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HSV-2 post exposure prophylaxis

So, I had a recent encounter with a partner whom I did not know his status. I told him I wanted us to be tested before going any further than kissing and fingering… he was a little bit pushy with me and his penis ended up touching my pantyline. Not a brief touch, but a rough grinding I would say.

Anyhow, two days later I’m having some burning and tingling feelings down there, but urination feels fine. No sores yet. I’m super stressed and worried that I have herpes now.

A week prior to this incident I started taking Acyclovir 800mg 2x a day to avoid getting a cold sore before we were going to hang out together. Well, I’m glad because I did a little research and seems it could potentially be a sort of prophylactic to prevent a primary HSV outbreak. I found some studies on rats and also a study on a wrestling team using antivirals prophylactically.

What are your thoughts on this? Since I’m having symptoms, which may or may not be HSV, should I continue taking the pills for a couple more weeks just in case?

On a side note, I’m going to see an OBgyn ASAP to be swabbed as well.

Thank you for your help!
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Burning and tingling aren't really herpes symptoms, at least without other signs, like blisters or sores.

It's unlikely that you got herpes from this encounter. It takes a lot of friction, usually the kind associated with intercourse, and you had your underwear on.

The question of antivirals as prophylactics needs more study, but it does look promising.

If you get anything swabbed, asked that it be a PCR swab. It's more sensitive than a regular culture.
Helpful - 1
Thank you! I’ll be sure to get the PCR swab.

Do you think the sores could be inhibited by the Acyclovir though? So this could be a very mild primary ob that wouldn’t develop sores? Or these are prodrome symptoms prior to the sores showing up? It’s only been two days after all.

Will taking Acyclovir impact PCR results, causing a false negative?

Sorry for the questions. My mind runs a mile a minute worrying…
I should also mention the tip of his penis seemed pretty sensitive, and he did rub it pretty hard on my pantyline. A fair amount of friction. I don’t know if he had sores there, and I didn’t look closely. But considering outbreaks can happen anywhere below the waistline I’m pretty nervous.
The PCR won't be affected by the acyclovir. If you are having symptoms, you'd be shedding the virus, and the PCR swab should find it.

Be prepared that the doc might tell you there is nothing to swab. If you can get them to swab, point out the area that has the most itching/tingling/burning. You'll have the best chance of getting the most accurate results that way.

I suppose it's possible the acyclovir is inhibiting the sores - we just really don't know. You could always stop it, but then you'd have to wait and see what happens, and there's no guarantees you'd get a sore even if you were infected. You might also get an oral outbreak.

I'm not sure what you mean when you say the tip of his penis seemed sensitive - how do you know that? Do you mean that it seemed painful for him?

Usually, the friction involved has to be the kind involved with intercourse - rubbing the tip along your panty line isn't the same, really, but I understand why you're concerned.

Where on your pantyline was this? Was it near your vaginal opening, or more near your hip? If it wasn't the thinner, moist skin of a mucous membrane, it won't be infected. Your thigh, hip, etc., all has skin that is too thick to be penetrated.

Thanks again for your reply.

Well, I went to the clinic today and they said they don’t have any viral swabs at all. Darn. I guess I have to try going to another place for a swab.

She did do a visual inspection and I have no lesions. My cervix does have a little bit of a rough patch. She said it doesn’t look herpetic, it just looks irritated.

Though it’s only been two days, so who knows, right? My lip only looks kinda red the day before I get a cold sore, so it could be the same deal. I know I’m thinking on the dark side here…

He seemed to be in a little bit of discomfort for a moment, but I asked are you okay, and he said he was fine. His tip touched my labia majora near where it joins the thigh. Not the mucous membrane, but the area where I have pubic hair. I trim and do not shave, so no open skin breaks in that area.

I’m guessing if I was infected at that area, I wouldn’t break out on my cervix first, right? So that’s more likely to be from his fingers/nails? He washed his hands, but there was still some brief touching of his penis before touching me.
That area isn't likely to be a high infection rate, so I wouldn't overly worry, especially because your skin wasn't broken or irritated from shaving.

Not to sound crass, but maybe he had discomfort from sort of poking at you, and not because he had sores. Maybe your underwear chafed him.

If you have no lesions, don't spend a lot of time now searching for swabs. Give it a few days, see if anything else appears.

I'd be surprised if you got an outbreak first on your cervix - most often, it's the point of infection. Not always, but that's the most common.

Hang in there, okay?
Thank you so much for your help. I will hang in there and see what happens.
You're welcome. Keep me posted. :)
No lesions today, but I seem to be having a burning sensation after peeing. Not during peeing at all, but about a minute or so after peeing. I can feel the burning in my labia and anal area. What are your thoughts about this? Does Herpes usually burn during peeing, or is it after?
If it was herpes, it would burn during. It burns because urine hits sores.

I don't know why you are burning a minute after you're finished. Could you be allergic to your toilet paper?
Ok, thank you. That is very helpful.

It’s possible I’m allergic, I have very sensitive skin, but I’ve been using the same toilet paper for years (hypoallergenic wipes) and this is a very sudden onset of symptoms. Maybe it’s a toilet paper I used at a restaurant days ago. Or something in the hotel sheets or from the carpet.

Oddly enough, today I woke up with no symptoms at all, then after I used the bathroom, my labia burned and stayed that way all day. Maybe it’s because I woke up and started thinking about it (in other words, purely anxiety induced).

I have a weird dull ache too, almost like period cramps, focused in my clitoris area. Which of course is where he touched me the most (with fingers only)…

I’m guessing none of this sounds like herpes… even the predrome symptoms? It involves the nerve endings though right?

Thanks again,
You wouldn't have nerve pain with herpes without an outbreak.

I feel you on the sensitive skin. A couple of years ago, I suddenly became allergic, or sensitive, or something to toilet paper, and I had to start using hypoallergenic wipes, too. A hotel stay or even using a restroom at a restaurant can wreak havoc for a few days.

Did he touch you roughly? Maybe he just bruised you.

Prodrome only lasts 2 days at the absolute most. If it lasts longer and you don't get an outbreak, it's not prodrome.

I hope this weekend brings some improvement in your symptoms. :)
Thank you, that is very comforting to know. I’m sorry to hear you’ve dealt with sensitivity too… it’s such a pain, literally!

Yes he was a little bit rough with me, but it doesn’t really feel like bruising or tears. More like menthol icy-hot and cramps.

I’m hoping for improved symptoms too. Thanks again, I hope you have a great weekend.
Yes, the sensitivity is literally a pain lol.

How are you feeling today? Any improvement?
Thank you so much for checking on me. Feeling about the same… although the burning seems to come and go through the day, it’s not really matching up to when I wipe anymore (although that does aggravate a little bit). Yesterday was a bit better, but today it’s really burning. I don’t see any visible sores, but I did feel my cervix with my fingertips, and it seems a little bit rough and bumpy. After touching that, I seem to be much more sensitive overall. I’m kinda freaked out about it tbh… I’m hoping things improve soon.
It's not unusual for the cervix to feel a bit rough and bumpy, unless yours usually feels smooth. Both are normal, it just depends on what is your norm.

When you went to the doc, did they do any testing at all? Check for a UTI, yeast, BV or anything?
Well I’ve always thought it was smooth, but it’s possible I didn’t pay close attention until now.

Yes, they tested for everything except HSV. I’m still waiting on the results though, it takes 5 business days. I’m a bit worried that if they are all negative, with my anxiety I’ll just assume it’s HSV. So I almost don’t want to know until I get my HSV results. I have another doc appt tomorrow… hopefully they have the swab in stock this time.

As far as symptoms go… I’m totally fine when I wake up in the morning… no burning, pain, anything all night. Then as I wake up the symptoms seem to start up again. I assume an HSV outbreak would be more consistent, right? Or, if anything, possibly worse in the middle of the night, due to the Acyclovir wearing off after 8-12 hours without a dose?
If it were herpes, the acyclovir would only help heal an outbreak. It's not a pain reliever, and doesn't help nerve pain. It isn't like aspirin or ibuprofen that would wear off so you'd feel more pain when it does. It's an antiviral, so it helps stop the replication of the virus. If you take an antibiotic for strep throat or something, you don't feel more pain when that wears off and it's time for your next dose. An antiviral works the same as an antibiotic, just on a virus, not a bacteria.

What kind of hsv testing did you get done? Not that I think you had risk with this most recent encounter, but even if you did, it wouldn't show on an IgG blood test yet. It takes, at minimum, 2 weeks to show positive on that test, as it looks for antibodies. 70% will be positive by 6 weeks.

They may have done an IgM test. That's a test that looks for new infections, for certain types of antibodies that develop with new infections. The herpes IgM antibody test is very unreliable. It's wrong at least as often as it is right, and shouldn't be used anymore.

How long was he touching you with his penis? A few seconds? Minutes?

How much of this do you think could be anxiety? Do you feel it constantly during the day, or do you not feel it when you are busy? Herpes pain is constant.
Ok, thank you for clarifying about the Acyclovir. It sounds like the symptoms are coming and going too sporadically for this to be herpes. The thing is, I do feel a difference in nerve/pain symptoms when I use Acyclovir for cold sores. Is it different for genital herpes?

They didn’t do any HSV test at all. They didn’t have a swab, and couldn’t get a proper blood draw when they stuck my arm.

His penis touched my thighs while cuddling, with underwear on. And then direct, rough contact with my labia majora for a couple seconds. We slept in the same bed as well. He was not clothed.

When I am really busy, I don’t notice the symptoms for the most part. I know for a fact I have severe anxiety that could cause these symptoms, but the potential risk of direct contact with an untested partner is really concerning me.
You might feel a difference in pain when you take the acyclovir for the cold sores because it's slowing the viral replication and healing the cold sore. It's not actually relieving pain, though.

To transmit herpes, you need direct, unclothed skin to skin contact with mucous membranes. Your labia majora is not a mucous membrane. Your thighs aren't, either. The labia minora are, as is your vaginal opening, anus, etc. It's the thin, moist skin.

Also, there needs to be friction, usually the kind associated with intercourse.

So they did urine testing? That's it? You peed in a cup? When do those results come in?

Hang in there. :)

Thank you, I’m trying to hang in there. Very nerve-wracking.

They did a swab but it was for everything except HSV, because they didn’t have any viral swabs. I just got my results back, and negative for yeast, bv, chlamydia, gonoreaha, trich. So I’m kinda freaking out even more. All that’s left is HSV, allergy or anxiety.

So I just had another doctor appt this morning… and again, they have no viral swabs. They can only do a blood test. Ugh!! Why is this so hard?

I tried to make an appointment with gynecology, but it’s a two month wait. So I guess I won’t be getting a virus swab anytime soon, and I may have to wait the 6-12 weeks for peace of mind with the blood test…

I’m trying to stay positive and hoping for the best. Thank you again for your support, it’s so helpful when I’m feeling kindof let down at the doctor’s office <3
Are you in the US? Can you try a Planned Parenthood for a viral swab? I don't know that they'll find anything to swab, and at this point, a swab would likely be unreliable - the sooner it's done, the better - but you can try it.

I'm glad everything else is negative, and since it couldn't be herpes, I hope this helps ease your mind.
Thank you. Yes, I’m in the US. Maybe I’ll try planned parenthood next week, but I’m probably just going to wait the 12 weeks and get another blood test. I’m in a fair amount of pain at this point from multiple invasive swabs and doctor visits.

I feel like I’m on fire down there. It did not go away even with busy activity today. I had reduced my Acyclovir to 400mg 3x for the past 24 hours, so maybe it has something to do with that. I’m going to increase my dose again to 800mg.

I’ve never felt quite this uncomfortable “down there” before, and even if there are no visible sores, I wonder if I’m one of the people that will be “asymptomatic” or get mild outbreaks. Which is somewhat comforting, but still not ideal.

Can anxiety really cause symptoms this bad?
What dose were you on?

If you are having an initial outbreak, the dose is 400 mg 3x a day for 10 days.

A recurrence is 800 mg either 3x a day for 2 days.

For oral herpes, the recurrence dose can be acyclovir 400 mg orally 3 times/day for 5 days.

You aren't asymptomatic - you are having symptoms.

You had no risk for herpes, hon. You just didn't. I'm not saying you don't have something going on. It's just not herpes.

If you want to see if you develop sores, and put this to rest, stop the meds. You didn't have a risk, and you won't develop sores, but I wonder if that will help you move beyond herpes being the cause.

Continue working with your doctor for the cause.
Thank you for your help.

I will consider coming off the pills soon. I was taking 800mg 2x a day until I started getting symptoms then went to 3x a day. Trying to prophylactically block an infection from happening. I’m afraid to stop taking the meds until after 14 days past this potential exposure, just in case.

To tell the truth, in the past I’ve had multiple situations where I was raped in my sleep. Not a pleasant thing to think about, and not something that I necessarily think this partner did, but I can never rule that out completely. So the idea that I had zero exposure is not really something I can say with certainty.

The fact that he was pushy with me as well, coupled with the direct skin to skin contact that I specifically asked him not to do, I’ve got a lot of concerns about what happened that night.

I’ve read a lot of places that you can catch herpes from sharing toys, any skin contact “below the belt”, etc. So I’m worried that’s what happened. But if that’s impossible, and it can only happen with mucous membrane contact… and if it turns out I really did catch herpes… well, that means something much worse has happened here.

The doctor doesn’t seem to be much help, since they didnt have the viral swabs for HSV, they just did the other tests and since it’s negative then their job is done. On my end, it creates even more anxiety. At least a positive yeast test is something I can treat and move on. Now I have to wait on the HSV blood test. It’s going to be a rough couple months.

Thanks again, I really really do appreciate your help. I’ll post an update if anything changes.
I'm really very sorry that happened. I hope you've received therapy for that.

Knowing that, it makes sense why this has triggered such anxiety for you.

Please consider decreasing your dose. A lot of people have reported feeling nerve type pain from high doses - and sometimes not so high - of antivirals. It's anecdotal, and not something that the pharma companies report, but patients report it quite often.

Thank you, yes I have been in therapy for years and I’m doing much better. The hardest part now is trying to trust new partners…

I’ll decrease my dose to 400mg, and the 14 days is coming up this weekend, so I’ll try stopping completely at that point. In the meantime, I’ll find some comfort in the idea that maybe these nerve pains are just side effects.

Thanks again, I really appreciate your help. I’ll post updates soon.
You're welcome. :)

Have a good weekend.
So… the clitoral nerve pain went away after burning like crazy for a couple of days. I’m still on the antivirals.

Then a small bump showed up on my inner labia Sunday, but I can’t tell if it’s an outbreak or a cyst/pimple. I do have very sensitive skin, so irritations happen from time to time… but it does have me freaked out. Because of the nerve pains that were happening, and the timing from exposure (exactly 14 days later)… it’s worrisome.

I’ve been taking pictures every day to keep an eye on things, and putting some antiviral oils on there to help soothe, and it seems to be working. Or at least, it’s not making anything worse. The bump looks almost the same today (3 days later) as it did when it first showed up. A little bit red, with a couple very small white spots in it. Like pin head sized, almost like pores. I’m watching for the spots to get bigger, but they are not. I do not know if it’s because I’m on antivirals, or because it’s not really an outbreak. It does not burn when I pee, so that’s a good sign.

I tried calling Planned Parenthood, they have no openings until next Sunday, and I doubt there will be anything to swab by then.

I guess I’ll just try not to freak out. I’m finding comfort in the fact that this bump isn’t that terribly painful, and if the first outbreak is the worst one, maybe it won’t be so bad to live with. The emotional pain is probably the worst part… if something bad happened that night… I don’t want to accept it… and I don’t want to accuse my boyfriend of anything… so I’m just pretending everything is okay :/
What about going to an Urgent Care?

Remember that you didn't have a risk.

Oh this guy is your boyfriend? Does he know you are so worried? Has he tested? That would end your worry.
I went to urgent care, and my doctor, they did not have viral swabs.

Yes we went official after this night. He sent a lab test over a week ago.

Just got the results back this morning, and he is HSV2 positive.

So… I’m almost certain I have it. I had the nerve pain, I have the tiny white bumps on mucous membrane (inner labia). So I’ve pretty much accepted that I have it.

I really want to know though… we had no contact on my mucous membrane. Certainly not while I was awake. Do you really believe it cannot show up in a place other than the original infection site? (which would have been my panty line, near the thigh)
What was index value on his hsv2 test? It should say something like "HSV2 IgG 8.9" or something.

Yes, that is true, and even if his penis came into contact with your mucous membranes, it takes significant friction to transmit, usually the kind associated with intercourse.

He briefly touched you. You didn't get hsv2 from him, if his test is a true positive.

Tiny white bumps are not herpes.

If you feel you must accept that you have herpes, I'm not sure what to tell you.
It’s the Elisa Igg test, it just says positive > 1.0. They did not list the number on the results. I will ask to see if they have that number on file.

It’s a swollen area that looks a lot like the cold sores I get on my lips, kinda reddish but there are a few white dots in the middle. One of the white dots is kindof protruding out just a little bit like a tiny bubble. It depends on the camera angle, it is hard to see. It looks herpetic to me. I’ve seen a lot of pictures online, it looks similar I think.

But yes, the brief touching being unable to transmit is exactly why I’m concerned. If it truly cannot be possible, then I have to consider the possibility of him doing something to me while I was asleep.

I’m going to call every urgent care in the area today to see if they have swabs in stock. Planned parenthood is $255 for the visit, and I have to wait, so there may be nothing to swab by then.
When you call them, don't ask if they have viral swabs - ask if they can do herpes cultures. Viral swabs will make them think covid, not herpes.

Is there an STD clinic near you? Try there, too.

You can also consider that this isn't herpetic. You don't typically have to look at the correct angle to find a herpes sore.

Get the index number on his test, for sure. Do you know what lab did it?
Okay thanks, that is helpful. I don’t want any confusion when I call them, for sure!

Just got the lab info, his value is 1.145

It’s the Elisa Igg test from mylabbox.com
Ohh that is almost certainly a false positive. The cut off for a positive is 1.10, and anything under a 3.5 needs to be confirmed with another test.

At 1.14, it's easily an 85-90% chance of a false positive.

He can get another test done and see if it's negative, or he can get a Western Blot test done.

His doctor can do a Western Blot, or he can go through a clinician named Terri Warren at https://westoverheights.com/getting-a-herpes-western-blot/

He'd have to self-pay, though, and it's expensive. I'd start with another IgG, maybe from STDCheck.com or LetsGetChecked.com just to get it from a different company and/or lab.
Thank you so much, that gives peace of mind. He’s getting another test and we will see what happens…

My sores are now about 2-3mm across, white colored. I have 4-5 of them
…aaand now that I took a shower, most of the “sores” are gone. It’s just a few tiny dots again. It’s gotta be zits or clogged pores or something.

Oh my, so, I’m just worrying myself. You’re absolutely right, it could totally be anxiety.

I’m just gonna hope for the best and wait for the test.

Thank you again so much for your help. I’ll post an update soon
The sores are itching and burning again, they are still very small pinpricks but they are starting to bubble a bit like blisters. 4-5 of them in one 1/2” wide area.

Also, the clitoral pain has returned with a vengeance. Highly uncomfortable.

My boyfriend is still waiting on the western blot test kit to come in the mail, but meanwhile I’ve noticed the testing scale for mylabbox.com Elisa igg is different from the standard igg. So 1.145 is not a weak positive, it’s a definite positive. It says:

“IMPORTANT: These reference ranges are based on dried blood and do not correlate to published serum values”

Negative: ≤ 0.590
Equivocal: 0.501 < 0.600
Weakly Positive: 0.600 - < 1.000
Positive: ≥ 1.000

Value: 1.145

What are your thoughts about this?

Thanks again.
I don't know what kind of test he had with that kind of range, so I can't address it.

I do know that a 1.14 is not that much higher than a 1.0, on any scale. It's not a "strong positive" when it's just barely over the cutoff.

You are driving yourself mad. It doesn't matter what his results are, ultimately. From what you describe, you had no risk.
Thank you again for your help. I know I’m being difficult, but I’ve had a lot of sexual trauma that makes me worry. I also originally caught oral HSV-1 by simply sharing a soda bottle with a friend. They had one sip, that’s all it took to infect me. So I’m rather paranoid that HSV-2 is similarly highly contagious.

For peace of mind, I think I will get myself tested in several weeks. I think the usual cutoff is 12-16 weeks, but since I’ve been on antivirals for 3-4 weeks now, how long do you think I should wait to get tested?
You'll get an accurate test because you didn't have a risk.

If you had a risk, you'd need to be off antivirals for 3 months in order to get an accurate test.


I hope you understand what you're saying here - that there is a possibility that your current boyfriend assaulted you in your sleep, and you are staying with him, thinking he is capable of that.

I know you've had sexual trauma, and I'm sorry for that. I hope you've gotten counseling for that.
Yes, I’m aware that is what I am saying. My abusers were men I knew and trusted. I have been going to therapy for years. I am doing much better, but it doesn’t erase the fact in my mind that people are capable of terrible things while pretending to be something entirely different.

I guess what I’m saying is, I would assume that anyone I sleep next to is capable of anything, and no matter how much therapy I get, that is something I’ll always have to cope with.

My boyfriend is aware of all of this and is sticking around and helping me learn to trust him. We plan to avoid all sexual activities and sleepovers until we build more trust, sort out the testing and know what both our statuses are.

Thanks again for your help. I will get tested 3 months after coming off the antivirals and post an update.
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