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STDs (Expert Forum)
Question of simultaneous oral/genital herpes symptoms
Answered by
University of Washington
Seattle - WA
This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomoniasis, Warts, Yeast Infection.All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
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Question of simultaneous oral/genital herpes symptoms
by jj in CA, Jul 26, 2007 12:00AM
Hello doc,
My sexual history: protected sex 10 years ago, oral sex once 4 years ago, mutual masturbation/manual vaginal fluid transfer with a few women, the last one about 1 1/2 years ago.
I’m also exposed to cadaver spinal tissue at work, and I was sprayed once or twice on the face. Can you catch herpes from cadaver tissue?
I had my first cold sores 2 months ago – at the same time an itchy area on my penis that turned into a light scab. The lip sores were “typical”, the genital symptoms almost unnoticeable.
A month later, same thing. The cold sores were milder. But the penis symptoms were much more significant, small but obvious blisters and on the same spot. It lasted 14 days. I also developed a red area at the corner of my right eye (on the skin) that looked like a cold sore. I saw my doctor at the end of the 2nd outbreak. He suggested to wait for another penile outbreak to take swabs. He saw no point in a blood test since I obviously had cold sores on the lips, he just wasn't sure if I also had genital herpes too since my symptoms had subsided by that time.
1. Given my limited sexual history, what do you think was the cause of my initial infection with the virus?
2. How did it get on my penis and my eye?
3. Is it normal for oral and genital herpes outbreaks to occur and recur together?
4. Get a blood test now or wait for another outbreak to take a swab like my doctor suggested?
My sexual history: protected sex 10 years ago, oral sex once 4 years ago, mutual masturbation/manual vaginal fluid transfer with a few women, the last one about 1 1/2 years ago.
I’m also exposed to cadaver spinal tissue at work, and I was sprayed once or twice on the face. Can you catch herpes from cadaver tissue?
I had my first cold sores 2 months ago – at the same time an itchy area on my penis that turned into a light scab. The lip sores were “typical”, the genital symptoms almost unnoticeable.
A month later, same thing. The cold sores were milder. But the penis symptoms were much more significant, small but obvious blisters and on the same spot. It lasted 14 days. I also developed a red area at the corner of my right eye (on the skin) that looked like a cold sore. I saw my doctor at the end of the 2nd outbreak. He suggested to wait for another penile outbreak to take swabs. He saw no point in a blood test since I obviously had cold sores on the lips, he just wasn't sure if I also had genital herpes too since my symptoms had subsided by that time.
1. Given my limited sexual history, what do you think was the cause of my initial infection with the virus?
2. How did it get on my penis and my eye?
3. Is it normal for oral and genital herpes outbreaks to occur and recur together?
4. Get a blood test now or wait for another outbreak to take a swab like my doctor suggested?
Doctor's Answer
by H. Hunter Handsfield, M.D., Jul 26, 2007 12:00AM
, Jul 26, 2007 12:00AM
I have never heard of HSV acquisition by splatter or aerosol from any source, and definitely not from spinal tissue, especially if the cadaver had been fixed with formalin or something similar.
Given your limted sexual experience, sexual acquisition of HSV of either type is statistically unlikely. I don't understand your provider's reticence to do a blood test. You can expect it to be positive for HSV-1, which causes almost all oral/facial herpes. That won't tell the anatomic site of infection, i.e. oral, genital, or both. However, if positive for HSV-2, you would be pretty certain you have genital herpes; and negative for HSV-2 would reduce that likelihood. Either outcome would seem to provide useful information. As your doc says, testing the next genital outbreak for HSV would also help sort things out. However, cultures often are negative even with fresh outbreaks. And who knows how long you'll have to wait? Or whether you'll be able to get into your provider's office promptly (within a day) when it happens? (What if it happens Friday night or when your doc is on holiday?)
Given the apparently fairly frequent recurrent genital outbreaks you describe, my prediction is that you have both HSV-1 orally and HSV-2 genitally. Genital HSV-1 doesn't usually recur so frequently (40% have no recurrences at all, after the initial infection; and another 40-50% have only 1-2 recurrences over the next couple of years, then nothing more. So your apparent pattern clearly favors HSV-2.
To your specific questions:
1) I cannot predict when or where you acquired your HSV infection(s). A blood test would provide a clue. Condoms are not perfectly protective, and lots of people remain asymptomatic for long periods then start having recognized outbreaks, so you could have acquired genital HSV-2 years ago.
2) Can't tell. Also depends in part on virus type.
3) I have never seen or heard of a patient with simultaneous oral and genital recurrences. Another possibility to consider: One of the more common complications of HSV infections is the occurrence of erythema multiforme and/or Stevens Johnson syndrome with each herpes outbreak. The rash of EM can be subtle or in a site where it isn't readily visible, perhaps missed; S-J syndrome is EM plus genital or oral ucers. You might ask your doc whether this might explain your facial and/or genital symptoms, rather than HSV itself--i.e. true herpes at one site and EM/SJS at the other. Don't get me wrong; EM and SJS usually are not subtle, and this scenario is unlikely. But the whole situation is atypical, so perhaps worth discussing with your doc.
4) See above.
Good luck--- HHH, MD
Given your limted sexual experience, sexual acquisition of HSV of either type is statistically unlikely. I don't understand your provider's reticence to do a blood test. You can expect it to be positive for HSV-1, which causes almost all oral/facial herpes. That won't tell the anatomic site of infection, i.e. oral, genital, or both. However, if positive for HSV-2, you would be pretty certain you have genital herpes; and negative for HSV-2 would reduce that likelihood. Either outcome would seem to provide useful information. As your doc says, testing the next genital outbreak for HSV would also help sort things out. However, cultures often are negative even with fresh outbreaks. And who knows how long you'll have to wait? Or whether you'll be able to get into your provider's office promptly (within a day) when it happens? (What if it happens Friday night or when your doc is on holiday?)
Given the apparently fairly frequent recurrent genital outbreaks you describe, my prediction is that you have both HSV-1 orally and HSV-2 genitally. Genital HSV-1 doesn't usually recur so frequently (40% have no recurrences at all, after the initial infection; and another 40-50% have only 1-2 recurrences over the next couple of years, then nothing more. So your apparent pattern clearly favors HSV-2.
To your specific questions:
1) I cannot predict when or where you acquired your HSV infection(s). A blood test would provide a clue. Condoms are not perfectly protective, and lots of people remain asymptomatic for long periods then start having recognized outbreaks, so you could have acquired genital HSV-2 years ago.
2) Can't tell. Also depends in part on virus type.
3) I have never seen or heard of a patient with simultaneous oral and genital recurrences. Another possibility to consider: One of the more common complications of HSV infections is the occurrence of erythema multiforme and/or Stevens Johnson syndrome with each herpes outbreak. The rash of EM can be subtle or in a site where it isn't readily visible, perhaps missed; S-J syndrome is EM plus genital or oral ucers. You might ask your doc whether this might explain your facial and/or genital symptoms, rather than HSV itself--i.e. true herpes at one site and EM/SJS at the other. Don't get me wrong; EM and SJS usually are not subtle, and this scenario is unlikely. But the whole situation is atypical, so perhaps worth discussing with your doc.
4) See above.
Good luck--- HHH, MD
Thank you for your comments. Your suggestions give me some more info I can use to have a useful discussion with my primary doctor. I will get a blood test done next time I see him. The maddening thing about my symptoms is that they seem so atypical compared to everything I've been reading about herpes!
One other thing that was suggested in the patient forum that I wanted to ask you was, do you think this could have anything to do with an allergic reaction to latex? It may be a coincidence, but when I retrace my calendar, the day before my more severe 2nd outbreak I spent the whole day wearing cheap powdered latex gloves working on my car and I spent several hours wearing surgical gloves and mask (cannot say if they were latex or had latex components since I was at an away hospital) about 2-3 days before my 1st outbreak. My hands never had any allergic symptoms by the way. Although I wear gloves all the time at work, we only have non-latex gloves there. Can allergic reactions only happen on sensitive local areas of the body and can they look somewhat like herpes symptoms? Please let me know if this is a completely foolish line of thinking or I have something further to investigate here. Thank you very much.