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STDs (Expert Forum)
what have I done
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which 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.
what have I done
by shoals, Jun 30, 2009 11:53AM
Hi Doc,
I am male, married for 25 years. Very fit/healthy great immune system. 8 weeks ago I received unprotected oral sex from a woman I believe to be high risk. My concern is HSV2. My symptoms, redness and stinging on my penis followed by a couple paper cut like lesions. No crusting or blistering, took several wks to heal and has left a shiny patch of healing skin. Got a very bad rash (possibly blisters) on my anus and butt crack that lasted nearly a week. All that was between wks 2 and 5 post exposure. At 6 weeks I had IGG tests done: HSV 1 (2.85) - HSV 2 (<0.91)
Between wks 7 and 8 (after the test) I had very sore lymph nodes in the groin area, the timing of this has me very concerned. My wife has had cold sores, once or twice a year for many years, but she is very cautious/conscious about it and will not kiss me when she has one. I have never had HSV1 or 2. I know HSV2 is rarely acquired from receiving oral sex, but it appears I am left choosing between 2 unlikely scenarios:
1.)My wife of 25 years has oral HSV1 and I have never acquired it. This would account for the rather significant symptoms that I had.
2.)I hit the bad luck lottery and came across one of the very rare persons who not only had Oral HSV2, but was shedding it at the time.
my questions:
1.)is it likely that prior to this exposure I did not have HSV1 if my wife of 25 years probably does ?
2.)is it likely that if I had not had a prior HSV1 infection, that I could have antibodies to the tune of 2.85 in 6 weeks?
3.)Should I be concerned that after my test at 6 weeks my lymph nodes began to hurt for a week, is that a sign that they were producing new antibodies (possibly HSV2) that would not have been present at the time of the test?
4.)How much (if any) comfort should I take in a test at just 6 weeks?
5.)Simply for some peace of mind I am considering another HerpesSelect IGG test at 9 weeks, what is the increase in conversion between 6 and 9 weeks?
I am male, married for 25 years. Very fit/healthy great immune system. 8 weeks ago I received unprotected oral sex from a woman I believe to be high risk. My concern is HSV2. My symptoms, redness and stinging on my penis followed by a couple paper cut like lesions. No crusting or blistering, took several wks to heal and has left a shiny patch of healing skin. Got a very bad rash (possibly blisters) on my anus and butt crack that lasted nearly a week. All that was between wks 2 and 5 post exposure. At 6 weeks I had IGG tests done: HSV 1 (2.85) - HSV 2 (<0.91)
Between wks 7 and 8 (after the test) I had very sore lymph nodes in the groin area, the timing of this has me very concerned. My wife has had cold sores, once or twice a year for many years, but she is very cautious/conscious about it and will not kiss me when she has one. I have never had HSV1 or 2. I know HSV2 is rarely acquired from receiving oral sex, but it appears I am left choosing between 2 unlikely scenarios:
1.)My wife of 25 years has oral HSV1 and I have never acquired it. This would account for the rather significant symptoms that I had.
2.)I hit the bad luck lottery and came across one of the very rare persons who not only had Oral HSV2, but was shedding it at the time.
my questions:
1.)is it likely that prior to this exposure I did not have HSV1 if my wife of 25 years probably does ?
2.)is it likely that if I had not had a prior HSV1 infection, that I could have antibodies to the tune of 2.85 in 6 weeks?
3.)Should I be concerned that after my test at 6 weeks my lymph nodes began to hurt for a week, is that a sign that they were producing new antibodies (possibly HSV2) that would not have been present at the time of the test?
4.)How much (if any) comfort should I take in a test at just 6 weeks?
5.)Simply for some peace of mind I am considering another HerpesSelect IGG test at 9 weeks, what is the increase in conversion between 6 and 9 weeks?
Doctor's Answer
by H. Hunter Handsfield, M.D., Jul 01, 2009 07:06AM
, Jul 01, 2009 07:06AM
Welcome to the STD forum.
Responding first to the opening line, it is exceedingly unlikely you acquired HSV-2 by oral to genital transmission. It never happens, or at least so rarely that the risk can be ignored -- mostly because oral HSV-2 infections are rare.
Now having read the rest of the question: Most likely your anal symptoms were due to something other than herpes. The symptoms are compatible with herpes, but it would be very unlikely to get primarily an anal outbreak after an oral-genital exposure. Your positive HSV-1 blood test could represent a new infection, but most likely you have been infected with HSV-1 for a long time, perhaps since childhood or perhaps from your wife. So an initial genital/anal HSV-1 infection is a conceivable explanation, but not a likely one. Most likely something entirely different was the cause of the anal symptoms, lymph node inflammation, etc.
In addition to the low likelihood of oral sex as a source, HSV-2 is also unlikely on the basis of your blood test result, since the large majority of persons with new HSV-2 infections have positive antibody tests within 6 weeks. For all these reasons, I disagree with both of your stated "likely" scenarios. To the specific questions:
1) Unlikely; see above.
2) Strength of a positive antibody test says nothing whatsoever about the duration of infection. It could be anywhere from a few weeks to your entire life.
3) Initial herpes would not cause lymph node inflammation 6 weeks later. That's yet another argument against herpes of any kind as the cause of any of your symptoms.
4) As noted above, the negative test at 6 weeks is quite strong evidence against a new HSV-2 infection, although by itself, not definitive.
5) If you insist on further testing, wait unitl 4 months after onset of symptoms. There won't be that much difference between 6 and 9 weeks, but by 12-16 weeks almost all infected people have positive HSV-2 antibody tests. You can expect any additional testing to remain negative.
Finally, since you don't mention any health professionals in your question, I fear you have been doing all this testing on your own, perhaps through an online web resource. If you remain unconvinced by my judgment, please see a health professional for personalized evaluation.
I hope this helps. Best wishes-- HHH, MD
Responding first to the opening line, it is exceedingly unlikely you acquired HSV-2 by oral to genital transmission. It never happens, or at least so rarely that the risk can be ignored -- mostly because oral HSV-2 infections are rare.
Now having read the rest of the question: Most likely your anal symptoms were due to something other than herpes. The symptoms are compatible with herpes, but it would be very unlikely to get primarily an anal outbreak after an oral-genital exposure. Your positive HSV-1 blood test could represent a new infection, but most likely you have been infected with HSV-1 for a long time, perhaps since childhood or perhaps from your wife. So an initial genital/anal HSV-1 infection is a conceivable explanation, but not a likely one. Most likely something entirely different was the cause of the anal symptoms, lymph node inflammation, etc.
In addition to the low likelihood of oral sex as a source, HSV-2 is also unlikely on the basis of your blood test result, since the large majority of persons with new HSV-2 infections have positive antibody tests within 6 weeks. For all these reasons, I disagree with both of your stated "likely" scenarios. To the specific questions:
1) Unlikely; see above.
2) Strength of a positive antibody test says nothing whatsoever about the duration of infection. It could be anywhere from a few weeks to your entire life.
3) Initial herpes would not cause lymph node inflammation 6 weeks later. That's yet another argument against herpes of any kind as the cause of any of your symptoms.
4) As noted above, the negative test at 6 weeks is quite strong evidence against a new HSV-2 infection, although by itself, not definitive.
5) If you insist on further testing, wait unitl 4 months after onset of symptoms. There won't be that much difference between 6 and 9 weeks, but by 12-16 weeks almost all infected people have positive HSV-2 antibody tests. You can expect any additional testing to remain negative.
Finally, since you don't mention any health professionals in your question, I fear you have been doing all this testing on your own, perhaps through an online web resource. If you remain unconvinced by my judgment, please see a health professional for personalized evaluation.
I hope this helps. Best wishes-- HHH, MD
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to the best of my knowlege
I had to omit a few things due to the 2000 word limit:
1.) at 7 weeks, went to the clinic and had a complete STD checkup including HIV and was negative for all.
2.) the girl that provided the oral sex made it clear (afterwards) that she enjoys doing that and does it often, providing unprotected oral sex to men. since she admittedly does this often, I am thinking she is a likely candidate for the "rare" exception.
I have not touched my wife in 8 weeks and will not until I test again, but I am desperate for something to hang onto until then, could you humor me with a few more questions?
1.) is oral HSV2 rare even in people who have lots of exposure like this, or becasue most people do not have lots of exposure like this (which would put me at greater risk)?
2.) assuming my HSV1 infection is old (prior exposure) would that have kept primary HSV2 infection symptoms to be less severe than what I had (assuming that is what I had)?
3.) I feel some stinging/burning again on my penis again for the last couple days, no lesions or blisters, but it seems like that is the way it started last time. my initial symptoms just cleared up a week or so ago, is this likely to be another outbreak this soon or psychosimatic?
4.) If I had an existing HSV1 infection (likely oral) could I still have acquired a genital HSV1 infection with these symptoms?
5.) if you could humor me and assume I did indeed acquire an HSV infection from this exposure (which I know you do not believe), which would be the most likely scenario, would it be having acquired HSV2 or HSV1 (even with my prior exposure to my wife)
thank you for the service you provide here and I realize that I have now gotten more than my $15 worth. I will not hound you further unless something dramatic changes ur until I get another test at 12 weeks.
I went ahead and tested again at 9 weeks for HSV-2 only, <0.91...got my results back today for a test 2 days short of 12 weeks post exposure, again for HSV-2 only, again <0.91...I am sure I acquired some sort of genital herpes in that event, as the lesions came back again, no blisters, no crusting, looked like a large papercut that took a couple weeks to heal the first time or two, the last time GoldBond powder dried them up quickly (a couple days) and things seem to be settling down with the exception of an irritation in my urethra...the clinic will only see me if the lesion is a day or two old, and getting in that quickly wasn't possible...I have now lost over 20 pounds and have not had a nights sleep in 3 months...which leaves me wondering the following:
1.) I know GHSV-1 is not supposed to recur, but it is it possible to have a rather nasty GHSV-1 primary that goes on for a couple months with my stress/fatigue?
2.) should I now test again at 16 weeks if I can't get a culture done before then if it comes back again?
3.) would you think that at 12 weeks I should have gotten at least a weak positive if I had picked up HSV-2
4.) what percentage of people never convert, or take 6 months or a year if the do?
thanks again for putting up with me...
But for herpes to be the cause of your symptoms, several distinctly unlikely scenarios would all have to break the wrong way, including 1) catching HSV despite a low risk exposure, 2) atypical symptoms (especially getting anal symptoms despite no direct anal sexual exposure), and 3) negative blood test at 3 months. The odds that all those would go the wrong way are astronomically low. You're going to need to drop herpes from all consideration and look elsewhere as an explanation for your symptoms. And for goodness' sake, start having sex again with your wife!
That will be all for this thread. Take care.
thank you for your inout and patience, I have 1 last question, seeing that you have ended the thread, if you chose not to answer it, I will understand...
>>>Around 90% of people with new HSV infections have positive blood tests by 3 months. A few percent of people indeed take 16 weeks to seroconvert<<<
would that include someone serconverting HSV-2 with an existing HSV-1 infection?
thanks again, either way...
Thanks for the thanks about my patience, but it has now run out. If you post anything more, the entire thread will be deleted without reply. And please do not start a new thread on the same topic, which would suffer the same fate. Your statement "I am sure I acquired some sort of genital herpes in that event" is irrational nonsense. This forum does not tolerate anxiety-generated "yes but" or "what if" questions from people who have difficulty accepting rational evidence and advice.