Herpes Question

I have been with the same woman for 7 years now.  We dated for 2 years and have been married for 5 years.  I have been completely faithful to my wife and believe with all my heart she has been completely but faithful to me.  

About 2 years ago I began to notice a small cluster of bumps on my penis.  The bumps itched quit a bit and would soon become slightly painful sores.  The sores would scab over and eventually go away.  Every now and then the sores reappear generally in the same spot.  There seems to be three different places on my penis the sores will appear, but they only appear in one spot each time they occur.  Never having these symptoms before, I thought them to be some type of fungal infection as I am constantly in the gym and sweating.  I thought the symptoms may be jock-itch.  

After 2 years and further investigation, I find my symptoms resemble herpes.  Over the course of the pass 2 years, my wife and I have had sex when I had the bumps because I had no clue as to thier possible cause, but she has never said anything to me about suffering from the same symptoms, nor has our sex life suffered.  Here are my questions:

1.  In your opinion, does it sound like I have herpes?
2.  If not herpes, what other problems could resemble herpes?
3.  My wife and I both have had cold sores in the past.  Could I have contracted HSV-1 on my penis from oral sex?
4.  If I contracted HSV-II in a prevous relationship, would it have waited years before rearing its ugly head?

[H. Hunter Handsfield, M.D.]

1.  Yes, I think it is herpes.

2.  I can't give you much reassurance; almost nothing else sounds likely.  The clues are the nature of the lesions, red bumps, then scabs, followed by healing (total duration from red bump to scabs falling off usually 10-12 days); plus repeated recurrence "generally in the same spot".

3.  Possibly genital HSV-1 infection acquired by oral sex, but unlikely.  Most people who get genital HSV-1 infection have no recurrences or only one or two over the next 1-2 years, then nothing.  Almost all cases of recurrent genital herpes, particularly over several years, are due to HSV-2.

4.  Yes, genital herpes often first causes recognized symptoms several years after acquisition.  In fact, 40% of persons with the first known outbreak of genital HSV-2 infection have been infected for several months or years.  Therefore, as you imply, you might have brought HSV-2 into the relationship.  But it is just as likely that your wife brought it into the marriage, and that you acquired it from her 2 years ago.  The fact that she apparently has no symptoms (or none that you describe) doesn't mean much; most genital HSV-2 infections are entirely asymptomatic.

In other words, with the currently available information, there is no way to know whether or not your wife is infected; or if she is, which of you infected the other.  In fact, it isn't certain either of you infected the other; since 25% of the population has genital HSV-2 infection, you could have both come into your marriage with unknown genital herpes.  Most important, the presence of herpes in the relationship does not necessarily imply that either of you has had other partners.

If you want to sort this out--but perhaps only partially--you and your wife can both be tested for HSV-2.  Be sure and get the right blood test; be sure your health care provider requests the Focus company's HerpeSelect type 2 test; all other commercially available tests are unreliable, especially in persons who also may have HSV-1 infection, as you apparently do.  But for the reasons above, be aware that if you both are positive for HSV-2 (which I predict), you will never know who was infected first.

On the other hand, if only you are positive and your wife hasn't yet been infected by you, you will know how to protect her:  avoid sex when you have an outbreak, consider condoms, or consider antiviral therapy to prevent outbreaks and help prevent transmission.  None of these by itself prevents all transmission, but many couples in which only one persons is infected continue healthy and rewarding sex lives without ever transmitting the infection.

I hope this helps.  Post a follow-up and let me know what happens.  Best wishes--

HHH, MD