Worried about Herpes

[herpesworrier7]

I received unprotected oral sex from my gf approx 5X off/on over the past 4wks (dating for about 6wks from today and no vaginal sex). She has genital herpes but is asymptomatic. 3wks ago, i noticed (in shower) a mild rash sparsely distributed around the shaft of my penis with a few more under the head around the frenulum. Much smaller than pimples, blisters, or in-grown hairs with no redness or inflammation. There was no broken skin, it looked like a skin irritation of some sort and i didn't think much of it. A week later when it hadn't gotten better nor worse, I freaked out (quit having sex) & went to the doc.He took my hx, saw the bumps and couldn't say either way, sent my blood out, did a swab, and put me on valtrex. I had none of the prodromal symptoms (no fever, headache, myalgia, pain on urination, itching, tingling, etc..). I had a cough which i think i got from a sick roommie. But otherwise, healthy. After 3days on val, nothing changed, so i did research, called the doctor & told him i doubted it was herpes due to the time course of events, no typical prodrome, cropping pattern, red base,ulceration and finally no response with val. He agreed but told me stay on the val. I noted it could be fungal gotten from the gym where i often shower (maybe i used someone else's towel). He px’d clotrimazole. I waited 2more days for val to work (it didn't) then started the anti-fungal while still on the pxn of val. After 3days on the anti-fungal, the rashes have cleared signficantly with only minor rashes on the shaft remaining. I was convinced the answer was fungal until my test results came back. The culture was (-) as i expected but my blood labs were (+) for both HSV-1 and 2 (with doc's lab using IgG). That put a wrench in my thinking and i guess my question is given the totality of events, what do you think is going on? (i already exhausted the 7day pxn of val and i'm only on the anti-fungal now & there are still minor rashes around the shaft lessening day by day).

[H. Hunter Handsfield, M.D.]

Your risk of herpes, due to either virus type, was pretty low and your symptoms don't really suggest herpes.  On the other hand, that your doc suspected herpes makes it possible.  Your positive blood test probably has nothing to do with the recent sexual exposure, and it certainly has nothing to do with your symptoms.  Certainly you couldn't have caught HSV-2 from the oral sex event.  Unless you have other, more typical symptoms you don't mention, it seems most likely that you have asymptomatic oral herpes (the positive HSV-1 test) and asymptomatic genital herpes (the positive HSV-2 result), plus a non-herpetic genital rash of some sort.  But your HSV-1 infection could be genital rather than oral.  Regardless of virus type, lack of more rapid improvement on valacyclovir suggests herpes isn't the cause.

Your positive HSV-2 blood test result means that you indeed have genital herpes; it just isn't the cause of the symptoms you describe.  And as I said, it is doubtful you caught it from oral sex.  However, you should keep your awareness up for more typical herpes symptoms, such as mild blisters, sores, etc.  Even without such symptoms, you need to assume that you are infected and can potentially infect a sex partner, even when you don't have an outbreak.  You need to start telling all potential partners of your infection.

Your comment toward the end suggests that absence of prodrome suggests HSV-1 over HSV-2, but that isn't true.  Prodrome is associated with recurrent herpes anyway, not the initial episode; but can occur with either virus type.

Aside from herpes, a fungal infection indeed seems possible, although lack of response to that treatment is against it.  Keep working with your provider if the penile rash or other symptoms continue, or consider seeing a dermatologist.

In summary, I doubt herpes caused the symptoms you describe, but this isn't certain.  You need to work with your doctor or a dermatologist about the cause and treatment.  However, keep on the lookout for more typical genital herpes symptoms.  Start informing your partners about your HSV-2 infection.  Finally, if things clear up but similar symptoms recur in the future, definitely seek health care immediately (within 1-2 days), when an accurate herpes diagnosis is easiest.

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

[herpesworrier7]

I guess my questions are 3-fold.
1. I've read many people have ab's to both HSV-1 and HSV-2 from exposure while lacking "genital herpes". Could this explain why my lab came back positive?
2. Since the val didn't work for 5days before i started using the anti-fungal, could the following 2days in which i used both valtrex and topical anti-fungal and saw a response be actually a result of the valtrex kicking in during those last 2days and not the anti-fungal?
3. Could my response be due to neither the valtrex nor antifungal but rather my natural host immunity? Or was the rash perhaps HSV-1 which i've read is more likely transmitted during oral sex and explains the lack of prodrome.
Any insight would be amazing, thanks so much.

[H. Hunter Handsfield, M.D.]

The purpose of the word limit is so that questioners will put it all in the first post.  As you can tell, I didn't see these questions until after I responded.  But I think they were answered.

1) See above.

2) Valacyclovir (Valtrex) usually starts to work within 2-3 days.  It is conceivable that the improvement was partly due to the val, but I suspect the antifungal product was the one that made the difference.  Your own doc is in a better position to judge than I am.

3) Most skin rashes (and most infections of all kinds) clear up on their own, without treatment.  Sometimes it's the immune system, sometimes it's just the natural course of the condition.

[herpesworrier7]

Thanks so much. I'll be more on the lookout for the more typical symptoms. It's sucks that i have genital herpes but i've probably had it for awhile so there's no reason to loose sleep over it now. In any case, I'll be more far more vigilant and tell future partners. Thanks again.

[H. Hunter Handsfield, M.D.]

This thread is closed. I deleted a nonsense comment by username dr_Logan about finding out "reasons" for herpes recurrences.  There are no well established triggers of genital