Confused and Concerned

[bob1234510]

      A friend and I decided to sleep together, we had unprotected intercourse once and she performed oral sex on me once that same evening. A week prior she received a full panel std test from Quest and was negative across the board. That was the end of our sexual relationship. 31 days after the encounter I noticed what looked like a brush burn on the front of my penis about an inch below the head. Two inches around on the right side of my penis was an isolated and rather small sore. I am quite confident that the symptoms had just emerged because I had been watching my penis closely.
         I called my friend and told her of this, and she was concerned that I had given her herpes, whereas I thought she had given it to me somehow. She was promptly tested for HSV-2 by Quest and was negative. I was then tested 41 days after my encounter with her and was positive for HSV-1 and negative for HSV-2.  I have only had two other partners and we had had only protected sex many months before my test. Further, I called them after my scare and they had each been tested a few months after we slept together and were negative for everything.
      I do not know what to make of the positive HSV-1. My mother remembers me having cold sores, but perhaps they were canker sores since they were in and on the outside of the mouth. It has also been more than three months since my encounter and I have not had any recurrences (but, if it is hsv-1 that is not unusual). Further, from reading this forum my symptoms seem ambiguous: the sore was never a blister like is typical of herpes; it has left a scar (atypical); it is on the other side of the penis from the brush burn (atypical); and I received these symptoms over a month after the encounter from a partner that received a full panel exam and who has told me she has no history of cold sores. (She has assured me that she was not with anyone in the seven days in between her exam and our encounter).
  What should I make of these facts?

[Edward W Hook, MD]

Yes, if she was tested and found to be negative a week before your encounter, you can have confidence that you were not exposed to HIV. The chances that she had become infected and was in the "window" period over the week or so since her testing is so low as to not be something to worry about.  EWH

[bob1234510]

Doctor Hook,
    One last question: I mentioned above that my ex was tested a week prior to our encounter for HSV-1 and was negative (though you are correct in that she was not tested following our encounter). Is there a lot of merit in this "prior" test as evidence that I don't have genital HSV-1? I would also like to genuinely thank you for your time and expert advice. It is deeply appreciated.

[Edward W Hook, MD]

You have summarized your situation quite well and provided a lot of information, thank you.  In addressing your questions, we can discuss possibilities but there will be no definitive answers. The only way to get them would be with a PCR test of culture from a lesion.

From what you tell me, you have  a reliable blood test which is positive for HSV-1, just is the case with about 60% of American adults.  Whether the lesion you noted on your penis was HSV-1 or not is impossible to say but it is unlikely. there are several reason I say this.  This include:

1.  Atypical description.
2.  It appeared long after the 4-14 day period following exposure in which most new HSV infections appear.
3.  It did not last the 14-21 days typical of initial HSV.
4.  Transmission of HSV-1, if your partner had it (and this is unknown.  sounds like she did not have an HSV-1 blood test), is inefficient and far less than 1% of exposures to infected partners lead to transmission.  You had a single exposure and no lesions were noted.  

My assessment. Given the history from your mother, it is most likely that you acquired HSV-1 and a child and have not been troubled with it sense (remember about 80% of persons with HSV are unaware of it).  If your ex would get tested for HSV-1 and were found to be negative, this would increase the scenario I just mentioned to near certainty.  If not, I think it is still the most likely scenario.  If the rash you noted re-appears, getting a HSV PCR or culture might also help to rule out genital HSV-1.

Hope this helps.  EWH