STDs Expert Forum
Sacral Herpes
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Sacral Herpes

I have only had my outbreaks on my buttock (HSV2 swab tested) and once on my thigh. I have never had genital lesions. Does this mean I'm less likely to shed in the anal/genital region? Do I need to cover up my thigh/buttock as it could shed from there? There was an incident where the man who I slept with who had HSV2 bit me very hard on the left buttock, and my lesion came up a few weeks after that, though we were having sex when he had no lesions present. I also get a tiny cold sore bump under my lip; that came up with the buttock lesion! I'm just very confused.
Is this similar to the guy who had HSV2 lesions on his abdomen?
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

I reviewed your discussons on the herpes community forum.

Your opening comment suggests both your buttock and thigh lesions were tested and positive for HSV-2.  But on the community forum, it didn't seem clear exactly what tests you have had.  Can you clarify what tests have been done from which sites, and the results?  And if you've had any HSV blood tests, let me know those results as well.

If the initial buttock outbreak indeed resulted from the love bite described on the community forum, and if that was the only site you were infected (i.e. no direct genital infection) then it is possible that you don't have genital shedding and may be unlikely to transmit the infection to sex partners.  However, this also depends on virus type: genital HSV-2 is much more likely to be sexually transmitted than genital HSV-1.

Fill in the information about past HSV testing and we'll take it from there.

Best wishes--  HHH, MD
4 Comments
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I had a swab done on the buttock lesion and it was HSV2. I haven't had any blood tests,as it's tricky in the UK! The thigh one I just knew as it felt the same as the buttock one!
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239123_tn?1267651214
So the buttock outbreak was clearly herpes, but you can't be sure the thigh one was herpes just because it felt similar.  It's unusual to have recurrent herpes in widely spaced locations.

The dilemma now is that we really don't know whether the buttock outbreak was really the initial infection with HSV-2.  Its occurrence at the site of a love bite, by a partner with HSV-2, certainly suggests that possibility.  OTOH, even in people with HSV-2, oral infections are uncommon, and I think it's possible you actually had an initial genital infection sometime earlier (without symptoms) and the buttock problem was a recurrence.  If so, you have to assume you can transmit the infection sexually to current or future partners.  But if it really was a primary lesion of the buttock, you may not have a true genital infection, and transmission sexually would be less likely.

I recommend you see a herpes/STD expert.  You could start with your nearest NHS GUM clinic, or if you prefer private care, consider London's Freedom Health Clinic.  (There may be private sexual health clinics in other cities as well.)  Genital PCR testing might be done to determine whether you have viral shedding that would be a risk for transmission.  Also, if and when you have another apparent outbreak on your thigh, or anywhere else, it should be tested for HSV.

With the positive HSV-2 test you have had, blood testing probably isn't necessary -- but see what the expert says if you seek such care.  Getting an HSV blood test isn't at all "tricky" at GUM clinics, Freedom Health, etc.
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Thankyou for your help xx
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