oral sex and HSV 2

[morgan2]

Thank you for your time:

In April/May 2004 (last year) I was dating a man who has had genital herpes for 20 years. We never had sex or oral sex. One time, he masterbated next to me (mostly on my chest). I was only wearing underwear.  He did rub his penis on my thighs and stomach. He assures me he was not having an outbreak at the time and had not had one for a year. I stopped dating him.

In June, I went off my b/control pills and started getting weird symptoms every month - burning and itching on my vuvla and mild groin pain (the groin pain stopped going away after a few months). I had a genital wart removed in the same spot several months before and thought the pain was from that.  

In July, the ridge of one nostril turned bright red for about two to three months and tiny blisters appeared and lasted about a week or so. I was out of the country and when I finally got home, I saw a dermatologist who gave me a blood test for both types of HSV. The testing was done in late October. Both tests came back negative, which is weird because I remember having a cold sore as a child.

I'd still get the burning and itching almost every month, but thought I didn't have herpes due to the blood test.

I was recently working in harsh conditions with children in a third world country and was exposed to a lot of junk (scabies, etc.). A couple of weeks into my work, I shaved my bikini area and one of the hair follicles became infected (it was also not the cleanest water I was showering in) and turned into about 10-15 huge painful blisters, which lasted at least two weeks. Another series of smaller blisters/bumps formed over part of the other blisters and in the same region (all left upper thigh and bikini area). The smaller blisters/bumps went away without scarring, but the bigger first blisters left red marks, that seem to be fading. The outbreak happened mid July, and the red marks are still there. Right now I have a lot of pimple/bumps on my buttox, some with whiteheads, that have been there since about the same time as the groin blisters. They do not seem to be going away. Sometimes itchy and annoying.

Of course, I'm convinced now it's herpes and I'm going to make an appt. for another round of blood tests, etc.

I'm so confused because the sexual contact I had with someone with herpes was so limited (I thought I was being so careful) and my blood test was negative.

I'm very concerned because I also just performed oral sex on a man four times: twice when I thought it was just an infected hair follicle and twice when the blisters were going away (I never exposed myself from the waist down with him). I'm confused because I've read some of your threads suggesting oral sex doesn't spread hsv 2, and I didn't think it did, but other websites say it does. At this point I'm mostly concerned I may have passed it on, if what I was having was a real herpes outbreak. Of course, I'm still confused about my symptoms and past diagnosis.
Thanks.

[H. Hunter Handsfield, M.D.]

As you know, I can't try to make a specific diagnosis online, or to give definite answers; those will have to come from your own healthcare providers.  All I can do is discuss probabilities.

Those probabilities tell me you probably don't have genital herpes.  First, if the right kind of blood test was done (e.g., the HerpeSepect test; see numerous other threads on this forum about herpes testing), the results are highly reliable.  I don't know what sort of "cold sore" you had as a child, but perhaps it wasn't herpes; it it was, your HSV-1 test should have been positive.  More important, the negative HSV-2 blood test result is a strong indicator you don't have that virus.  Second, the infection you describe in the shaving area sounds just like folliculitis, not so much like herpes.  Third, the exposure(s) you describe with the partner with genital herpes were very unlikely to result in HSV transmission.

The information about oral HSV-2 infection is confusing.  Initial oral infections with HSV-2 aren't all that rare; a fair proportion of persons who have initial genital herpes also have oral lesions.  It also just "makes sense" that either HSV-1 or -2 can infect any exposed site.  However, for reasons that are not well understood, recurrent oral herpes due to HSV-2 is very rare.  Almost nobody with recurrent oral herpes has HSV-2.

Of course, there is always the possibility that your blood test was inaccurate; wierd things happen (e.g., if the lab somehow mishandled the specimen), or perhaps the lab wasn't using up-to-date testing methods.  So you might have the test repeated.  If you do, make sure your provider orders a truly type-specific blood test such as HerpeSelect.  You can also be on the lookout for more "outbreaks" and arrange to see your provider immediately (same day) for a virus culture.

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

[happynkentucky2005]

Can you once again clarify what can be transmitted through unprotected oral sex(receiving)?

Can ureaplasma?

[morgan2]

Many thanks for your answer and the reassurance. I will book an appt. just to be safe.

[morgan2]

yes, I would be interested as well in receiving clarification regarding what can be transmitted via oral sex, thanks.

[H. Hunter Handsfield, M.D.]

Most STDs can at least occasionally be transmitted by oral sex; most are much less efficient by cunnilingus than fellatio.  HSV-1 very readily, HSV-2 less so.  HIV transmission is rare by fellatio, primarily from penis to oral partner, almost nonexistent in the other direction; and to my knowledge HIV has never been transmitted in either direction by cunnilingus.  Syphilis yes, gonorrhea yes.  Chlamydia is transmitted orally rarely, if ever, in either direction.  HPV probably can be transmitted, but rarely causes disease or persistent infection of the mouth (and probably is not transmitted mouth to genitals).  Ureaplasma is a normal bacteria in almost everyone's genital area, not a cause of STD, and to my knowledge oral transmission has never been studied.  Finally, as discussed many times on this forum, it is likely that bacteria that are normal in the mouth and throat sometimes cause inflammation (nongonococcal urethritis, NGU) when transmitted to the urethra during fellatio.  No similar problem has been reported for cunnilingus.

HHH, MD

[BAzzalino]

A related discussion, Non-sexual contact after lesion was started.

[John9]

A related discussion, oral sex and HSV 2 was started.