STDs Expert Forum
Herpes Questions
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Herpes Questions

6 weeks ago I had protected vaginal sex with a girl I met in a bar, I also performed unprotected oral sex on her. She didn't perform oral sex on me. She had no obvious sign of herpes that I could tell. I have no history of oral/genital herpes, no symptoms, but never tested.

Anyway, 6 weeks passed, no symptoms of anything. Yesterday I noticed 5 raised red patches on my inner thigh, near my jeans pocket, so first thought was I had got irritated by carrying stuff. They are about 6mm in diameter and have little clear boil like things in the centre. All five are contained in an area about 2-3 inches across. No pain, none have burst.

Today I feel a sore throat, and see what looks like a canker sore right at the back of my mouth near the roof by the tonsil. I do suffer from these but usually on tongue/gums. Anyway I'm a concerned now that these might both be herpes from that incident. I have not had sex since that incident.

So to my specific questions:

1) Is 6 weeks ago too long to be herpes caused by that encounter? Some sites say 5-10 days for primary outbreak, others months/years?
2) Could I contract oral and genital herpes from the same encounter at the same time?
3) Is the thigh a likely place for a primary outbreak?
4) How can I distinguish between a canker sore and a herpes lesion?
5) If this is herpes and if it recurs, will the sites always be the same as the primary outbreaks? ie. if it's oral herpes at back of throat will it alway recur there or could it appear on lips as a coldsore?
6) How should I monitor these "outbreaks" to determine what they might be? ie. what is the typical timeline if they were herpes? How long will they last if it's herpes?
7) From the info I've given is this likely to be herpes, do I need to get tested or shall I wait to see what happens?

Sorry for so many questions, the info on the web is very vague and often conflicting so I appreciate your professional opinion.  Thanks for your time.

Welcome to the forum.  Thanks for your question.

Initial herpes symptoms are almost always located exactly where the virus enters the tissues, and infection usally doesn't take hold unless the virus is "massaged" into the tissues.  Therefore, initial herpes is pretty much limited to the sites of maximum friction during sex.  In this case, you would have expected the skin lesions on the head or shaft of the penis (from the unprotected oral exposure) or perhaps at the base of the penis (from condom-protected vaginal sex).  Also, the timing is wrong:  initial herpes starts within a few days after exposure, rarely as long as 3 weeks but certainly not 6 weeks.

Having said that, your description of the lesions on your thigh is quite typical for a herpes infection of some sort.  My guess is you have herpes zoster (shingles).  However, it is also possible that this is recurrent genital herpes.  If so, you may have had it for a long time, entirely unrelated to the sexual exposure 6 weeks earlier.

Those comments pretty well cover all your qeustions, but here are explicit replies to assure there is no misunderstanding:

1) Some primary HSV infections are asymptomatic, followed later by noticeable recurrent outbreaks.  Therefore, the first symptoms can indeed be months or years after catching the virus.  But when primary infection is symptomatic, the symptoms always begin in the time frame described above.  Six weeks is definitely too late.

2) Simultaneous oral and genital herpes occurs from time to time, depending on specific sexual practices.  But the timing still is wrong.

3) As discussed above, it would be rare for primary HSV to involve the thigh.

4) Individual canker sores can look a lot like herpes.  But initial oral herpes usually has multiple lesions, and the timing still is wrong.

5) Recurrent oral herpes is usually on the lips, not since the mouth or throat.

6,7) Let's not get ahead of ourselves in predicting future symptoms.  You need to get to a doctor's office ASAP, i.e. in the next day or two, for professional evaluation and diagnostic testing.  As noted above, my bet is on shingles, with (recurrent) genital area HSV as my second choice.  PCR tests for both varicella zoster virus and HSV are highly accurate if done when the lesions are fresh, as yours are now.  You also could have a blood test to see if you already are infected with HSV-1 or HSV-2.

The other reason for urgency is that if indeed you have shingles, you need to be treated promptly with high doses of one of the anti-herpes drugs, such as valacyclovir.  Not only will it help clear up the outbreak faster, prompt antiviral treatment helps prevent post-herpetic neuralgia, which is a common and sometimes very painful consequence of shingles.

FYI, in case you didn't know, herpes zoster (shingles) is a localized recurrence of chickenpox, which almost everyone has in childhood.

I'll be interested to hear how it all turns out after you have been examined and tested.  Please return with a follow-up comment and let me know.

Best wishes--  HHH, MD
Dr H,
You asked for a follow up post, so here goes...

Following your advice I visited a UK GUM clinic within 48 hrs as advised. The Doc examined me and took some routine bloods (for HIV and Syphilis) - standard procedure in a UK GUM clinic I think.

She examined the rash and the oral lesion, and said that the rash didn't look like herpes and the oral lesion was too far at the back of the throat to be from giving oral sex to a woman. She also confirmed that the timings were all wrong, as you had said. She didn't think shingles either, but, of course she had the benefit of seeing the rash 1st hand!

She burst one of the blisters and took a swab which went for testing, She said she wasn't quite sure what the rash was but that it didn't look like an STD. She gave a me an anti bacterial/steroidal cream (trimovate) and advised me to try it but stop if it agrevated the rash (as apparently it would make herpes worse if that was the case), I was scheduled for a follow up in a week to get the results.

That was today. All results were negative, and the rash is clearing up. Doc reckoned most likley a common garden bacterial skin infection and no further treatment required.

So, thanks for your help and advice. As ever your scientific approach is very reassuring.

In return, I'll give you some advice... keep up the excellent work, and I recommend you and Doc Hook publish an "Idiots guide to STDs". I'm sure your honest, unbiased and factual advice would make it a best seller and it would put alot of minds at ease plus it would dispel alot of the myths and predjudiced views that circulate the internet re STDs.

A not to technical handbook that explained the facts about transmission, prevention, symptoms etc should be a vital for every boy (and girl) scout's christmas stocking!

Once again, thanks for your time and help.

Thanks for your kind thoughts about the forum.  I'm happy to hear the problem was nothing serious and glad to have helped.
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