if I did it while I had that cut on my penis?
1c) What are the chances of her or I getting oral HSV-1 from unprotected oral sex? As far as we know, she does not have genital HSV-1 (or any symptomatic HSV-1) and both of us will be getting an HSV blood test done as soon as she finishes work in a week.
2) I am still extremely paranoid about getting HSV-1 in my eyes/mouth even months after the primary OB. I wear contacts/glasses. How likely is it I will ever get it in either of our eyes if we are cautious?
3) Some people seem to disagree on the likelihood of transfer between partners and other locations on your body. What is the final consensus on HSV-1 transfer for unprotected vaginal and oral sex between monogamous long-term partners?
4) Cost:benefit ratio aside, do suppressive meds reduce outbreaks AND viral shedding of GHSV1? Does it reduce the possibility of infecting my own eyes/mouth or my GF’s eyes/mouth? Can it increase the likelihood of transferring the infection AFTER you stop taking it?
5) How could this have not shown up until now? Is it either we have avoided transfer of virus this long or that we were both seropositive and I just got unlucky and somehow it transferred to my genitals?
Had a primary OB of Genital HSV1, 2 months ago. Had a cut or mark on shaft of penis for a week before OB, looked like skin was pinched somehow, scabbed over. Sex w/ GF on Friday. Blisters and lymph swelling by Sunday. Cultured positive for HSV-1.
1a) What is the most probable explanation for how I contracted HSV-1 genitally?
1b) Is it possible that I transferred it to myself through masturbation with my own saliva? Would that be more possible if I did it while I had that cut on my penis?
1c) What are the chances of her or I getting oral HSV-1 from unprotected oral sex? As far as we know, she does not have genital HSV-1 (or any symptomatic HSV-1) and both of us will be getting an HSV blood test done as soon as she finishes work in a week.
2) I am still extremely paranoid about getting HSV-1 in my eyes/mouth even months after the primary OB. I wear contacts/glasses. How likely is it I will ever get it in either of our eyes if we are cautious?
3) Some people seem to disagree on the likelihood of transfer between partners and other locations on your body. What is the final consensus on HSV-1 transfer for unprotected vaginal and oral sex between monogamous long-term partners?
4) Cost:benefit ratio aside, do suppressive meds reduce outbreaks AND viral shedding of GHSV1? Does it reduce the possibility of infecting my own eyes/mouth or my GF’s eyes/mouth? Can it increase the likelihood of transferring the infection AFTER you stop taking it?
5) How could this have not shown up until now? Is it either we have avoided transfer of virus this long or that we were both seropositive and I just got unlucky and somehow it transferred to my genitals?
MEDICAL PROFESSIONAL
The reason for the character limit is to prevent long-winded questions in order to make things more efficient for the moderators; it isn't appropriate to for an original question to spill into a comment window. Dr. Hook and I have never seen a question that could not easily be stated within the 2,000 character limit -- almost always 500-1000 characters would be sufficient. (Many MedHelp forums, the moderators set their browsers so they never even see any follow-up comments.)
Please compress your questions into 2,000 characters or less (preferably a lot less) and re-post them in a comment window -- then I will respond.
HHH, MD
Please compress your questions into 2,000 characters or less (preferably a lot less) and re-post them in a comment window -- then I will respond.
HHH, MD
I had expressed my anxiety about the above concerns with my GP and she said she could prescribe daily suppressive meds purely to put my mind at ease. I considered them but decided against it after reading your advise to hold off for 6 months to a year to determine your recurrence pattern. As well, I saw somewhere else online that someone had taken suppressive meds for HSV-1 for a at least a few years and after coming off of them, somehow infected herself with occular herpes. Is that true/possible or in any way related to being on suppressive medication?
Are suppressive medications effective in reducing viral shedding as well as limiting the number of outbreaks?
How likely is it that my girlfriend and I (or only one of us) were seropositive already for HSV-1 and transferred it to my penis by pure bad luck? If we have been together for a long time and frequently kissed, kissed with open mouths, performed oral sex on each other, oral-anal sex and unprotected vaginal sex, how is it that only now, did I develop a gential HSV-1 infection?
Are suppressive medications effective in reducing viral shedding as well as limiting the number of outbreaks?
How likely is it that my girlfriend and I (or only one of us) were seropositive already for HSV-1 and transferred it to my penis by pure bad luck? If we have been together for a long time and frequently kissed, kissed with open mouths, performed oral sex on each other, oral-anal sex and unprotected vaginal sex, how is it that only now, did I develop a gential HSV-1 infection?
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
