Inflamed Fordyce Spot or HSV-2?

[abdkr34]

Hi there Doctors:

Here is my situation: Tested negative for HSV-2 in January 16 weeks after last exposure. Never symptomatic. Cold sores as a child and thus HSV-1 positive. My only exposure after the negative test is receiving oral sex from a girl 9 days ago. Claimed no history of herpes. No visible lesions on her lips.

I have many Fordyce spots on my scrotum and shaft. I also have hair growing up the shaft, which I shave. This often results in irritation and ingrown hairs. After shaving two days ago I then masturbated fairly vigorously the next two days. Today I noticed that one of the Fordyce spots had become inflamed. There was hair stubble growing nearby. I popped the single lesion/Fordyce spot and clear fluid came out. No pain. It looks like all my Fordyce spots except for the inflammation. But, the clear fluid has greatly troubled me.

1. Is it possible for an inflamed Fordyce spot to leak clear fluid due to shaving and the friction from dry masturbation?
2. Is it possible for me to have contracted HSV-2 from receiving oral sex? Is it possible for me to have contracted genital HSV-1 despite my existing antibodies? Which would be more likely?
3. I've read that oral HSV-2 is usually contracted along with genital HSV-2. Would most people contracting oral HSV-2 thus have a symptomatic genital infection coupled with an oral outbreak?
4. Does having existing oral HSV-1 antibodies prevent against contracting oral HSV-2 on top of it?
5. I've read that oral HSV-2 sheds 3 days a year. Is the shedding on all of those days is sufficient for transmission?
6. Would those 3 days of oral HSV-2 shedding usually occur in conjunction with a symptomatic genital outbreak? The girl had a visual exam 4 days after and the doctor said everything looked fine.
7. What should I be on the lookout for in the next couple days to either confirm or dismiss my worry?

Thanks so much!

[Edward W Hook, MD]

LAst answers:

1.  Zero risk.
2.  Same answer


There will be no further answers.  If you cannot stop your unwarranted fixation on HSV, I suggest you discuss this with a trained mental health professional as your anxieties are negatively impacting your relationships with others.  EWH

[abdkr34]

Hey there Dr. Hook,

I have to ask two quick follow-up questions. If you choose to briefly answer, please lock this thread after for my own benefit. Already arranged professional help.

I had a long discussion with my partner tonight. I explained my fears and we tried some safe options. But, even our seemingly 0 risk activities are too much for me right now.

1. She lightly kissed my penis a few times through my mesh-like underwear. As close to zero risk as possible in medicine?

2. Another really inflamed Fordyce spot appeared today after masturbating. At 19 days and with its appearance, another definitive zero risk?

Embarrassed to ask these questions. But, I decided to risk annoying you rather than go through another 14 days of torture.

Really, I do apologize. Both of you have been just awesome.

[Edward W Hook, MD]

Either a simple pimple or  what is called a "pearlyu penile papule.  this is not HSV.  EWH

[abdkr34]

Hey Dr. Hook,

In the medhelp tradition, just a final-final follow up as I near the 14 day mark that you specified.

Right beside this inflamed Fordyce spot (that has went down quite a bit), there is now what looks to be a very tiny pimple with a white head. Would this be the beginning of the "cluster" that we read about? Or, can we write this off as a simple pimple?

Sorry for the follow up. Thanks again.

[Edward W Hook, MD]

No, a HSV lesion would not look like a Fordyce spot.  HSV blisters appear in places where they were no before and tend to be fluid filled but go on to break in a dy or two, even without squeezing.  I see NO medical reason to pursue HSV testing.  EWH

[abdkr34]

Thanks for your reply Doctor Hook! Just a final follow-up to help wrap my head around everything:

1. Would a herpes blister would be distinguishable from a Fordyce spot? This spot looks identical to the dozens of other Fordyce spots on my genitals (save for the fluid).
2. Assuming no new symptoms, would you recommend testing in this situation?

You were a massive help tonight. Best wishes.

[Edward W Hook, MD]

You risk for acquiring HSV-2 from oral sex is incredibly low and not something to worry about.  It sounds as though between your shaving your genitals an masturbation which you then irritated further by squeezing (never a good idea).  None of this raises any concern about HSV.   Going straight to your questions:

1.  Yes, this is possible
2.  Since you already have HSV-1, you are not at further risk for acquisition of HSV-1 at other locations.  As for HSV-2 acquisition through oral sex, as I said above, it is incredibly rare an what you describe does not suggest this.
3.  Whatever you have been reading is incorrect.  HSV infections are typically acquired at only one location, not simultaneously at the mouth an genitals.
4.  There is some evidence to suggest that oral HSV-1 reduces risk for HSV-2 somewhat but not 100%.  There are other studies that indicate that there is not significant protection from HSV-2 by existing HSV-1 antibodies. Thus there is still some debate on this topic.
5.  I have no idea where you heard this.  There is occasional asymptomatic shedding of oral HSV-1 but precisely how frequently it occurs is not well know. Probably 5-10% of the time.  When virus is present (i.e. shedding is occurring), the infection can be transmitted.
6.  Shedding of either HSV-2 or HSV-1 an be symptomatic with lesions present or asymptomatic and without lesions.
7.  I see no reason for worry.  If you were to develop HSV you would develop small, fluid filled blisters art a site of exposure at some time between 4 and 145 days after exposure.  Should this happen, the lesions should not be squeezed or treated but should be tested by culture or PCR to make a definitive diagnosis.

Hope this helps.  It appears that you've been reading about lesions and HSV on the internet. BE careful.  The internet has not only the power to inform but also to mislead.  While there is much useful information available on the internet, much of it is also taken out of context or a bit unbalanced and some of it is just plain wrong.  EWH