Genital HSV?

[balzac100]

Dr. H...

You have been very helpful in answering questions for many people on this websit... I have posted once before. Here is anohter problem...

I was diagnosed with oral hsv1 earlier this year. went on Valtrex for a couple months then stopped... I suddenly had numerous oral outbreaks one after the other, not on lips but on gums. So... my docotr put me back on valtrex.

I had a protected (with condom) sexual encounter exactly 4 weeks ago witha female that has tested positive for hsv2. I know her well and she has not had an outbreak in over a year and a half. I have been on Valtrex for about 6 weeks as of today. At exactly 21 days after protected enounter I noticed a small irritated area on the base of my penis shaft. I thought nothing of it, thought maybe hair follicle, etc.

This "irritated" area never developed into a typical blister and only one spot was noticed about the size of a crayola marker point. It is now 7 days later and it is nearly completely healed.

I never experienced any other symptoms at all... I am regretting not going to get the area cultured last week. But i convinced myself every day that it didn't look "bad" at all.

HERPES 2 OUTBREAK?

Facts are: 1 protected encounter with hsv2 positive girl with over a year since outbreak. No symptoms other than small area of irritation. Plus I'm on Valtrex, which actually concerns me bc it may have reduced any progressive symptoms.

Any help?

[Edward W Hook, MD]

Most exposures to infected partners does not lead to infection meands that most peole who have sex with partners who have herpes do not get infected.

Symptoms typically present in 4-10 days following exposure

I continue to doubt that this is HSV.  EWH

[balzac100]

You say "most exposure to infected partners do not lead to infection"? I don't think I am clear on that statement.

Also, if 21 days is an unusually long incubation time... How long is an average time to symptoms after exposure?

I am at day 8 now with the... I'll call it "lesion" nearly healed completely. Probably one more day. But again, never fluid filled or raised or "itchy"...

Thanks again

[Edward W Hook, MD]

Comments both about your oral HSV and your genital lesion.

Oral HSV first.  The recurrences you experienced after you stopped valacyclovir- were they all on your gums and has starting the valacyclovir helped. The reason I as is that recurrent oral HSV is more typically involving the lips than gums.  Lesions on the gums are more likely to be aphous ulcers which don't respond very well to antiviral therapy.

As for your genital lesion, it is most unlikely that this is HSV-2.  Here are the reasons I say this:
1.  Most exposure to infected partners do not lead to infection.
2.  Your lesion appeared 21 days following exposure- it would be most unusual for HSV to do this.
3.  The lesion lasted only 7 days, most initial HSV lasts longer
4.  You were on valacyclovir which, as least in theory (there has never been a study) would be expected to prevent HSV acquisition.

Now that the lesion has healed, there is not much to do diagnostically.  Far too early for a blood test. Should it recur I would suggest getting a culture or PCRT test performed on it sa soon as possible

Finally, if you have follow-up comment here, please do not start a new question/thread- it will only cost you money.  Use the comment site


Hope these comments are helpful to you.  EWH