Herpes Questions

Thanks for the great service. I have been in a sexual relationship with a woman for 4 months who has genital HSV2.

1. We have been following the "avoid outbreak", condom, Valtrex recommendations. A couple months ago, we had sex (with a condom). The next morning my girlfriend found a herpes sore on her labia majora. It's possible the sore was there the night before but we did not notice it. What kind of risk would a situation like this bring? Is it necessary to do a visual inspection every time before sex?

2. Does an initial genital herpes outbreak always involve some sort of lesion or visual clue? Or can the initial herpes outbreak be completely asymptomatic?

3. I have seen you say several times that the initial outbreak for males usually (or always?) happens on the penis. Is it possible that an initial outbreak could appear on the thigh with no signs on the penis?

4. Related to question 3, a small "pimple" appeared about 6 inches down my inner thigh about a week ago. It was one red bump that developed pus like a pimple. I squeezed it quite a bit thinking it was a pimple. After closer inspection, I found a hair growing out of it and assumed it was folliculitis. About 4 days later, 3 more little pimples appeared in various places about 3-4 inches from the initial one but these don't seem to have hairs growing out of them. Is it possible to spread folliculitis? Does herpes ever appear slowly (meaning one pimple one day, and then a few more a week later)?

[H. Hunter Handsfield, M.D.]

You can assume your partner was infectious when you had sex the night before noticing your partner's lesion.  But apparently you used a condom, and that provides a high degree of protection. Even without a condom, you wouldn't necessarily be infected; not all exposures result in transmission even when an overt lesion is present.  If you haven't had symptoms over the next 2 months, probably you were not infected.  Anyway, focusing on the one time your partner had a noticeable lesion is a waste of time.  For every outbreak she recognizes, there are many other times when you are being exposed to asymptomatic viral shedding.

My other general comment, scanning your questions but not yet reading them carefully, is that both the questions and my answers are speculative.  The way to know whether or not you are infected is to have a blood test.  All else will be guesswork.

1) All in all, the event was low risk because of the condom.  I'm not sure 'we' should have a clinical interlude before having sex.  Your partner should be on the lookout for lesions if sex is anticipated.

2,3) Most initial herpes has lesions, although they may be pretty mild.  Most alert/concerned persons (like you) probably would notice them.  But truly asymptomatic infection is not rare.  Most recognized cases indeed involve the penis.

4) The pimple on your thigh probably was just a pimple or folliculitis.  Yes, multiple lesions are the rule in folliculitis, which is often caused by staph or strep infection.  Herpes doesn't generally behave the way you describe.

So as I suggested above, I cannot say whether or not you have acquired your partner's infection.  Probably not.  But the way to know is to have a blood test.

Final thought:  You seem pretty bummed out by your partner's herpes.  Given the precautions you describe, most likely you could go through a lifetime of sex and never catch it.  

Good luck--  HHH, MD

[zz564]

Hello Doc,

I had a stinging sensation in the urethra since April.  The stinging pain was very intense in the begining.  The feeling went from the urethra to my anus. Doctor diagnosed me with HSV 1 and 2 and also said I have NGU.  Clamydia (chlamydia), Syphyllis and Gonarhea results came back negative. I used zovirax ointment, the pain subsided little.  I was given doxycycline, levaquin. ciproflaxacin, metronidazole.  The feeling is mild, I still feel it in the urethra and anus(it's been 10 weeks since the onset).  I did use valtrex for a week but the feeling is still there.  I'm also taking lysine supplements.

1)My question is could this be due to Herpes or some thing else.  I thought Herpes comes and goes.  it is not supposed to last this long(10 weeks)?.  

2)I did have  few pimples on the lips then flu like symptoms and a week later stinging pain in the urethra. The bumps are gone just the feeling in the urethra and anus remain. The doctors can't determine what's causing it.
could it be a viral or bacterial infection?

3)do you recommend I take other antibiotics or get additional test done

Your help is appreciated.

Thanks,
zz564

[H. Hunter Handsfield, M.D.]

All I can possibly due is speculate.  You should follow up with your own health care provider about the cause of your symptoms and/or advice about diagnosis or treatment.  I don't have any other thoughts at this point.