Herpes transmission

[NUDUS]

I am male, HSV1 positive since childhood.  I had 2 separate activities that may have exposed HSV2 or possibly movement of HSV1.  9 weeks ago, I gave/received oral and had protected sex with a female prostitute.  About 7 weeks ago, I rec'd oral from a man I met online.  He says he is clean never having a cold sore.  2 days it felt like someone rubbed icey/hot on my scrotem. I had a complete STD panel which included a HerpeSelect® 1 and 2 ELISA IgG test.  I was positive for the HSV 1 and negative for the HSV-2 .
I am now 7 weeks out from the last encounter. I have had a little pressure, on the tip of my penis as well as icey/hot sensations.  It now it looks like I have 4 little pimples under penis ridgeline.  

I’ve read that the activity was considered low risk.  I did have an HSV-1 cold sore about 2 weeks ago. I have a couple of questions that you might be able to answer :

1) I continue to read that the activity I engaged in: Received /gave oral sex and protected intercourse is considered low risk for herpes transmission.  I also understand it is much harder to get HSV-2 when you have had HSV-1 since being a kid.  What is the truth in this?

3) Is it possible that I had HSV-2 for many years and that this is the first flare up?  I read somewhere that you could go for 10-15 years with HSV2 and never know?  But would the antibodies be present if I’ve had it that long?  The HSV-2 test showed antibodies, but they were low so the test was negative. How likely is it that this is from a long ago infection (assuming that it is an infection).  What other possible causes could there be?

4) My concern is transmitting the disease to my wife. I have avoided sex with her but that is getting increasingly difficult. I will tell her if I am positive, but she will obviously ask why this is just showing up now to her doctor, which also happens to be my doctor.   What ways could this have been introduced outside of the recent sexual encounters? I prefer to leave that out.

[NUDUS]

A related discussion, Risk of trnasferring to infant children was started.

[Edward W Hook, MD]

Last answer.  Another name for clogged pores is folliculitis.  This occurs when a hair follicule get's clogged with skin cells or other matierils.  It is not in any way an STD.   Once again, I must say, you are asking me the sorts of questions you should be asking (and discussing) with your own doctor.  EWH

[NUDUS]

Doctor things have finally settled down for me.  At my doctor's recommendation, I will be going in for one more test this Friday, but it seems that I am in the ALL CLEAR.  My Doctor wants to do the test as a precaution for HIV, which she says if very unlikely, but it is to err on the side of caution.  It will also reduce my future anxiety.

I did see a dermatologist regarding the sores.  He says they are not herpes or genital warts and most likely clogged pores.  He did take a culture which was negative.  Unfortunately, he said clogged pores on the penis may not go away or disappear.  Which *****, but may act as a gentle reminder to be careful.

....Of course I am now distraught that I can't find anything online about "Clogged pores on the penis" ...but I am working with a therapist regarding my anxiety issues.   Of course, I welcome any information you have on the topic.

[Edward W Hook, MD]

I'm sorry.  You are asking me to second guess your docotr instead of talking with him/her.  that will not serve you well.  Levofloxacin in the dose you report would be expected about 80-90% of gonorrhea and about all ch,amydia infections, if they were present.  HOWEVER, you state you had negative tests.  Thus you do not have those infecitons.  

It appears to me that your anxiety is geting the better of you.  I will not fuel that and will delete further anxiety driven, circular questions wilthout comment.  Please let us know what the dermatologist says.  EWH

[NUDUS]

It seems I found a partial answer on the CDC website. However, my dose is 750mg for 5 days.  The article says:

Chlamydia  "Levofloxacin (Levaquin) 500 mg orally once per day for seven days"
Gonococcal "Levofloxacin single dose of 250 mg"

I guess I can assume the a 750mg 1x per day for 5 days is likely effective.   Of course I don't understand the lower dose for longer periods vs higher for shorter and it's effectiveness.  Seems like a high up front dose would be better.

For those that want to see it you can cut and paste
http://findarticles.com/p/articles/mi_m3225/is_4_75/ai_n17217204/pg_3

[NUDUS]

Sorry it seems I am trying your patience.   I do have an appointment scheduled. I have seen lots of questions about Levaquin with little response or information about it's effectiveness on various STDs so I wanted to ask to educate myself.  I am sure there are lots of others that would also like to know the answer.

[Edward W Hook, MD]

I'm not even sure why you are asking this question.  Your risk of STD is low, you have had negative tests.  As far as he rash on your penis is concerned, did you go see a dermatologist?  EWH

[NUDUS]

Doc,

One last question, I think.  Last Friday I became pretty ill.  Yellow mucos (from nose), fever, head/back ache, fatigue and the sores on my penis were very visible.  They burned a little, but no burning when urinating.  I called my doctor and she seemed to think it was a bacterial infection and prescribed a 5 day course 750mg of Levaquin  (1x day).  She told me to come in if I finished the prescription and still felt ill.

Within 24 hrs of taking the first dose, the penis sores seemed to reduce.  I am on day 4 and the sores are barely visible, but I can still see them.

While I know it is not indicated for all bacterial STDs, is this enough to knock out any/all of the possible curable STDs out?  Is it enough?

[NUDUS]

Thanks again... I appreciate the help and guidance but hope I never need it again.

[Edward W Hook, MD]

Glad to hear you go the results you did.  As I said, you do not have HSV-2.

The chances of you spreading your HSV-1 from a cold sore to other parts of your body is very, very small.  It is not numerically quantified but it is very uncommon and not something to worry about.

As far as what is on your penis, I cannot say.  I would suggest you talk to a dermatologist about this.  EWh

[NUDUS]

Doc,

I just got the test results.  They were negative for HSV-2. Although my HSV-1

Frankly, I was surprised because the little pimples on my penis shaft seem suspicious and consistent.  I hope these will be my last questions on this thread.  

What are the chances/probabilities of spreading HSV-1 to my own genitals?  Are their percentages on this?

Any thoughts on what might cause a small grouping of "pimples" on the shaft of my penis?  I will follow up with my own MD next week, but I'd be curious if you had any thoughts.  

Thank you so much for your help.  I am still terrified as to what lies ahead for me in my marriage, but at least I know I won't infect my wife.   Now it is in the therapists hands.

[Edward W Hook, MD]

There is no evidence that yoo got a new infection.  In addition. without a professional confirmation (i.e. an examination and culture or PCR test) I remain unconvinced that you spread your HSV-1 either.  I look forward to hearing what your most recenttest shows.  I'm betting it will be negative.  EWH

[NUDUS]

Dr Hook,

I appreciate your patience as I ask a lot of stuff.  As I think about this whole thing, it may actually be that I gave myself genital HSV-1.   I did have an outbreak due to the stress of my infidelity. I did masterbate during this outbreak..to help avoid having sex with my wife.  

Is sounds like it is more likely that I gave myself genital HSV-1 than getting a new infection from my activity.  While it appears both are rare, Which is more likely?  

For what it is worth, I did have another test done today and I should have the results in 24-48 hours.  I will let you know what they are.  I also plan to see my regular MD next week about the sores.  I took a picture in case they clear up by then and if the test results are negative.

Thank you so much.

[Edward W Hook, MD]

No, I am saying that you have HSV-1 and that it is most likely due to your cold sores. In persons with cold sores it is unusual for the infection to "migrate" to other sites,  it occurs but is unusual.  While I do not have an infectious alternative to suggest for your scrotal and penile sensations, it is most unlikely that they represent herpes.  EWH

[NUDUS]

Thank you for the response.   It seems that what you are saying is that I likely have Genital HSV-1 and not HSV-2.   Is it possible for HSV-1 to travel?  Because of the guilt, I had a cold sore and it is possible I touched the sore then my genitals...I know this is reaching, but is it possible?

Guilt is a powerful thing and I have plenty to share.  But I am trying to learn as much as I can so I can try to have a factual conversation with my wife...if she will listen.

I am going to have another test today.  .

[Edward W Hook, MD]

You've apparently read a bit on herpes so I suspect that what I will be saying to you will just be repeating what you already know.  So be it.  
directly to your questions.

1.  What you read is correct.  Your exposures were low risk and having had HSV-1 confers a partial degree is resistance to HSV-2 infection to you.  It will also make it  very unlikely that your will get genital HSV-1  

2.  No.  You have a negative antibody test, thus you have not had HSV-2 "for years".  A negative antibody test at 7 weeks post-exposure can be expected to identify about 2/3 of new infections.  In your case HSV-2 is really not much of a concern - your genital exposure was condom protected and for all practical purposes oral sex puts you at risk only for HSV-1.  Your test did not show HSV-2 antibodies - the low level reported is the test background level of reactivity or cross reaction with your HSV-2 antibodies.

3.  I'm not sure I follow your last question.  You don't have any evidence of herpes.  Your guilt seems to driving this.  EWH