Herpes Questions

[Concerned in GI]

I'm a 50 year old male. Back in the mid 90's  and in 2003 I was in a relationships with a two women that told me they had genital herpes. To my knowledge we never had intercourse during one of their outbreaks. Neither of them knew if they had genital HSV 1 or 2. In the first relationship only once did I have pimple / sore break out at the top of the shaft into the hairline a bit. It was sore and a smelly puss came out for a few days and then healed over. Never had a reoccurrence. In 2001 I had a like a lesion / sore break out on the head of the penis. Quickly went away and since has never come back Once in a while my Urethra track is red / darker from the outside, almost like a rash running inside of it.  Doesn't really bother me so I've never really been concerned that it might be related to any STD. I also have two very very small like pimples on the outer Foreskin of the penis. There always there and have never gone away. I showed these to an Urologist back in 2001 but he said they didn't look like herpes. He did take a blood test back then for HSV 1 and 2 and the test came back HSV 1 positive and inclusive for HSV - 2. So since then, I've really never known if I had genital herpes or not. Back then, the Herpes Select test wasn't available and the Urologist didn't seem to concerned anyway. He just said where a condom while having relations.  To my knowledge no one I have been with has had an outbreak of herpes and in my relationships we usually had unprotected vaginal intercourse. My questions to you are:

1. Do any of these symptoms I have seem typical of HSV 1 OR 2?

2. You have stated many times in various threads that even if you did have unprotected vaginal intercourse with an infected HIV partner your chances are 1 - 1000 you could become infected yourself with one episode of unprotected vaginal intercourse. What are the odds then if a person is having a small outbreak of genital herpes and he / she doesn't realize it?

3. Since Asymptomatic HSV shedding, or "sub clinical reactivation," occurs in all HSV-infected individuals, and is an important factor in HSV transmission to sexual partners due to the absence of noticeable signs or symptoms of active infection, does while in the shedding stage increase the risk of transmission of HIV to either the male or female partner and if so what is the transmission rate odds on something like that? Have there been studies done on that?

[H. Hunter Handsfield, M.D.]

Since you were sexually exposed to at least 2 women with known genital herpes, even if you had not symptoms, the odds are probably at least 50:50 that you are infected, most likely with HSV-2.  Since your symptoms are pretty consistent with herpes, it seems a good bet (i.e., better than 50:50) you indeed are infected.  Most of the commercially available blood tests several years ago did not accurately distinguish HSV-1 from HSV-2, but it sounds like that result at least was compatible with HSV-2.

To your specific questions:  1) Your symptoms indeed sound suspicious for herpes, although I don't know how to square that with a urolgist's opinion that the lesions weren't typical. But "typical" is in the eye of the beholder; many docs don't understand that most herpes lesions aren't all that typical looking.

2) In general, the odds of HIV infection are doubled in the presence of genital HSV-2 infection.  That risk is independent of having symptoms; that is, just having a positive HSV-2 blood test doubles the risk.  But remember, double 1 in 1000 still is only 1 in 500 risk.  And anyway, most likely you have never had sex with an HIV-infected woman.

3) Presumably the enhanced HIV transmission risk is correlated with subclinical (unrecognized) genital lesions, but this hasn't been proved or directly studied.  On the other hand, the longer genital herpes is present, the fewer the overt outbreaks and also the less the frequency of sublinical viral shedding.  Even if HSV-2 infected, at age 50 you may not be at high risk for either.

Bottom line:  Have a modern HSV-2 blood test, then follow up with your provider, or another provider with good STD/herpes knowledge.  But don't lose a lot of sleep over the HIV risks.

Good luck--  HHH, MD

[Concerned in GI]

Thank you for the info Doctor. Your forum is of great value to a lot people and your compassion for people that are very worried is admirable and should be commended. In all fairness to the Urologist, he didn't see the lesions that healed up. What he saw were the two very small like pimples that are always there. The are so small there very hard to see. That's what he said didn't look typical of herpes and at that time said if I did have another lesion breakout to come in right away and he would do a culture. That was before the modern Herpes Select test was available. I guess what I'm asking is could the two small pimples be herpes? Do typical herpes lesions sometimes never heal?  Like I said they are very small and you really have to look to see them. They could be due to the fact I workout daily and sweat an awful lot on the stair master.  I am going to go for a herpes select test, but I am in a relationship and want to her to understand there might be an increased risk of her getting genital herpes if the two small pimples that are always there could be herpes. Only fair for her to know, so she can make an informed decision based on the best available information. I'm just worried maybe I could be having a small breakout 100 percent of the time or is this not possible. I know you have stated that 25% of the population probably already has HSV 2, but I believe that might even higher for people who are dating, not married and tend to move from one relationship to another trying to find the right partner. Thank you for your time.

[t1234]

I suspect you're right about the HSV2 infection rate
being higher in 50ish single population.  Most
single women I've met have tested positive for HSV2
in spite of the fact they had no idea they were infected.

Very flustrating.

I do hope at some point we get a good study documenting
the transmission rate in serodiscordant couples where
the infected partner has never had any known symptoms.

Since 80 per cent of HSV2 infected persons fall into
this category, it would certainly be helpful in
accessing real risk to the non-infected partner which may
be much lower than it would be if the infected partner
experienced periodic outbreaks.

[H. Hunter Handsfield, M.D.]

Herpes lesions always heal; persistent "pimple-like" lesions definitely aren't herpes. The HerpeSelect HSV-2 result is the only relable basis on which to advise your current or future sex partner(s).  If positive, you are infected; if negative, you are not infected and all the rest of your story is irrelvant.  So you might be wise to hold off on discussion with your partner until you know the test result - otherwise you might raise an alarm unnecessarily.

HHH, MD

[Concerned in GI]

Last Question:

I will go and have a herpes select test done. If it comes back positive for Genital HSV 2 Herpes is there an obligation to go back almost ten years when the infection might have happened and tell everyone you might have been with that they had a chance of getting this while I might have been shedding? Like I said, nobody I've been with has ever had an outbreak and I really don't want to go back and disrupt someones life for no reason. Its like, how do you even start to explain somthing like that after most people have moved on with their lives? I understand about telling current or future partners.

[SoScared03]

Hey i have a few questions and i was hoping someone could help me. Im confused about the symptoms of herpes. I dont have any sores or blisters, i just have genital itching. I took a herpes select blood test at about 9weeks after exposure and it came back negative for both type one and two but i read online that you should wait 12-16weeks before testing. What are the chances my test results could be wrong? I am going back for another test but i am so paranoid i have herpes. Help?

[H. Hunter Handsfield, M.D.]

CiGI:  You're asking an ethical question, but if you are positive for HSV-2 I don't think most people would consider that you have an obligation to inform all past sex partners you might have been infected.  You won't know for sure when you were infected; your partners likely have had other partners over the years, so even if they are infected, it won't necessarily have come from you; and the risk of transmission for any one exposure would have been low anyway.

ss03:  Your question is a thread jump, but the answer is quick and easy:  Herpes isn't the cause of your symptoms, period.  Post a question in a new thread if you need any more information than that.

HHH, MD