some redness, irritation, on head and foreskin.

Hi-

I am an uncircumcised 36 yo male who is recently intensly sexually active after the pause of a divorce. On at least two occasions I have noticed a red irritation (blotch, bumps) the morning after sex on the rim of the head and shaft (the foreskin) of my penis. This usually goes away in a day or two.  

The other day I received vigorous oral sex and then masturbated later that night. The next morning I had two red spots, one on the rim, one on the foreskin. Two days later (today), these spots are fading but still sensitive and sore.

Some 15 years ago I had sexual relations with a girl who had HSV2. We never had sex during an outbreak.  She had contracted the virus about 6 or 7 years before I met her. I never showed any signs of infection. I had an HIV test years ago (negative), and a syphallus test in '99 (negative). I don't know if the HIV test screen also screened for anything else.

My ex-wife and I were together for 8 years. She never had ANY signs of HSV. I have had some irritation on the foreskin in the past. But never have had lesions or ulcers (which I don't now). I always chalked it up to not washing or rinsing off well enough.

What's going on? Should I get tested? Or just lay of the sex for a while and give my penis a rest? I mentioned it to my doctor and he said not to worry about it.  But he also seemed like he was in a hurry.  I'm going for an STD screening on Tuesday.  The Doc said he didn't think I needed to do HIV or Herpes.  But I've read that 1 in 4 men have HSV2--and some never show symptoms?

Please. I need advice.

[H. Hunter Handsfield, M.D.]

The red spots you describe don't sound like herpes; both the apparent onset following stimulation and then fading without ever causing blisters or ulcers are against herpes.  However, I'm not going to speculate on the cause.

On the other hand, it would not be surprising if you have genital HSV infection. As you suggest, in the US about 25% of the population is infected with HSV-2 and most of them do not have recognized herpes; some have no symptom at all and others have mild or subtle symptoms that they don't consider abnormal.  Your likelihood of having HSV-2 probably is higher than the average, given your partnership with a known-infected person plus your recent multiple partnerships.  So you might want to consider testing.  If positive, though, it won't necessarily mean the red spots are due to HSV.

If your sexual activity continues, HIV testing once a year would make sense; so if you're going to have blood drawn, you might want to include HIV.  But there is nothing in your story to raise suspicion about HIV.

Good luck--- HHH, MD

[sorehead]

Thanks.  Just to clarify, I'm not having sex with multiple partners. I'm involved only with a single person.  

If I am HSV2 positive, but show no signs (blisters, ulcers), does that mean if I infect someone that ALSO will have no signs?  

If I have it, and I didn't just get it, I can't beleive that I would have passed it onto my ex-wife, with whom I had unportected sex with (monogamously) for years and years.  Is this possible?

[sorehead]

Sorry.  That should read:

I can't beleive that I would NOT have passed it onto my ex-wife

[H. Hunter Handsfield, M.D.]

The symptoms (or lack of symptoms) in one person isn't necessarily the same in partners.  Asymptomatic people often transmit symptomatic infections, and vice versa.

Among monogamous couples in which one partner has HSV-2 and the other does not, who have sex with average frequency (2-3 times per week), and who do not use condoms, the risk of transmission is 3%-5% per year.  So if you were married for, say, 5 years, there would be only a 15%-25% likelihood your wife caught it from you.  And if she did, she could have remained without symptoms.  So the history that your wife doesn't have herpes really doesn't say much about whether or not you have HSV-2.  If you get tested and are positive, however, it would be a kindness to inform your former wife so she can get tested herself.

HHH, MD

[sorehead]

Thanks Dr. H.