Herpes Autoinoculation worry

4 weeks ago, I made out with a girl that had a cold sore.  A day after, I noticed tingling around my lip area and tiny white bumps on my upper lip appeared after two days. I bought abreva and started applying it. Over the next two weeks, I saw tiny bumps that appeared and disappeared within a day or two. Still constant tingling. I went to my PCP and he put me on acyclovir and diagnosed me with oral herpes. I also at 3 wks (i know early) from exposure got a HerpesSelect blood test done. Results came back negative for both hsv1 & hsv2. Last saturday, I noticed red blotches on my penis and got concerned about autoinoculation so went to my pcp. He said it was probably a yeast infection and so gave me some antifungal cream. The redness did go down.
Now today, I went to a dermatologist to get a more thorough examination of all my symptoms. The small tiny white bumps were still present and the dr looked at it and said it was probably glands and definitely didn't look like herpes.  He said I don't currently have any herpes sores on my lip area. When I was showing him my lip area, I was using my fingers to stretch my lip to show him the white spots. And then without washing my hands, I proceeded to show him my penis, pulled back my foreskin and showed him where i believed to have seen the redness. He looked and said, its not herpes and it looks a little like balanitis and soo he gave me some cream.

That really did rest my nerves, but what i'm really worried about right now is that after touching my lips, I actually touched my penis and probably rubbed it quite a bit to show him my redness. I am really scared that as a result of this, I could've autoinoculated myself right there in the doctors office?
Since this is probably my primary infection of coldsores due to - tests above, do you think I autoinfected myself in the genital area? Would one have to touch open sores and then your genitals to become autoinfected?  i had experienced tenderness in lips prior to this.

[Edward W Hook, MD]

The first sentence of your second paragraph speaks volumes for what I'm about to tell you ("That really did rest my nerves, ...).  You presume that the spots on your lips are herpes (presumably HSV-1)  although at least one doctor (the one who specializes in lesions of the skin and mucous membranes) does not think this is herpes.  In addition there are several other facts that make it rather unlikely that you have herpes - these include that you do not have a culture result, that the lesions your doctor saw were not sufficient for him to want to do a culture, and you now have had lesions present for somewhere between 2 and 4 weeks, despite several forms of therapy aimed at herpes. In addition, although it is too early to put any credence in the results of your blood test, it does tell you that if this is herpes a repeat blood test in another 4-6 weeks should be positive if this indeed is herpes.

Now on to the topic of auto-inoculation.  While there are rare cases, they are very very rare. Again, what you seem to be worried about differs from what the doctors think and indeed the therapy you were given which was not directed against herpes appears to ahve helped.

In summary, I find myself approaching your question from a different perspective than you.  I am not sure (doubtful in fact) that you have herpes and even more doubtful that you have auto-inoculated yourself.  I think the first things for you to do is to pursue a more definitive diagnosis.  If there are still lesions present you should have them cultured or have a PCR test done on them, in addition you should return to the dermatologist to seek an alternative diagnosis.  Finally in a month or so, I would suggest you to get another herpes blood test.  In the meantime, I would urge you not to worry about the possibility of auto-inoculation.  It is just not a concern.  Please let us know how your tests turn out.  EWH

[yeehawtex04]

A few additional questions?  

How early will the symptoms arrive if indeed I was autoinfected by this incident?

When will I be in the clear?

Thanks a lot doctor.  I've just been really worried these 4 weeks with this whole ordeal.

[yeehawtex04]

I appreciate the prompt response.

In regards to auto-inoculation.  Hypothetically, if indeed I did have herpes on my lips, What are the chances that I did auto-inoculate myself in the above described incident given that I did touch my lips and then proceeded to touch my genitals?  In the very rare case you describe, do open sores need to be present or can it occur from touching tender spots where tingling occured, etc?

Now in response to you being doubtful of it actually being herpes in the first place.  Yes these small tiny white bumps on my lips are still present 4 weeks from when they appeared.  They started appearing about 2 days after exposure.  I also experienced the classic symptoms such as a tingling/burning sensation around the lips.  I never really experienced a classic cold sore..I sensed a little bit of scabbing in my mustache area but I have a goatee/mustache so it was hard to tell..also like a week into it..i did notice a tiny bump and then it disappeared in a day but i'd constantly apply abreva on my lips during that 2 week period.  The girl infact did have a cold sore and the symptoms i experienced seemed soo classic except for the sores.  The first PCP diagonsed me from my story as the tiny white bumps which were probably a little more than what i have now.  The dermatologist said they dont' look like herpes sores and they look more like "glands?"  but i'm not sure why they'd appear after the exposure.

Do you think I should ask him to scrape these white lesions? and get a cultured test?

Thank you again doctor.  This service you provide here is priceless!

[Edward W Hook, MD]

Did you not read my comment?  The chances that you auto-inoculated yourself are too low to  accurately measure- less than 1%.  

Secondly, again, you choose not to accept the assessment of a dermatologist.  I'm not sure why.  Do you want to have herpes?  There is nothing but your feeling that you have herpes and your decision to believe the assessment of  your PCP over the assessment of a specialist.   The unusual nature of your symptoms and course of disease do not suggest herpes.  The only way you'll convince me that you ahve herpes is with positive tests.

EWH

[yeehawtex04]

Wanted to provide an update and also ask a few questions.

At approximately 6 weeks 2 days since exposure I took another herpes select blood test and tested negative for both hsv1 and hsv2.

My symptoms:
Last friday noticed two tiny spots that are still present today at the corner of my mouth..started to pick at them, they wouldn't disappear then i also noticed the corner of my mouth (directly where the top and bottom lips meet, only one side) inflamed and it seemed like blisters were growing...It was hard to say since it also seems like corner is chapped with cracks due to open and closing.  I squeezed the bumps and a some little clear fluid seeped out.  I also applied a hot washcloth to the area and it seemed to go down a little.  within 1.5 days i think the area that i poked at scabed up and within 3 days the scab fell off.  Right now it seems like theres excess skin there like if it was a blister that healed.

Other symptoms include intermittent prickling, tingling on upper lips especially the area that was probably exposed to a cold sore.

My questions:

1)  I know 6 weeks could be too early to have faith in a blood test, but   whats the probability that I should have seroconverted by now?  Should I take a 3-4 month test and would that totally confirm everything?

2)  Do the symptoms above suggest herpes?  They seem pretty classic, except i didn't experience any tingling right at the corner of the mouth before noticing the blister-like bump.

Thank you for you time doctor.

[yeehawtex04]

I should also add that that Thursday I noticed that my fordyce spots on my lips were more prominent after drinking beer.  Wasn't sure if the yeast had contributed to that and possibly the bumps?

[Edward W Hook, MD]

Your symptoms are not suggestive of herpes and sound like non-infectious irritation at the angle of your lips (medical term is Chelosis).  Sometimes similar problems arrise form yeast infection.

  At six weeks about 75% of HerpeSelect tests will be positive, thus there is still more evidence that you do not have herpes.  I am highly doubtful that you have herpes.  Please stop worrying and move on with your life.  EWH

[yeehawtex04]

I appreciate your comments.  I am on my way to moving on with my life, however just for further clarification:  I have read on numerous sites that taking anti-virals can potentially suppress the virus and either delay the growth of antibodies or prevent them entirely.  1.5 weeks after exposure, I started taking acyclovir for 2 weeks straight.  

Does this have an effect on my 3 or 6 weeks negative test results?  Could the virus have been suppressed by the medication hence not allowing antibodies to develop?  Should a 3 month test completely confirm my herpes standing?

Thanks doctor!  Have a good day.

[yeehawtex04]

btw the forums at herpes-coldsores.com seem to suggest that seroconversion can take a long time..>6months in some ppl, etc...i guess that got me really concerned, but I trust  a professional over them...

[Edward W Hook, MD]

Humans are highly variable and indeed, at least in theory, taking antiviral therapy COULD delay one's antibody response.  In practice however this is most uncommon.  Similarly, indeed a very small proportion of persons with herpes can take up to 6 month to have a positive antibody test following a TYPICAL first outbreak.  Nonetheless, give your very low risk exposure and negative tests to day, the chance that you have herpes remains very small.  Get another test at 6 months if you wish.  In my opinion, this is a waste of time and money and it to will be negative.

This post has gone on quite a while.  It is now time for it to end.  No more questions please.  EWH

[yeehawtex04]

Sorry, Dr, but you say my exposure was a low risk exposure?  I made out with a girl with an active cold sore.  Isn't that high risk?