Herpes Concerns

[spiralling_concerns]

Hi Doc, Hopefully you can help me sort this out.

I am in a mutual monogamous relationship for 7 months. Prior to this relationship we were both in mutual monogamous marriages for many years. But here is where things get dicey. Exactly 2 weeks ago, I noticed 3 small (less than half the diameter of an eraser) pinkish-red spots on my shaft. They formed an tight isosceles triangle about 1 cm wide. A few days later the three spots seemed to merge into a triangular shaped red spot. It is flat, no heads, no pus, no pain, nothing. I thought is was an abrasion from the energetic sex the day before. However, 2 weeks later it is still there. It was getting much better (fading) until yesterday, we had sex again, and now it has fully returned. Still no pain. Maybe a little burning...very minor. I have no other issues, no fever or painful urination. I'm in great health with regular physicals. I'm 32.

I spoke with my girlfriend and she has never had any issues. She's very honest. Chlamydia and Gonorrhea tests were negative. We both give blood often, so no HIV. Here are my questions:

1) Does this sound like herpes?
2) It is possible for one of us to have herpes for years and never know it?
3) Herpes testing info is concussion. When and how should I be tested?
4) Is there any other condition I should be worried about?

Thank you.

[H. Hunter Handsfield, M.D.]

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

This description does not sound like herpes.  In general, herpes lesions progress from red bump to superficial blister to open sore to scab over about a week, the the lesions heal over the next week or so.  Red spots that do not turn into blisters or pimple-like lesions, and that do not develop scabs over a 2 week period, probably are due to something else.  Same for any red patch of the sort you describe.

1) Therefore, the answer to question 1 is no.  I doubt this is herpes.

2) Sure.  In the US, around 1 in 5 of all adults have HSV-2, the main cause of genital herpes, and most have no symptoms (that they remember) that suggest genital herpes.  However, given your and your partner's apparent sexual lifestyles, your chance of being infected probably is lower than the 20% national average.

3) I recommend against testing for HSV, unless and until you have seen a health care provider who has examined your penis and advised you about the likely causes and the pros and cons of HSV diagnostic tests.

4) Any of the innumerable causes of skin rash anywhere on the body sometimes can cause rash on the penis.  What you describe doesn't sound like any particular rash that I can think of, and it certainly does not sound like any sort of serious health threat.

See a health care provider, either your personal physician or clinic, or a dermatologist.  In the meantime, neither herpes nor any other STD sounds likely.  After you have been examined, feel free to return to the forum to let me know that provider's opinion.

Regards--  HHH, MD

[spiralling_concerns]

Doctor,
I forgot to mention that my left testicle seems a little tender, off and on. And the spot is o on the left side of my shaft...if that makes any difference at all. Sorry. Thanks.

[H. Hunter Handsfield, M.D.]

This doesn't change my opinion or advice.  On and off testicular discomfort is not a likely STD symptom and undoubtedly is entirely unrelated to the penile skin problem.

[spiralling_concerns]

Yesterday I went to my doctor. The lesion appeared quite irritated and dark red. He was unsure of the cause of the lesion but suspects that it is an atypical herpes lesion. He did a swab and took blood for testing. The results will not be ready for a couple of days. In the meantime I was given Acyclovir to take three times daily. The lesion has scabbed over and feels very dry and is peeling a little.

[spiralling_concerns]

I forgot to ask... In case this lesion is not herpes and is some sort of fungus, would it be safe to apply a topical anti-fungal cream, or would that be problematic if it turns out to be herpes?
Thank you.

[H. Hunter Handsfield, M.D.]

Not knowing the likely cause, I am not going to give any further advice that might conflict with that of your own doctor.  He is the one for these questions.

But please report back when a particular diagnosis is confirmed; I'll be interested to know, especially if it turns out to be herpes.  However, I expect the swab test to be negative.  Once a herpes lesion starts to heal, such tests for the virus usually are negative.  If so, and if your doctor still suspects herpes, you'll need to either have blood tests or wait until there is a recurrence, and have a swab test promptly, preferably within 1-2 days of onset.

[spiralling_concerns]

There has been an interesting turn of events.

After a 2 days of Acyclovir there was no change. Then I applied an antifungal and the lesion nearly cleared up overnight. Just to be sure, my girl friend got tested for everything, including a herpes (blood test). She tested positive for HSV2. However, she has never had an outbreak. The doctor told her that the infection was at least 3 months old, likely six months. A few days later my test results were in and were negative. Odd. I do not know if a blood test was conducted in conjunction with the swab test. Three vials were drawn, but I was also tested for syphilis, which was also negative.

My girlfriend was last tested in early 2007 when she was married and prior to giving birth; the test was negative then. The only person she has been with sexually between then and me, was her husband (ex-husband now). I guess that is rather incriminating for him...not that it matters now. For some reason this is all a little funny to me.

Am I correct to think that I may possibly have a herpes infection, despite my negative test, since the swab test is unreliable and it is too early for an antibodies test?

Also, she has never had an outbreak, but should she consider using Valtrex to help reduce the likelihood of transmission.

[spiralling_concerns]

This may be teetering on the verge of lunacy, but is it possible to be deliberately given herpes, medically I mean. Can a doctor infect a more desirable location, like the bottom of my foot for instance, or arm pit, thus rendering me practically immune from a genital infection. We have a very sexual relationship; I'm just being realistic and trying to weigh my options.

[H. Hunter Handsfield, M.D.]

No, I suspect you don't have herpes.  It's very common for one partner to have herpes and for it not to be transmitted to the other partner for months or even hears.  The average rate is that transmission will occur in about 1 in 20 couples per year, if they have unprotected vaginal intercourse 2-3 times per week.

Also, I'm inclined to agree with your own instinct:  the whole situation is "a little funny" to me as well.  It may be your partner's test is false positive.  That depends a bit on the details.  If she can speak with her doctor and learn the detailed test results -- the type of test and the numerical values -- we could probably sort this out.  Neither of you should take any antiherpes drug until the situation is clarified further.

The "should I be infected intentionally" question comes up from time to time.  The answer is always no.  Although it is very rare, severe complications can result from HSV infection anywhere on the body.

[spiralling_concerns]

She just checked her HSV2 results. The form says "HSV 2 Glycoprotein G Ab 6.53H IV SLN.

Also, I would like to thank you profoundly for the superb service you have provided; it far outweighs the meager $15 fee. Is there any way to donate money via the website?

[spiralling_concerns]

Oh, and her test results also say..."Herpes I and II, IgG with reflex". Whatever all that means.