HSV2 from Oral to Genital?

[BadDecisionGuy]

Hi Drs,
I've been doing a ton of research on your valuable website, and I am afraid I am at a loss.  Around June 12th, I made a mistake and had an encounter with a CSW.  Now, this was a very short encounter of about 1-3 minutes.  And all she did was lick and suck on my scrotum/balls.   Well, after that evening, I regretted this and have been checking myself down there almost on a daily basis.  As the weeks passed, nothing showed, so, I assumed that encounter was too short and not really a big risk. Fast-forward to last week (about 7 weeks after the inital exposure), and I found a little bump on the left side of my scrotum.  I probably wouldn't have noticed it had I not been checking down there on a daily basis.  It wasn't red or painful.  It was about 2mm, and round.  I squeezed it and clear liquid came out.  Again, it didn't really hurt at all.  Then, the next day is started to itch and turned red.  And looked like the pictures of a herpes blister.  At first, my thought was that it was too many weeks out to be a primary HSV2 outbreak.  Plus, it was only one, and it didn't have all of the prodrome symptoms.   Now, I do have oral HSV1, and in fact, noticing this bump just happened to coincide with one of my cold sore outbreaks. So, I am familiar to what herpes feels like, and at first, I just thought I had popped a pimple, and because of its location (to the left, near the groin - a bit moist) the pimple had become a bit infected and a scab couldn't form.  So, I put on some antibiotic gel on it, and the redness went away, but it was still open and clear fluid would ooze for about 3 days, and it bled a bit last night.  This morning (5-6 days from popping the bump) it seems to almost close up. Went to the Dr, and he said it "could be", and ordered the HerpeSelect for HSV2 -- around 7 weeks from exposure, and it came back negative.  He then said he very much doubted that it was but, of course, 102 days would be perfect.  What do you think?

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.

You can be very sure you did not acquire genital herpes from this event, for several reasons.  You apparently know some or all of themn from your previous research on the forum; your problem is in over-thinking the situation and over-interpreting meaningless symptoms and skin changes, which is clouding your ability to objectively "get it".  But at the risk of telling you what you already know:

First, oral HSV-2 is very rare and oral-to-genital transmission is unheard-of.  Certainly I have never seen a case -- so you weren't at risk for HSV-2.  (And you're not at risk for HSV-1, since you already have it.)  Second, your symptoms don't suggest herpes.  Although people talk and worry about "atypical" symptoms, actually almost all herpes has typical symptoms -- just mild and therefore sometimes missed.  But if you had caught herpes, you would have had blisters, then open sores, then healing with scabs, all over 10-20 days.  The scrotal skin bump sounds like a pimple, not herpes.  (Any open or scabbing sore of the genital area "could be" herpes.)  Finally, the large majority of people with new HSV-2 infections have positive blood tests by 7 weeks.

In other words, for you to have genital herpes, several very unlikely scenarios all have to break the wrong way:  CSW with oral HSV-2, transmission if she had it, atypical symptoms, blood test result.  The chance of that is zero for all practical purposes.  If you would like still further reassurance, have another HSV-2 blood test at 3-4 months.  But in the meantime, you can go forward with 100% confidence you don't have it.  

Now to the genital wart problem, discussed below:  Genital warts usually clear up within a few months, even without treatment.  Recurrence a year later could be a wart, but might just be scar tissue or some other skin bump.  Should it persist or recur again in the future, see a health care provider to confirm the diagnosis before you treat it on your own.  Aldara can cause skin irritation, although only at the exact spot of application; and would not usually cause a pimple-like lesion.

Bottom line:  Really no herpes worries here, and maybe not a wart problem either.

Good luck--  HHH, MD

[BadDecisionGuy]

I have also seen that since I do have HSV1 orally, it could have lessened the effects of an initial HSV2 infection. I never had any flu-like symptoms, and I never had any swollen glands in the groin. So, here I am almost 8 weeks from the exposure and it is driving me crazy.  Do you think this could be HSV2?  I should also say that I have been using Aldara for a pesky wart that seems to have come back in the same area (from a year or so ago), and I thought maybe that caused this bump, the Aldara, that is!

Please help me sleep at night!  Do you think I should test again in a few weeks?  Is the 6-7 weeks negative test pretty good evidence considering the exposure?  I dunno... my logic is a bit undone, and though my Dr. is good, I don't think he's much of an STD expert.

[H. Hunter Handsfield, M.D.]

I saw this before I replied; see above.

[BadDecisionGuy]

Hi Dr

Sorry for the late response ... thanks for your reassurance.  As for the wart, funny thing is, it is "almost" in the same area as the last one.   When I pinch it, it doesn't hurt and clear fluid does come out of it, but it doesn't 'pop'.  Recently, the head did come off (I assumed the Aldara was working), but it also seemed to have appeared rather quickly.  It didn't look like a pimple since it wasn't red.   I do keep things trimmed down there, so, I think I would have noticed it developing ( was checking rather frequently thanks to the herpes fear) ; however, it seems to have appeared within a few days.

So, I am worried ... do you think I could have gotten different HPV/wart from the incident I described?  It has been about 2.5 months.   It just seems odd that the area this wart appeared wasn't on the scrotum, but toward the base of the penis.   That's where my other warts were.  Could I have autoinnoculated myself?   I've read that it is very rare to get HPV from an incident like mine, but now that this wart is there, maybe I did something to spread an otherwise invisible HPV infection to an area that would be more susceptible to a wart appearing?

Thanks again for all that you and Dr. Hook do.  It really is God's work, as I know there are thousands like me who's lives turned somewhat upside-down when stuff like this happens.

[BadDecisionGuy]

Last post ... I also did some research that hairs are not usually growing out of a wart.  It looked like there was one, but once the head fell off, it just left a scab.   The area of the wart is toward the base of the penis where there is definitely pubic hair.  I've also read that warts almost never appear there either.

Well, I will let you answer when you have the time.   Thanks again!

[H. Hunter Handsfield, M.D.]

True, no hairs coming from warts.  Your description doesn't sound like a wart either.  Sounds more like folliculitis or some other superficial infection -- and for such a problem, Aldara is the last thing you should be using. Stop the Aldara and see a health care provider.

[BadDecisionGuy]

Will do... I already have an appointment with the Dr.   Do you think there is a significant HPV risk associated with my incident?  I've read some different info on other websites, but I think you and Dr. Hook clearly have the depth and breadth of experience to be definitive.  So, what are we talking about?  1:1000?

I would just like to rest at night that I am not going to pass some new infection to my significant other for what was a really short and stupid exposure.

Thanks again!  I will report back should my Dr. find anything out of the ordinary.

[BadDecisionGuy]

Oh yeah ... and is it unusual for a wart to seemingly secrete a clear fluid when squeezed?  It didnt change the form of the wart ... very weird.

[H. Hunter Handsfield, M.D.]

I already said this doesn't sound like a wart.  No fluid of any kind can be squeezed from a wart.

That's all for this thread unless you want to make one final brief comment after you have been examined.