HSV-1 - CONFUSED.

[OnceTwice22]

I am a 23 year old male.  During a short

[MacBernie]

A related discussion, HSV-1 test positive was started.

[OnceTwice22]

Much appreciated.  I guess my main fears were, if I was not seeing any lesions, that maybe they were in my urethra which was causing some of the mildly stinging urination and general uncomfortable feeling in my penis.  Is that common?  It seems that Internet resources are the herpes subject in general are extremely broad, information wise.

It's tough to find a definitive resource on the subject, IMHO. Hence, my reasoning for consulting an individual like yourself, with a solid knowledge base and a special interest in the field.

Thanks for your help.  Hope this goes away; haven't been anxious about it, just concerned when I start to feel the symptoms recurring again.

[H. Hunter Handsfield, M.D.]

The additional clarification doesn't change my overall opinion or advice.  However, if you or your provider want to prove to yourself that your genital and systemic symptoms aren't due to HSV, you could be treated with suppressive antiviral therapy for a couple of weeks.  If there is no effect on your symptoms (as I predict), it will definitely mean your symptoms aren't due to herpes.

HHH, MD

[OnceTwice22]

Also, forgot to add.  Symptoms last from 3-5 days, and I usually have a headache continuously through the entire time....so you can imagine why this is bothering/concerning me.

[H. Hunter Handsfield, M.D.]

Herpetic urethritis generally is very painful.  The mildness of that symptom is against herpes at all, and the frequency of the "outbreaks" argues against HSV-1.

HHH, MD

[H. Hunter Handsfield, M.D.]

It is likely your oral lesion plus sore throat represented initial oral HSV-1 infection.  Although your positive HSV-1 test could reflect chronic infection, perhaps since childhood, the symptoms you describe are classical for initial oral HSV-1.  But I am uncertain about the source.  The negative HSV-1 test in your casual partner proves you didn't acquire it from her.  But oral herpes is often acquired from casual (social) kissing or other non-sexual contact; or, as you suggest, you might have acquired it from your regular girlfriend (most likely by kissing, not oral sex).  Another possibility is that you indeed had chronic oral HSV-1 and acquired a garden variety viral respiratory infection (the sore throat), which triggered a recurrent oral herpes outbreak (i.e., a classic 'cold sore').  Most likely you never will know for certain.  However, your girlfriend could be tested; if she is HSV-1 negative, it will rule out infection from her--but if she is positive, you still won't know that she was the source.

Having said all that, your genital symptoms do not suggest herpes at all, and your HSV-1 infection most likely is limited to your mouth.  And since you could not have acquired HSV-1 from your HSV-1-negative partner, and apparently have no other recent sources of genital infection, there really is no concern about genital HSV-1.

To your specific questions:

1) No, there is no realistic suspicion of genital HSV-1 infection.  Neither the specific symptoms you describe nor their timing nor duration are suggestive of herpes or any other STD.  A more likely explanation is anxiety magnifying otherwise normal body sensations.

2) Possibly yes; see above.

3) Your genital symptoms are not HSV-1.  I suggest you ignore them, with the expectation they will fade with time.  If not, see a health care provider for proper evaluation.

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