Genital HSV1 Timing?

[whatcoulditbe226]

On Day 0 I received unprotected oral sex from an old girlfriend.  She said she had a cold sore but being ignorant I didn't think it was any big deal.  I do not recall any symptoms, other than (perhaps, not sure) a little irritation in the abdomen area just above the penis, for 30 days.  On Day 32 I had vigorous genital to genital sex with my current girlfriend, with whom I have been having unprotected sex with regularly for the last 1.5 years.  Immediately thereafter the shaft of my penis near the base (on one side) started appearing raw and red.

On Day 36 my P.A. diagnosed it as a rash and advised me to start using an anti-fungal cream (which I did only
sporadically).  After more discussions with my P.A., on Day 46 I had a Herpes Simplex Virus Profile:  IGG Type1 was 3.11.  IGG Type2 was 0.08.  He said he still thought (since most people have oral HSV 1) that it was a rash and told me to continue using the antifungal (which I have sporadically).  I don't know if I had HSV1 before.

On Day 62 I convinced him to start me on Valtrex.  He prescribed 500 MG twice per day for 30 days.  After 6 days with no change and doing some reading, I decided to double the daily dosage.  Now, here I am at Day 70 and I still have the same symptoms I had at Day 32 - angry rash on one side of penis and on abdomen just above shaft that will kind of dry up, then start over.  Also, very little, if any spots, never any blisters, and periodic rash over about half of my ball sack.  By the way, I idiotically never told my P.A. about the original oral sex encounter.  Also, I have not had sex since Day 32.

Questions: 1. How likely is it this is HSV 1 genital?  Didn't it take too long and has gone on too long?  2. If it is, how likely is it that I have given it to my current girlfriend?  She hasn't said anything but I'm scared and have learned a lesson, regardless of the outcome.  3. Is the blood test reliable at that time of the occurrence?  4. Where do I go from here?  Thank you.

[Edward W Hook, MD]

I would guess that you have had HSV-1, most likely oral (like about 2/3 of adults, most of whom do not know it), for some time and the rashes that you describe are not herpetic in origin.  Let's review the reasons I say this.

1.  For starters, let's forget about HSV-2.  Nothing to suggest it.
2.  Both of the rashes you describe do not sound like HSV but something else.  As to what- hard to say but nor herpes..
3.  Both the lack of response to valacyclovir and the fact that your rash has now persisted for at least 4 weeks are likewise inconsistent with herpes.  

Since it is not herpes, you could not have given herpes to your GF.

My recommendation, go back to the PA, ask for a dermatologist referral to sort this out. It has gone on too long, is a bother and you need to get to the bottom of it.

Hope this helps. EWH

[whatcoulditbe226]

Thank you, Dr. Hook.  I am following your advice.  However, it is going to be several days until I can see the dermatologist.  On the off chance that I haven't described the symptoms very well, does the delay in symptoms and the length of symptoms basically rule out my receiving genital HSV-1 from the old girlfriend?  I mean, I guess there is always some chance, but does this make it extremely unlikely?  I am not trying to be a pain, but I've had many sleepless nights and I would like to reduce my fears.  Also, I was wondering why you think I have had HSV-1 "for some time".  Is that because of the test value of 3.11?  Again, thank you for your help.

[Edward W Hook, MD]

The long interval between your exposure to your prior GF and the onset of your rash makes herpes very unlikely, as does the fact that the symptoms have persisted.  Typically the rash of herpes resolves in 10 days to 2 weeks for a first episode, more quickly for a recurrence.  In addition, the failure to respond to valacyclovir also make herpes unlikely.  

Most people acquire HSV during childhood.  I am presuming that your rash is not herpes, thus the positive blood test in unrelated to the rash and suggests some sort of infection in the past.  Truthfully however, one of the things the blood test cannot do is tell you either how long you have been infected or who you got it from.  EWH