Is this genital HSV1?

[froo23]

First off, just wanted thank you for offering this service. It really is much appreciated!!!
I am curious as to your opinion on whether or not these symptoms could be genital hsv1... History: 26 years old, haven't had sex in 9 months, negative IgG results for hsv 1 and 2 in may as well as september of this year (3weeks ago, just routine checkups). Last weekend I received unprotected oral for approximately 45 seconds to a minute. I  did not see any sores on her lips, I am unaware of her hsv1 status. Well, around day 8 (yesterday evening) I noticed 2 small red "dots", one on either side but more inside the urethral meatus, tiny, pin head sized, but bright red. Around the same time I noticed a mild-to-moderate but constant burning sensation in the urethra at the opening, no discharge I know of. GP's opinion was that it was most likely not herpes because it doesn't present with the blistering "classic" symptoms, and should be extremely painful. Well it is painful enough to be mildly annoying, the urethral swab was WAY more painful! I made sure I got a urethral culture for hsv, and he did another for bacterial infections. I also did one more IgG test for 1 and 2, just to confirm no prior hsv1 infection.Since you specialize in this area vs my GP who thinks its low risk and still gives out IgM tests, I have a few specific questions for you:
1. Does this sound like primary genital hsv1 (2 bright red tiny dots on urethral opening, mildly burning urethra)
2. Given the possible exposure, what are the chances of acquiring hsv1 from brief but substantial oral sex?
3. If this isn't herpes, does it sound similar to any other STD?
4. If this is herpes, what should my course of action be?
5. Does asymptomatic shedding occur only at the infection site, or can it occur anywhere?
6. Theoretically if this is a urethral hsv infection would a condom be a sufficient prevention method, or should antivirals be started?


Thanks for your help!!!

[froo23]

Just wanted to let you know that the IgG tests for 1 and 2 were negative (expected) AND the culture was negative (specifically negative for hsv. i didn't see it on the paper but i'm assuming it would have been also checked for other causes of ngu as well as gon. and clam.?). I'm wondering if i was just experiencing irritation due to normal oral bacteria? the dots only lasted 2 days total, and the mild urethral irritation subsided about a week later. do you think IgG testing in a few months is necessary? or if this was ngu does it sometimes subside on it's own? I have faith in the culture because it was taken within 24 hours of onset of symptoms. I'm still confused as to the cause but happy to rule out std's.  Thanks again for your advice.

[H. Hunter Handsfield, M.D.]

The precise location of the spots doesn't mean anything one way or the other with respect to possible herpes.  Certainly primary HSV infections can produce only mild symptoms (or can be entirely asymptomatic).  But this still doesn't sound like herpes.  But feel free to return to the forum in a few weeks with your HSV test results.

To username oohknow:  Personal health questions are not answered in other persons' threads, even if on the same topic.  Feel free to use the Post a Question link to start a new thread.

[froo23]

Just a quick update - I noticed the symptoms monday evening, got tests performed on tuesday, and today (wednesday) the red dots are gone along with the burning sensation, the only remnants are tiny tiny white flakes where each dot was, possibly part of the healing process? Could be the mildest primary ob ever, or something completely different. I'm a bit confused, and i'll await the test results. Thanks again.

[oohknow]

This was very interesting.  My husband and I have been married for 13 years and it now appears as though I have possibly passed hsv-1 to his penis through oral sex while I had a cold sore.  Contact was 11 days ago.  First thing this morning he noticed a small crust right at the top of his penis.  Tonight it looks like the beginnings of a cold sore.  We are devastated at the idea of losing our sex life as we have known it.  Nice to see some positive information that hsv1 may not be as difficult to deal with.  We will see our doctor day after tomorrow.  Hope we are wrong about this.  Any suggestions mean time?
Thanks,

oohknow

[froo23]

Thanks so much for your advice. It has only been a day and a half since I noticed the symptoms, and already the mild burning sensation is becoming a bit milder. The 2 red dots are still there, so we'll see what happens with the test results. I'm not ruling out hsv 100%, because it seems that one of the dots has formed a tiny whitish center, which could be a blister but the whole thing is so small i can't tell. If I'm allowed one last question, concerning the cases of NGU from hsv, do lesions usually occur in the urethra, or were you implying that lesions appear anywhere and accompany the ngu? in non hsv cases, do red spots appear in/on the opening of the urethra as well?

thanks again!!!!

[H. Hunter Handsfield, M.D.]

Directly to your questions:

1) It is conceivable this could be HSV-1, but very unlikely.  HSV-1 is possible but rare cause of nongonococcal urethritis (NGU) from oral sex (under 5% of cases) -- and most of those occur along with herpes lesions.  The red spots clearly do not qualify.

2) Probably 1 chance in a couple thousand, tops.

3) You could have NGU, which sometimes might be due to normal bacteria from a partner's mouth.  The urethral swab test probably included looking for white blood cells under the microscope, the main test for NGU.  As your GP about it.

4) Almost certainly it isn't herpes, so no point in going there.

5) Asymptomatic shedding is uncommon with genital HSV-1, and recurrent outbreaks also are uncommon.  This is why genital herpes due to HSV-1 usually is a minor problem compared with HSV-2, which is more serious and more troublesome.

6) For the same reason, ongoing antiviral therapy usually is not necessary for genital herpes due to HSV-1.

From your description of your GP's testing and overall evaluation, I believe he is on top of common STD issues and is providing high quality care.  Probably you can have confidence in his evaluation, and should ask him any continuing questions.  But the bottom line is that there is no reason for serious concern about herpes.

Regards--  HHH, MD