HSV-1 Genital Herpes

[joey882]

About 1 ½ years ago I had an outbreak of tiny scabs all over the shaft of my penis.  The scabs were not painful nor did they resemble ulcers at any point.  Along with the scabs I had fever like symptoms and my lymph nodes were swollen.  I was sexually active at the time, including oral sex.  A few days after the outbreak I saw my doctor, who suspected genital herpes but wanted tests to be sure.  The viral culture came back negative.  About 6 months after the initial outbreak I had a blood test, which came back positive for HSV1 and negative for HSV2.  In the last 1 ½ years since the initial outbreak I have not had any new symptoms in the genital area.  I have had one, possibly two, cold sores on my mouth.  I saw my doctor about three weeks ago and he did say it is possible that my initial outbreak was not genital herpes and could have been something else.  He suggested that before I have unprotected sex I wait another year to see if I have any more symptoms in the genital area.

1. Does it sound like I have genital herpes based on my history?
2. Is there any point in waiting another year?
3. I am terribly confused and would appreciate any advice!

[Edward W Hook, MD]

This question is very difficult to answer.  It is clear that you have HSV-1 somewhere, the question is where.  The genital outbreak that you describe could have been due to genital HSV-1.  If it was, characteristics of genital HSV-1 which differentiate it from HSV-2 is that recurrences are uncommon and many people with genital HSV-1 do not have any recurrences at all, there is less asymptomatic shedding of the virus from genital sites, and sexual transmission of genital HSV-1 is far less common than transmission of HSV-2.  

On the other hand, you get cold sore (at least you think they are cold sores).  It is rare for persons to have both oro-labial HSV-1 (cold sores) and genital HSV-1.  The infection typically occurs at one location.

So what do to.  Your doctor's advice to use condoms is a good one, particularly if your partner does not know of your dilemma, not only because of the HSV issue but also because condoms protect from other STDs.  If you have another cold sore, you could get it cultured for herpes. If the culture is positive, you probably do not have genital HSV-1.

I realize this is not a yes or no answer but it’s the best I can do.,  I hope my comments are helpful to you.  EWH

[joey882]

Thank you Dr. Hook.  I really appreciate your advice.  I definitely will use protection and inform any future partners of my situation.