HSV scare

[Concernedguy101]

Dr.,

Although I very diligent about using condoms, last night I had unprotected sex with a girl. However after about a minute we stopped and she informed that she has herpes. I am very, very worried now. She told me that she has hsv-1 and hasn't had a breakout in about 6 years. I have been reading a lot of your posts and while I want to believe her, I am afraid that she really has hsv-2 just based on how common genital hsv-2 is compared with genital hsv-1. She told me that she talked to her doctor when she first contracted it and was informed that there was little worry for spreading it. She kept telling me that I was going to be fine and apologized about telling me after we starting having sex (we were both drunk and things just got out of hand) which made me feel better. She does not take any daily suppressive medication.  

1. If she does have hsv-1, what are my risks for contracting genital hsv-1?

2. Now assuming that she may have hsv-2 am I at a serious risk for contracting hsv-2?

3. I really like this girl and would love to keep seeing her. In the future would condom protected sex be a safe option to prevent contracting hsv?

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.

For starters, please realize just how difficult it probably was for your partner to tell you that she has genital herpes.  She did a brave thing and a good thing for you.  I would assume that she was correct in telling you that she has genital HSV-1 since if she had been diagnosed with genital herpes without testing, the most likely cause would be HSV-2.  Thus what she has told you about having genital HSV-1 is likely correct and based on being tested.  

At the present time, in some settings, as much as half of GH is now caused by HSV-1.  Genital herpes due to HSV-1 is not commonly transmitted to sexual partners, both because about 60% of American adults have HSV-1 infection, making them not susceptible to further infection with the HSV-1 virus at any location, because genital HSV-1 is about 15-20 times less likely to recur than genital HSV-2, and because there is little asymptomatic genital shedding in persons with genital HSV-1.  For all of these reasons, as well as the generally low transmissibility of genital herpes, your risk of infection from this encounter is VERY low.  

I see no reason to assume that she has genital HSV-2 as outlined above. Even if she did, there is little risk of infection in the situation you describe.

Going forward I would suggest that your next step be to seek a type-specific test for HSV such as the HerpeSelect.  There is a greater than 50% chance that you already have HSV-1 an if this is the case, You have no reason to be concerned about infection by your partner.  If you o not have HSV-1 already, condoms will further reduce the already VERY low risk for acquisition of infection.

Hope this helps. EWH

[Edward W Hook, MD]

No, this does not raise concerns.  You really need to get a grip on yourself. I worry that this is becoming all consuming. There is little reason for you to think you have HSV.  Presuming that you have had other partners, this is most unlikely to be the first time that you have had sex with a person with genital herpes and to get worked up because you are FORTUNATE enough to have a partner who knows she has HSV and FORTHRIGHT enough to acknowledge it to you has actually be demonstrated in scientific studies to reduce risk for HSV transmission.  EWH

[Concernedguy101]

I had to change my PPH appointment because of work and the soonest I could get in was this Monday. I was hoping you give me some answers in the mean time. The red spots under my foreskin are practically gone and the red spots appear to be getting better on the head. The appear to be irritated papules or some sort and have gone from red to pink and appear to be getting less and less irritated. However in some light I am afraid they look like tiny vesicles, but I am not sure if that is me over examining myself. I noticed that even normal looking skin on the head of the penis can  sort look like it some tiny vesicles. They are not raised and with an erection they seem much less noticeable. I even tried to squeeze one to see if it would break, but it did not. They don't have any pain, although sometimes I feel like am mentally manifesting some itching of some sort.

I know that sometimes you are bombarded by needless questions, but with for my ease of mind and my appointment now 4 days away, I was wondering if any of this raises any concern. If say this were an outbreak. would they have developed into obvious painful blisters by now?

Thanks again for your help

[Edward W Hook, MD]

Still does sound like HSV-1.  

the lesions you describe could well be due to trauma related to roral sex, lets see what PPH says.  EWH

[Concernedguy101]

Dr.,

Some recent developments: After talking with her again, the girl that I am seeing said that while her Dr. never said it was hsv-1 exactly, her Dr. informed her that the blood test showed that her type of hsv does not require daily medication and the risk of spreading it is much lower (she was told not to really worry about spreading it without a sign of a breakout). Does this still sound like hsv-1?

We are holding off on vaginal sex for the time being, but last night she did perform unprotected oral sex on me. It was quite vigorous (at some points even painful, her teeth were involved slightly) and last night before going to bed I noticed what appeared to be purplish bruising on the head of my penis. Today I awoke to find small red spots (like an irritated papule) over the head of my penis and underneath my foreskin. They do not itch, burn or have any pain whatsoever. I wouldn't have noticed them if I did not examine myself. The ones under my foreskin seem to be "over" blood vessels. I am uncircumcised with pretty sensitive skin and have gotten these papule spots before, but just not as many. However, I never experienced any sort of purplish bruising before. Could my symptoms be as a result from irritation from the oral sex or from my original encounter last Sunday?

I know that asking, continuous anxiety driven questions is not allowed, but I do feel that I should mention my current symptoms and see what your thoughts are. I did schedule an appointment with planned parenthood today, but I was going to wait and see if the spots improve in the next day or so.

If I need to create a new question please advise and I will do so.

[Edward W Hook, MD]

I am not worried about you getting HSV-1 from your recent partner.  Given your history, the odds are quite good that you already have it and do not know it, as is the case for about 80% of persons iwth HSV-1.  

Take care. EWH

[Concernedguy101]

Dr. Hook,

First off thank you so much for the prompt reply, especially on a holiday. You are doing a lot of good for people.

I agree that she did a good thing telling me and it took a lot of courage to tell me. She did mention getting blood work done, so that would be a further indication that she most likely has hsv-1.

I do not get cold sores, however I understand that I still could have hsv-1 and just not show symptoms. In fact, my past 2 girlfriends all had gotten cold sores in their childhood at some point, so I know that I definitely have been exposed to it quite a bit, increasing my chances for having oral hsv-1.

I read earlier that accurate testing requires some waiting period. I take it that the purposes of your recommendation of the HerpeSelect isn't to see if I was infected from this exposure, but rather to see if I can even acquire hsv-1 from her.

So it seems that I am at a very low risk for catching hsv (of any type) from this encounter. I read a post of yours (or Dr. HHH) that stated the overall chances of being infected from a single encounter hover around 1 in 1000 or so, which is helping with my anxiety. If I develop any symptoms I will let you know.

Again thanks so much for your help. All the best.