very confused on the advice given about initial outbreak symptoms

[puzzle2779]

I have spent hours and hours and hours reading posts on this website including expert forums as well as other websites and I am extremely confused to say the least. Can anybody shed any light on the following?

It seems that people who are querying an initial outbreak, who have extreme symptoms but with no blisters are being told it is unlikely to be herpes. They are asking for help before they can manage to be seen by a doctor or are having to wait for blood tests as they don't have blistered areas to culture. The general feel seems to be that if they were in so much distress with itchiness,swelling,pain urinating, burning skin, pain, chills and fever then they would definitely have sore blisters present.

However the same doctor or website giving the advice (sometimes in the same post!) also say that most people with genital herpes don't even know they have it and won't recall when they were infected.

Therefore my problem is, I don't understand how doctors etc can be saying that you will have to have some ulcerated skin with an initial outbreak that is 'noticeable', that includes the other classic symptoms such as itching and fever etc...when others can go completely unnoticed. Surely there will be a whole spectrum of symptoms that people will display when first infected? A range from nothing at all to a full blown classic text book case. I'm struggling to understand why so many are being told that it is probably something other than herpes going on and to follow up with their doctor to find the real cause-when often all other symptoms except blisters are evident. Also does it not seem more likely to put all the symptoms down to herpes if they appear two weeks after sex and when all other stds and yeast infections etc are negative?

There appears to be a lot of threads like this with frequent 'yes, but...' continuations, desperate to understand it all and to find reasons why all there symptoms can not be herpes and to get an idea what else the heck it could be if everything else is negative. Of course, many of the posts have no 'ending' so there is no conclusion with regards to if these people were in fact having an initial outbreak of herpes or not.

Does anybody have any thoughts on the conflicting and confusing advice given (or is it just me missing something!)

[puzzle2779]

Thanks grace. I think maybe advice that the risk is low, for example skin to skin or auto innoculation, comes across as flippant and impossible rather than low risk. Therefore people think, well that can't happen to me because it's so rare it's just impossible, and therefore disregard that they may in fact actually have herpes and never follow up with it.

[gracefromHHP]

you can contract genital herpes from just skin on skin contact and no sex but the risk of such is incredibly low.

you can transmit the virus to other body parts but it doesn't happen very often when you take into consideration that 1 million new cases of genital herpes are diagnosed in the US alone each year.   If you think about infants and toddlers under the age of 5, 1 out of every 3 of them has oral herpes. Think about what those kids do - they have their grubby little hands in their mouths and in their ears and their eyes and down their britches non-stop all day long - how many kids do you know have transmitted herpes all over their bodies?  It's just not something you see and if children who do that sort of contact all the time, never wash their hands and have an immature immune system aren't able to transmit the virus all over the place, why think that as grown adults who tend to keep their hands a little more cleanly, would transmit their genital herpes or oral herpes to multiple body parts?  A little common sense of just washing your hands after touching yourself intimately really does go a long way :)


I know it's hard because the "official" info on herpes does make it seem like all you have to do practically is look at someone with herpes and you are at risk for it but real risk isn't all that high, especially if the infected partner is aware of their status. I've been doing the online forums for over 10 years now and probably less than 10% of folks who are concerned that they have contracted genital herpes , who go through testing at the appropriate times and then report back actually really did contract herpes.  Being a health professional myself, I do try to take in the "whole story" of the poster too when giving advice which I like to think also is helpful to the poster.  Oh and no, I didn't take your questions as being personal to me either - they just seemed like random wondering to me but glad you confirmed that too :)  

[puzzle2779]

Thanks. I knew the advice was on odds. Of course is it. People aren't contagious 24/7. However my mind goes into boggle mode when people are presenting with symptoms and then it's said that the odds are low from a one time encounter so it must be something else. Obviously when there are no symptoms and somebody is just concerned about the chance of having contracted herpes then the advice that the odds are small would be appropriate to ease their worries, but surely not when someone has some symptoms.

And again there appears to be yet another variation on advice.. (I think there may be smoke coming from my ears soon due to my brain trying to process all this, lol). I've read in places what you said- that it takes a lot of friction and time to transmit herpes and then other times it appears to be said that it is highly contagious and merely skin touching with mild friction is enough especially if there is an open area of skin for the virus to enter easily. And again further differences on self innoculation. Some say no, others say possible, others say absolutely! And further still on if someone can have this dormant for years and not display or pass it on until twenty years later-then that good old discussion on fidelitly raises it's head!

Please please don't take any of my ramblings as confrontation in any way, shape or form. That was and will never be my standpoint and sincerely hope it hasn't been construed in that manner. This post was not initially intended to drag people like yourself and grace to 'justify' any of your own advice given-certainly not. obviously that is incredibly interesting but moreso it was also to see what advice others had been given, on visits to clinics too, and there views on the outcome, as of course people know their bodies better than a stranger of a doctor does with regards to changes felt. I am merely puzzled and genuinely interested in the 'facts' of the virus and how advice and diagnosis is defined as this seems to differ greatly from person to person. I'm not a face-value kind of person...unfortunately I need to understand everything! I have a need to learn! Sometimes this is a blessing but sometimes it's a curse, lol.

[Mistakeguy789]

The advice for that is really about odds and chances.  For example the virus isn't going to touch the body and BOOM you now have herpes.  It takes lots some good friction to get into the skin deep enough.  But again its a low risk because of the amount of virus it will take to get into the body to do the damage and not be killed during transmission.

Think of it like pregnancy almost.  In order for a woman to get pregnant it takes a lot of things to line up.  Not every shot is going to lead to a pregnancy.  Some people are just that (un)lucky to get it on the first night of drunken sex and some (maybe most) aren't.  

The virus needs a lot of things to go right.  Heat, Friction, and enough virus to get into the body to make things go wrong.  Can that happen on the first time?  Sure but not all the time.  It's also like kissing while someone has a cold sore present.  Just because you kissed the person doesn't mean the virus was transmitted.  There is a good post on the biology of virus transmission.  If grace doesn't have it I will look to find it.  It was written by Dr. HHH on the I want to say HIV forums but he did touch on HSV.  But it maybe on the STD forums.  I will see if I can find it and post it here.  

[puzzle2779]

Thanks grace. It's nice to hear the rationale behind the advice. I obviously understand the different view points of each medical professional (and agree with you and Teri that testing is always a good idea) And by the way, I truly think you do a terrific job giving up so much of your spare time to try and help others. The problems I'm having with struggling to understand the conflicting facts and advice is no slant on those actually giving their time to help. Cause without forums like this so many people would be totally lost!

That said ;) ...The other thing that's bugging me is the advice that ...not to worry, the chances of contracting herpes from a one time encounter is extremely low ... But surely it only takes one time. And not full sex, skin to skin is enough. Especially if most don't even know they have it! - so partners won't necessarily notice lesions etc. This virus is all too much for me to grasp! :<

[gracefromHHP]

well you didn't post specific posts that had advice that concerned you but I know I and most other responders usually encourage folks to follow up properly with their providers.  obviously something is going on most of the time so finding out what is going on is important. You've probably even noticed that many times I'll even just tell folks "since herpes is on your mind, why not ask for testing when you are seen to see what your status is" to many posters who have herpes related questions. I know you've been here long enough to have figured out that I'm not a big fan of the no reason to routinely test for herpes way of thinking.

There is also a lot of "genitally focused anxiety" as HHH calls it on the forums too.  Some posters are making the proverbial mountains out of molehills due to anxiety about  an encounter that they have. We tend to take that into account too in our responses.  I've noticed over the years that Terri Warren and myself tend to encourage folks to get routine herpes and std testing in general compared to Dr Hook and Dr Handsfield. It's our differing styles and you'll find that with all medical professionals.  

hope this discussion is somewhat helpful for your questions puzzle :)

[puzzle2779]

Oh yes I know. Fully aware of that. However I am including posts on this site-which I assume you believe is credible, ha ha! ...such discussions as ...yes you have all the symptoms including fever, itchy, redness, burning, swelling, pain when urinating, discharge etc but no lesions. That spot is probably just a spot so don't worry about it- it won't be herpes....

This is also with doctors who see patients. The same is said. ...There is obviously something going on but you've no blisters so it won't be herpes,... and send them on their way. I'm just confused! I obviously have a simple mind!

[Mistakeguy789]

The problem is that the internet is FULL of information.  Sadly I blame search engines because they don't give credit to credible sites sadly.  It's a long story how they come up with who wins but sadly people will graps on to anything if it looks authenticate.  Working in this field for a number of years (System Engineer and my fair share of white hat [A good hacker]) I can tell you that it is easy some times to make people thing things.  

[puzzle2779]

Ha ha yes I am passionate. And yes grace always answers well. She obviously has a lot of knowledge and that's why people look to her for help I guess.

...but to continue... I'm worried about the folk who get advice on forums and the internet, and decide not to get follow up testing done because the advice they read states they must have noticeable lesions (and like I said, surely this could be a small papercut that they wouldn't link to herpes).

Sorry if I ramble in my posts. I kind of say it as it comes into my head!

[MrDonut]

Way to go with your discussion of the issue of confusion and contradiction. I think grace responded very well to your passionate discourse.  I've been trying to get some simple issues cleared up so that my wife and I can come to a resolution about whether or not she might be an active hsv1 oral carrier 'if she had a subtle symptom' vice being an asymptomatic carrier. From grace's answer to your discussion I would conclude that if a herpes lesion isn't present it really isn't herpes. It should be noted that all questions, even if they are clumsily worded, can maybe help some one else who is searching for help and finds themself bogged down in the the real or seeming contradictions.  Bravo Zulu!  (That's military talk for Great Job Done Well).  

[gracefromHHP]

herpes is so widespread mostly because most folks aren't aware that they are infected. Not knowing that you are infected means you are more likely to have sex when you have redness or itching or a presumed "zipper accident", anal pain/itching, discharge etc. If you are aware that you are infected, you are able to make the choice not to have sex if something is going on.  

I think most folks who are worried enough to be posting about their symptoms they are noticing, are going to get follow up testing to cover their bases. It's the folks who don't seek out information are the ones who are more likely not to get follow up testing.  

[puzzle2779]

Thanks grace. That sheds a bit more light on things. However, surely a lesion could be a small pimple or some rough irritated skin that would be overlooked as not herpes as the person would be looking for classic big blisters. Or indeed vaginal papercuts or roughness on the internal tissue-which again could be disregarded as herpes lesions presenting in this way? Surely the lesions would not necessarily have to display as 'severe' even if other symptoms were? Therefore people conclude they can't have herpes due to a lack of lesions. Of course testing should be done to clarify infection or not, if someone is in that much discomfort and is worried to have contracted herpes-but possibly some others may carry on as normal once things have cleared up, thinking it was a freak infection with no diagnosis, that has gone away. perhaps this is another reason why it is so easily spread... Just a thought.

[gracefromHHP]

yes, the majority of people who have genital herpes have no idea they have it. It's not that they aren't having symptoms, it's that they aren't attributing the symptoms that they are having as being due to herpes.  the assumption made on the boards, especially on the std experts forum is that if you are worried enough to be posting here, odds are you are looking closely at your genital area and would notice lesions.  the 'flu like" symptoms that folks post about, usually aren't herpes related at all. If you are looking at your genital area like most of the posters here are, odds are you would've noticed herpes lesions so when you post that you have X, Y and Z as symptoms but no lesions, we all feel fairly safe saying it's probably not herpes going on.  we know you are looking pretty darn close and likely would've noticed more than just pain and fever.  

most of the folks who follow up on their posts, don't test + for hsv2 with their follow up testing.

grace