herpes spreading - possibility of other stds

[jd2800]

hello-i apologize in advance if i am repetitive butlike many others i feel like my story has specific nuances that id like addressed:heres my history:i have had hsv 1 for many years(like most people)3 years ago i was diagnosed with hsv-2,my dr prescribed valtrex-i took it before sex(always protected)-i then had a outbreak about 3 months later-after that i went on daily valtrex-since then it has been three years and i have not had any outbreaks-i do often get a tingling on the right side of my penis(where the outreak occured)but that was it-about 4 months ago i started dating someone and we have been having unprotected sex-i believed her to be hsv-2 positive(for various reasons)-even though she claimed not to be-after dating for awhile and having unprotected sex(while still taking valtrex daily)i began to feel the tingling and soreness(that was usually only present on the right side of my penis where the intial outbreak occured)on my inner thighs, scrotum, and buttox-my gf later claimed i gave her hsv-2 due to an abnormal pap smear-which i know is a unreliable test-due to the anxiety of having unprotected sex i went to get two hiv pcr dna tests over a period of two months-both negative(thank god)we have since broken up-about one week ago i went to see a woman i met online and had protected sex with her-i also fingered her for quite awhile-the finger i used had a small cut on it due to me tearing off a bit of skin while i was en route to see her-she also perfomred oral on me-since then the tingling and soreness that was usually localised to the right side of my penis has spread beyond from my scrotcum and inner thighs and buttok(a symptom i was expiernecing after being with the previous gf)to my leg-to one knee-to my chest area-and my arm - beside my nose and under one eye-and my stomach-no lesions whatsoever-just very sore tingling(especially in the scrotum and buttox region)it also should be noted that i am in a very high stress situation with a family member in the hospital and i have been sleeping in the icu and the hospital for about a week
questions:
1.can my previous case of hsv-2 have gotten worse by having unprotected sex with a woman who also had hsv-2(possibly a more severe case)-could that have caused it to spread to all these other places??? if we both have it should we be protected anyway
2.i know hsv-2 can raise the risk of infection of other stds such as hiv-am i at risk for that by fingering someone with a cut on my finger?or is the risk only associated with the genital area?and am i at risk due to the fact that i have soreness on my scrotum(possible hsv-2 spread infection)which could have come in contact with her vaginal fluid
3.if i dont have sores or lesions present could i possibly be speading the hsv-2 to other parts of my body(due to shedding) by simply touching my penis and then possibly touching my arms and face and legs and such- if not what could these other tinglings be?
thank u in advance-sorry for the long msg
jd

[H. Hunter Handsfield, M.D.]

I'll go straight to your questions.

1) Super-infection is the term for acquring a new infection with the same virus type--in your case, HSV-2.  At most, it is very rare; some people believe it occurs from time to time, but to my knowledge it has never been proved to happen.  The immune system prevents new infection from an outside source.  In couples in whom both have HSV-2, even if their infections were acquired from different sources, the only necessary precaution is related only to comfort: no sex if there are painful lesions.  And your own infection cannot be influenced (frequency of outbreaks, etc) by such exposure.

2) The increased HIV risk due to herpes is because of lesions (with or without symptoms) at the site of HIV exposure.  Herpes doesn't increase the risk of, say, exposure by needlestick.  (A cut on the finger is more or less irrelevant; extremely low risk with or without HSV.)

3) Autoinoculation--spreading one's own HSV infection to another part of the body--occurs sometimes during initial herpes, but really isn't an issue in recurrent herpes.  If it occurs, it is extremely rare.  The only site at any risk whatever is the eyes, and even that is rare. But it's a good idea to wash your hands after using the john, before putting your hands to your face.  But everybody ought to do that anyway.

I hope that helps. Best wishes--  HHH, MD

[sh00tamcgavin]

i so sry to tread jump but the doc misread my question it was "unprotected"http://www.medhelp.org/perl6/STD/messages/2989.html

[H. Hunter Handsfield, M.D.]

See the original thread.  Your risk remains zero or close to it.  Get tested if you develop symptoms; or maybe this is a good time for routine testing for STDs, which you probably should do once a year.

HHH, MD

[jd2800]

thank you so much doc - i think you almost answered it fully

re question # 2 - you say that the increased risk of hiv transmission because i have herpes is due to lesions(with or without symptoms) - when you say without symptoms - do you mean without open sores and just having shedding? does the tingling delinate shedding? because i currently have tingling all the time -- also in this case the sex was covered by a condom - but i have tingling on my scrotum - can the vaginal secretions that may hit the scrotum cause hiv because the scrotum is exposed?

re question #3 - if this is not Autoinoculation - what can all this new tingling be - around the buttox scrotum knees chest..etc - it only started after being with the new gf who had hsv 2 and increased in the last week after my last sexual encounter(albeit during a period of heavy personal anxiety) - i have had tingling on my chest for years - and there is a history of shingles in the family - never had a sore or anything but i attributed it to that and it always went away - this new tingling and soreness is constant and has me worried

thanks again so much - this dialogue really helps

all the best

jd

[H. Hunter Handsfield, M.D.]

When people have asymptomatic shedding, there always is at least a microscopic break in the skin or mucous membranes of the genital area.  Those breaks are believed to be the point of entry or exit of HIV in asymptomatic people.

The tingling you describe is not a symptom of herpes; something else is the cause.  Anxiety seems a good bet.

The main neurological symptom of herpes is prodrome, i.e. temporary numbness, tingling, or other sensations that occur for 1-2 days (and only 1-2 days) just before an outbreak. The tingling is limited to the distribution of the nerve root where the herpes is hiding between outbreaks--for example, a patch on the thigh, on a buttock, or down a leg.  It never involves distant areas of the body (knees, chest, etc).  Furhter, if your symptoms occur on both sides of the body, they absolutely cannot be due to herpes; recurrent herpes symptoms (both sores and prodrome) are limited to one side or the other of the midline of the body.  Sometimes prodrome-only outbreaks may occur, that is, no progression to overt sores.  Whether there is more asymptomatic shedding during those times isn't clear.  And prodrome never lasts more than a few days at most, recurring no more often than once a month, with no symptoms at all between episodes.

Follow up with your providerr if the tingling etc continues and bothers you.  But you can be certain your herpes is not the cause, except as a possible manifestation of anxiety--which in turn could be related to your herpes.  You are a better judge of that possibility than I can be.

HHH, MD

[jd2800]

thank you for your quick response -

ok but now im slightly confused

from what your saying most of my tingling is probably not related to herpes - can the body stay in a prodome or tingling state for a longer period if valtrex is taken daily - therby possibly fighting off the outbreak but continually leaving one sheddning all the time

and the more important question - the tigling in my scrotum(which from what you say most likely isnt herpes related) can this tingling -if it was shedding- possibly lead to hiv infection through protected sex when the vainal secrtetions may have hit this area-that is obviously not covered by the condom????

also recieving female to male oral sex during shedding? same low to no risk as without shedding?

the tingling is all over my body now - and i have very slight diarreah- some muscle aches and one swollen gland in my neck - are these possible hiv symptoms(i know they are not herpes sytmptoms from what you said) --

thanks again - so worried over here

jd

[jd2800]

oh - also slight twitching in the right leg and a few headaches -  to many symptoms to remeber - terribly worried! thanks again

[H. Hunter Handsfield, M.D.]

I thought my previous reply was crystal clear.  Apparently not, so let me try again.

The tingling and twitching you describe have absolutely nothing to do with herpes.  Not "most" of your tingling, all of it. And as I said above, prodrome always lasts only for a couple of days, maybe up to 5 days, never longer.  

Transmission of herpes to another person--whether by genital intercourse, oral contact, or any other exposure--can only occur when there is virus shedding, not at any other time.  You cannot tell when asymptomatic viral shedding is occuring.  Asymptomatic means nothing abnormal is noticed; no tingling, nothing.

The tingling and other symptoms you describe also do not suggest HIV.  HIV does not cause tingling or twitching, and many things cause diarrhea and muscle aches and enlarged lymph nodes far more commonly than HIV does.

As I said above, it is possible your symptoms reflect mental stress, emotion, anxiety, etc, not a physical illness.  Follow up with a health care provider.  I will have no further replies.

HHH, MD

HHH, MD

[jd2800]

ok im sorry - i didnt mean to upset you - my main confusion came to the question:

can one be infected w hiv through herpes possibly on the scrotum while having protected sex - through the discharge of vaginal secretions to the scrotum area?

if u cannot reply i understand but this was my main area of confusion - thank you for all the previous help

jd

[H. Hunter Handsfield, M.D.]

"Can one be infected w hiv through herpes possibly on the scrotum while having protected sex - through the discharge of vaginal secretions to the scrotum area?"

Theoretically yes, but very low risk.  For some reason, recurrent herpes doesn't occur very often on the scrotum.  So don't assume you have it unless a health care provider has given you a definite diagnosis of herpes as the cause of scrotal sores.

This one really is my last reply.  See a health care provider and ask him/her to assess your anxiety, which is out of proportion to the risk you have anything serious going on.  

HHH, MD

[jd2800]

understand - thank you for your time and patience

all the best

JD