HSV2 ON THIGH

[vicman72]

Hello Dr.

Im a 36 years old  male who had protected sex with a female (vaginal ) (01-27-08), after two weeks i had some like flu symptoms, left leg pain,fever,swollen glands in the groin area (left side) ,low  stomach ache, low back ache, headache , after a week i saw a rash in my THIGH  (left side ) a quarter coin size, that one was red bump with small blister.I didnt see any rash on my penis or genita area.The rash was only on my left thigh.  On (02-28-08) (33 days after) i went to the doctor office and he told me that  could be herpes so he peformed some test:

* Varicel IGG AB  Result Positive
* HSV  !+2 IGM  Result HSV 1 IGM antibodies <0.8
                                   HSV 2 IGM antibodies <0.8

* HSV 1+2 IGG Result HSV 1 IGG antibodies 3.15
                                  HSV2 IGG antibodies

Also he told me to take valtrex for 7 days (1 g every 8 hours).
After couple days he call me and said that i was + for hsv1  but - for hsv2. I was so happy about it but couples month ago i saw on internet that my result could be a false negative.
I  havent had any ob since my firt one ( almost  7 months), so im so confused now, i went to my doctor office a couples days ago and i told him that i wanted to take  the herpes test again but he said that i dont need it because im hsv2 -, and also he asked me if i had ob and i told him no.
So this are my questions:
!
1. Do i need to take a herpes test again (IGG)
2. Why did i have my first ob on my thigh?? This is a normal spot for herpes
3. if i take the test again and the test is + for hsv2, do i need to star taking valtrex everyday???( 7 months without ob)
4. If my wife want to give me oral sex i have to wear condom??? ( no ob in my genital area)
5. If am i going to have ob in the future their going to be in the same spot (thigh) or could i get it on my pennis or genital area??
6. Could be hsv 1 on my thigh?.
7.Do i need wear condom all the time, (no ob and just one on my thigh)

[Edward W Hook, MD]

I'm suprise there waqs not a numerical value.  I would suggest you ask your doctor to find out what brand of test this was. As for your questiosn:

1.  Don't know.  I'm worried that it may not be.
2.  If it is a good test, it has provided a conclusive results
3.  This is nto zoster.  It could be HSV-1.
4.  The tranmission risk with HSV-1 is lower than for HSV-2.  There are fewer recurrences and less asymptomatic shedding. While tranmission can occur, it is uncommon.  EWH

[vicman72]

I got the igg test today:

* Herpes simplex  virus I-IgG  result igG antibodies detected for herpes simplex virus I
* Herpes simplex virus II-IgG  result IgG No Herpes simplex virus  IgG antibodies detected.

I Dont know why my result doesn't have numeric numbers. Just said negative antibodies detected for hsv I and no antibodies detected for hsv II.

1. Do u think I took the rigth test (IgG test without numbers).
2. If this test is the rigth one.. Do u think is conclusive??.(  8 months after )
3. I haven't have any ob.. Do u think this is for hsv1 or herpes zoster
4. What precaution do I have to take (transmition risk) hsv1

[Edward W Hook, MD]

Let me second what grace has just said.  

For starters, you have intruded on vicman72's thread.  That is not permissable by Forum rules and I made an error by even responding.  Secondly, you are playing games here and taking replies from threads out of context.  That is not fair to others who read the interchanges on this forum.  Stop!  EWH

[gracefromHHP]

I really do not appeciate you pitting Dr Hook and I against each other here on the forums which is what you've been doing.  If you chose to disagree with what I've been saying in your thread on the herpes forum so be.  

grace

[Edward W Hook, MD]

HSV lesions tend to occur in the same area as they originally occurred it.  there may be small variabiltiy as to where they occur but lesions occurring on the thigh are not going to recur on the genitals.  Genital recurrences follow genital lesions and are not due to some sort of spread from nerves innervating one part of the body to another.  EWH

[brookdale]

There seems to be an argument raging in the free side Herpes Forum.  If you obtained genital herpes on your thigh (as this post states) from rubbing, would it then appear later on your genitals or does it always show up at the site of entry.

One authority says...
Now if you just were infected thru the thigh that still would go to the sacral nerve ganglia which is the same nerve group that supplies the anogenital area so it does have the potential to go down a nerve pathway to the anogenital area.  I think most folks are having foreplay along with their sex so unless you were absolutely positively sure that you contracted hsv thru just someone humping your thigh and not thru sex I'd still take full precautions at all times if that was the area of your lesions.  Same with there's a fine line between what is the sacral nerve area in the lower back and what is the lumbar area. In theory you could be infected in the lumbar area thru someone naked sitting on your back and rubbing all over you so that's a tough area to call.  You can get infected without actual penetration but the vast majority of folks are going to get infected thru foreplay and sex all during the same encounter so it's safer to assume that you were infected during sex and having lesions appear outside of the actual genital skin than it is to assume that you only were infected on the thigh or buttocks area and don't have to worry about infecting a partner without obvious lesions present.  Look at how many posters here are confused about lesions on the buttocks or the anal area because they say they've never had anal sex before as an example too.  

YOUR THOUGHTS?

[Edward W Hook, MD]

Thanks for the clarification.  That solidifies my opinion.  Indeed this could be due to HSV-1.  If that is the case it is a (relatively) good thing for you.  Being HSV-1 it is less likely to recur or be transmitted to others than HSV-2.  Either way, the risk of transmission is rather low.  EWH

[vicman72]

Hi Doctor:

i had the symptoms after 2 weeks after exposure and 1 week after that i saw the lesion on my thigth. 2 weeks after that i took the blood test: (5 weeks after  exposure).
(02-28-08)
*HSV !+2 result HSV 1 IGG 3.15          
                        HSV 2 IGG <0.90.

I havent had any ob for  almost 7 months, i never had cold sore

[Edward W Hook, MD]

The situation you describe is by no means clear but there certainly is a possibility that the lesion you saw on your thigh about 2 weeks (do I have the timing right?) after your exposure could have been HSV (1 or 2).  Most such lesions are just folliculitis but I respect your doctor’s concerns and agree that HSV could do this (as we say often here, there is really no substitute for a direct examanination by a experienced clinician).  When you were seen, did the doctor culture the lesion or just do the blood tests?  Transmission to non-genital areas can and does occur during sex.  This sort of transmission is less common than genital transmission and there is less subsequent transmission risk to partners afterward when it occurs.  The most common locations for this sort of transmission are the thighs, the buttocks and the lower abdomen.  There is no doubt that you have HSV-1 by your antibody tests - do you get could sores?  If not, the lesion you saw could have been HSV-1.  If it is HSV-1, it is less likely to recur or for you to have asymptomatic shedding from the site of infection than if you had HSV-2.  With either virus however, transmission to others is less likely than if you were infected at the genital site.  On to your questions:

1.  It would not be a bad idea.  If the lesion was HSV-2 and you were tested only 2 or 3 weeks following exposure, you might not have developed antibodies yet (don't waste your time with IgM tests, just get a type specific IgG test).
2.  See above.  Such areas can get inoculated.  It is not common but is it also not terribly unusual either.
3.  Probably not.  The transmission risk from this site is far lower than for genital infection.
4.  If it was HSV (and you don't know that), than answer is still no.  The risk of transmission is from the area where the lesion(s) were.  You used a condom and had no signs of penile infection so genital transmission would not be expected.
5. If it was HSV and you had a recurrence, it would occur in the same area, not your genitals
6.  Yes, see above.  Do you get cold sores?
7.  No, if it was HSV, your risk for genital transmission is low

Hope this helps.  EWH

[vicman72]

HSV 1+2 IGG  result HSV 1 IGG 3.15
                                HS 2 IGG <0.90