HSV1 and oral sex

[focus385]

Hi Terri,

I have posted on this forum more before. My main concern was regarding an exposure which happened on July.25/2010. I received oral sex from a sex worker, and it was unprotected. Immediately after I panicked and definitely let my fear take over, I was depressed and anxious for months. I had my first HSV blood test approximately 8 weeks after the exposure. It was an IGG type specific test. The reason I had this test was because I had three small bumps form on the shaft which persist to this day. They were classified as genital warts and were frozen off I had another hsv test nearly 6 months after (2 days short of 24 weeks).

Test at 8 weeks and 23 weeks 5 days yielded the same results.

HSV1 - Positive
HSV2 - Neg

My question is simply, I did not notice any classic herpes lesions, however 4 months after the exposure i received a small scab that developed overnight I attributed it to my long nails which came in contact with my penis. The scab was over an apparent papercut like trauma on the skin. It took 2 days to heal entirely. There was no prodomal sign or such so I thought nothing of it, however recently I received another 2 scabs on the underside of my shaft close to the head. Once again no prodomal sign and they occured over night. These scabs formed after I masturbated 3-4 times in my underwear. I thought the friction had caused these cuts, however I am not sure anymore. I do not feel any pain from the cuts or in general down there.

1.What is the possibility that the HSV 1 is actually genital, and causing these scabs?
I want to really believe its trauma from masturbation but its happened twice since the exposure, and I've never had this happen before the exposure.
2. Is a 5 nearly 6 month timeframe sufficient to rule out hsv2 even though I have hsv1?
3. Is it possible to cause cuts on the penile skin cause of rough masturbation? (I was in my underwear during masturbation and think the button might have cut me, i did not feel any pain)

[Terri Warren, RN, Adult Nurse Practitioner]

Hi Focus,
I know that you are worried and scared about this encounter and that is certainly understandable.  Its too bad that there was no antibody testing done at the time of the encounter, as that would have told you if you had new infection or not - negative antibody at exposure, positive antibody later.  Unfortunately, that wasn't the case for you.  Your first antibody test occurred 8 weeks later.  
I would say that two days is very short for a herpes outbreak to heal, and certainly doesn't fit what I would expect from a herpes lesion.
You could certainly have broken the skin on the penis with masturbation combined with fabric, yes.  
I have a thought for you to get a correct answer about what's going on here.  Ask your healthcare provider to give you some swabs and viral transport media to take home.  At the very first sign of any scab in the future, aggressively swab the area and bring the swab back to your provider to send to the lab. By swabbing yourself, you will have very early access to the lesion and not have to worry that you waited too long to get into the doctor for testing.  If the swab test is negative, I would strongly encourage you to put this aside and move on.  don't swab again, just stop all activity related to herpes worrying. You will have enough information.  
To be really honest with you, nothing you've said makes me believe that you have genital herpes, type 1.  But I think you could do the swabbing to be extra certain and to provide yourself with reassurance.  If the swabbing is not available to you, then you could go into an urgent care clinic right away with any lesional appearance.  The trick here is moving on when things are negative.  This could take over your life for a while if you aren't careful.

And yes, you've waited long enough for HSV 2 testing - you are firmly negative.

Hope this helps.

Terri

[focus385]

I understand what you are saying but there was no lesion that ulcered or turned into a pimple. My penis was normal, I masturbated, woke up next morning with a papercut like scab and another one around the same area. No prodomal signs, no ulceration, no pimple. No pain.

I appreciate your insight but I'm hoping to hear from the doctor.

[yellowbean]

Although the classic description is of fluid filled blisters with redness on the surrounding skin, the presentation of herpes can vary widely from person to person.  

HSV1 is more common for cold sores (herpes of the mouth), but there are increasing numbers of cases of HSV 1 causing genital herpes.  HSV 2 is more common with genital herpes, but oral infections can occur.  

Remember that both herpes labialis (mouth) and genital herpes can be caused by either HSV 1 or HSV 2, and genital herpes caused by HSV1 is on the rise due to increasing popularity of oral sex.  

Although your symptoms are not classical it is possible that they could be related to genital herpes.  The only way to know really is to have one of the lesions swabbed when it is present, preferably when it is first noticed before it scabs over.

However, common things being common.  As you have described your symptoms, it seems like they have occured after penile manipulation, and chaffing or other mild trauma can occur.

By 5-6 months, the vast majority of people will have seroconverted, meaning they would have a positive HSV 2 test if they had truly been infected.  People who are do not have normal immune systems (Immunocompromised) may not seroconvert for longer periods of time (test negative even if they are infected), and the jury is still out whether the antiviral medications delay someone becoming positive.

Yes you can cause trauma to the penis by masturbation as well as other types of sexual activities.

Again, if in doubt the best thing is to go to the doctor as soon as a lesion first develops so they can examine it and if warranted take a swab for culture.