genital herpes question

[herpes_confused]

Few days ago, I discovered a cluster of three red bumps under the head of my penis. My GP examined the red bumps and diagnosed herpes. My GP ordered blood test to determine HSV 1 or HSV 2 and I will get the results next week. My anxiety is building waiting for the results and I am quite confused about how I could have gotten genital herpes.

My wife and I had never been with anyone else when we met and I am sure she never stepped out of the marriage. I have stepped out twice. The first time was in 2010 with an escort – uncovered oral and covered intercourse. The second time was four months ago with an escort – uncovered oral only. After both instances, I had full checkups (HIV, hepatitis, syphilis, gonorrhoea, chlamydia) and everything was fine. Herpes blood tests were not done.

My wife and both had cold sores on the lips before. Although I only remember having them starting two years ago – perhaps I was infected by the escort episode in 2010. I am OK if the blood test this time comes back positive for HSV 1. But if the blood test comes back positive for HSV 2, I would be in very deep trouble with a wife I love very much. So my questions are:

1. Is it possible that I got genital HSV 2 from receiving uncovered oral four months ago? I read elsewhere from Dr. Hunter that oral to genital HSV 2 transmission almost never happens. So can I eliminate this possibility?

2. It is possible that I got genital HSV 1 from receiving uncovered oral four months ago. But I thought having cold sores on the lip (HSV 1) over the past few years would provide me with immunity so that it is difficult to get HSV 1 again.

3. It is possible that I got either HS1 or HS2 both orally and genitally in 2010 simultaneously when I had no immunity. But then it seems strange that I had quite a few recurrences on my lip but never noticed any symptoms on my genital until now.

As you can see, my story is quite a mess and the possibilities are inconsistent. Any insight would be really appreciated.

[Edward W Hook, MD]

Sorry for the delay in getting back to you. Had some IT problems on our side.,

1.  You didn't need to test but yes. this result further confirms that there is NO evidence of HSV-2.

2.  I agree.  I am not familiar with tests that give this high a result.  A high value however does not invalidate other tests.  In general the problem with tests for HSV antibodies is that they give false positive results, not false negatives.  

A positive result says nothing about the location of your HSV-1 infection.  Statistically however it is most likely to be an oral infection, particularly with your history of cold sores.  .

Take care.  EWH  

[herpes_confused]

Dear Dr. Hook,

I got my results back.

anti-HSV1 IgG CLIA   Positive > 58.0
anti-HSV2 IgG CLIA   Negatve < 0.5
anti-HSV IgM ELIA    Negative < 0.8

While I am glad that I don't have HSV 2, I still have two more questions.

1. Since my last risk encounter was more than 4 months ago. Can I definitely rule out HSV 2 with this IgG value in the blood test results?

2. My HSV 1 IgG value seems really, really high to me. Could such a high value indicate an error that would invalidate all the tests, including the HSV 2 IgG? Or could such a high value indicate that I have a current HSV 1 infection genitally? I know you said this is impossible if I have been having cold sores on my lip for the past few years.

BTW, my bumps are now more like a red patch or lesion, but it is still there.

Thank you for your help.

[Edward W Hook, MD]

Welcome to our forum.  I'll try to help.  You are correct however, this is a mess.  For starters, your GP did the wrong test.  He/she should have done a culture or, better yet, a PCR test.  Many physicians think that cultures can only be done on the small blisters or sores which are due to herpes- this is incorrect.  Any recent lesion can be tested for herpes.  In addition, if this is herpes that has only been present a week, a blood test will not provide reliable results.  It can take up to 6 months for herpes antibody (blood tests) to be positive.

In addition to doing the wrong tests, the circumstances of your exposures are not consistent with a herpes infection acquired through some of your extra marital excursions.  If you and your wife both get cold sores due to HSV-1, then neither of you can get that infection again, even at another location (like your penis).  In addition, typically herpes lesions appear within 2 weeks of recent exposure so that fact that your last encounter outside of your wife was 4 months ago is also not suggestive of HSV.  Finally, herpes does not typically present as bumps.  This may very well not be herpes at all but some other dermatological problem.  

With these background statements, let's now address your questions:

1. Is it possible that I got genital HSV 2 from receiving uncovered oral four months ago? I read elsewhere from Dr. Hunter that oral to genital HSV 2 transmission almost never happens. So can I eliminate this possibility?

In medicine, for better or worse, we can never say never but I do agree with Dr. Handsfield’ s statement.  IT is incredibly unusual to get HSV-2 form receipt of oral sex and, as I said above, the timing is wrong.

2. It is possible that I got genital HSV 1 from receiving uncovered oral four months ago. But I thought having cold sores on the lip (HSV 1) over the past few years would provide me with immunity so that it is difficult to get HSV 1 again.

Nope, see above. Your cold sores would provide you with antibodies which will protect you from getting another HSV-1 infection.

3. It is possible that I got either HS1 or HS2 both orally and genitally in 2010 simultaneously when I had no immunity. But then it seems strange that I had quite a few recurrences on my lip but never noticed any symptoms on my genital until now.

Seems very unlikely as well.

My guess is that this is not herpes. Even experts are incorrect about 20-25% of the time when they clinically diagnose herpes without proper testing.  

I hope this helps.  EWH