Genital HSV via oral sex

[rkc91]

Hi Doctor,

I had unprotected oral sex and protected vagina intercourse with a private escort 10 days ago. I did not see any lesions on her lips. About a week later, I noticed a couple of red spots on the head of my penis and a minor sore throat. The red spots are fading (no sores or blisters) and my throat is better. Could these be the symptoms of genital herpes or not?

I have read several articles on this forum and other websites but I am still not clear about the risk of getting genital herpes (HSV 1 or HSV 2) via unprotected oral sex. I know I have HSV 1 since I get core sores 1 or 2 per year so my questions are:

1. Is it possible for me to get genital HSV 1 even though I already have oral HSV 1? If yes, what are the odds?
2. And is it possible for me to get genital HSV 2? l think from reading this forum the odds are low but how low? Like 1 in 1,000?
3. I understand I need to wait three months to get an accurate test for herpes and will do so in three months but do you recommend I see a doctor now based on the symptoms I described above?

By the way, I took the 8 most common STDs test from STD Test Express last Friday and should find out the results in a few days.

Thanks in advance for your advice.

[Edward W Hook, MD]

Welcome to our Forum.   This is such a common question that before I answer your specific questions I will make some relevant general comments which I hope will help to put things into context.  Fear of genital herpes is widespread. I think part of this reflects fear of the unknown. That is, when people hear that 9 out of 10 people with genital herpes do not know it and that  the infection can be spread by persons who do not have lesions, they begin to approach each new sexual encounter with fear and trepidation which is out of proportion to their risk.  The fact is that most people who do not know they have herpes do not know because they are not attuned to the possibility that a genital irritation could be due to HSV and therefore "miss" their initial outbreak- something that is not all that uncommon since the outbreaks do, virtually without fail go away.  In cases such as yours you would be unlikely to miss an outbreak, had it occurred.

Further with respect to HSV-1, this is so common, with about 60% of adults having it due to childhood acquisition, that most people do not get genital HSV-1, even if exposed in part both because not all exposures lead to transmission and in part because a person's immunity to their own infection, when infected prevents them from getting infected a second time. Thus in your case, since you already get cold sores, you have no reason to worry that you might get genital HSV-1 from receipt of oral sex with any new partner, escort or otherwise.  Further, in terms of oral sex, there is little risk of HSV-2 from oral sex because  to have it, your partner would need to have oral HSV-2 infections and these too are very, very rare.

With this (hopefully) helpful background, let me address your questions:

1.  Is it possible- yes, there really is almost nothing that is impossible.  How likely?  You are about as likely to get hit by lightening.  It is not something for you to worry about.

2.  Not from oral sex for the reasons I outlined above.  for you to get genital HSV-2 from receipt of oral sex you r partner would have to have oral HSV-2 (very, very rare) and she would then have to transmit it (also very rare).  this simply does not happen enough to worry about.

3.  I see no reason for you to seek evaluation at this time. If you develop genital lesions you should get a swab test taken from the lesions for culture or PCR. Otherwise, I would not seek evaluation at this time.  Further, I would not bother with a blood test at 3 months.  In the absence of more suggestive lesions, the risk is small and it is more likely that you will get a false positive test than find that you actually acquired HSV.

I hope these comments are helpful.  EWH

[rkc91]

Hi Doctor.

Thanks for the quick reply. It makes me feel better. I also felt anxious because my wife was complaining of UTI pain about four days ago. She went to the doctor and they gave her sulfameth/trimethoprim. Most of the red spots are gone except for 2 red spots that look like bumps but they do not itch or hurt. I have them for 3 days now. How long should I wait before I get a swap test? And one last question, I read somewhere online that condom provides "some" prevention during intercourse but one still can get HSV-2 through skin to skin contact.  What are the odds of getting HSV-2 with condom or skin to skin contact?

[Edward W Hook, MD]

Condom use reduces the risk of getting genital herpes by at least 60%.

If you have lesions (spots, sores, elcers, or other kinds of lesions) a swab test can be performed for culture or PCR testing.  EWH

[rkc91]

Hi Doctor,

Thanks for the info. I did not know that condoms reduce the risk of getting genital herpes by only 60%. I read online that about 35% of sex workers have HSV-2 so does that mean my chances of getting HSV-2 are: 35% (sex worker) x .40% (wearing condom) x 33%(12 days of shedding) = about 4.6%? My 2 red bump are pretty much gone (they lasted about 4 day) so should I still get a swab test even though I don't have sores, ulcers, blisters or can I assume I don't have HSV-2 and assume my normal sex life with my wife?  By the way, I got my test results and the only positive was HSV-1 as expected. Thanks!

[Edward W Hook, MD]

No, your risk is far lower.  Your calculations assume that every exposure leads to infection. This is nto the case.  Only a small fraction of expsoures lead to transmission of infection.  If you do not have a lesions at this time there is little reason for a swab test.  My advice would be to assume that you did not get HSV.  EWH