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Avatar universal

Possible HSV-2 Exposure

Hello Dr.,

Approximately 7 days ago I had protected sex with an individual. At the very end, the condom broke and was noticed after a very brief time. The next day I asked her if she had any STD's, as I was clean, and after some back and forth she told be she had HSV-2 for the last 5 years. I asked her when her last outbreak was and she said several months and that she had no symptoms now or recently. I will say I trust her statement in this.

On Day 1 after I heard the news, and especially on Day 2 I was riddled with anxiety. During that time I starting having a burning sensation (like Icy Hot) all over my genital area, including penis and scrodum. Since then the burning has stayed but is now localized the penis, but the sensation tends to move around to different parts. On some hours it is the top, others time it is the side, and yet others the tip. There are times it seems to subside as my mind gets on other things. Even though I have not had much anxiety or a panic attack over the last few days, the burning sensation that still lingers worries me. I have read in the forums that sometimes there is a psychological component to this, and I was wondering your opinion on the matter.

I have checked my genitals very regularly and there seems to be nothing out of the ordinary, no redness, no raised areas, I have no itching, just the burning skin sensation that seems to move and fade in and out. My mind is always focused on my genitals and the possibility of being infected, however. I am now on day 7 since the sexual encounter.

My questions are:
1) Your thoughts on the burning sensation
2) When I should realistically expect some sort of visible symptom
3) If there is an order of symptoms I should be on the watch for
4) Any other general thoughts

Thank you!
3 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the forum.  Thanks for reviewing questions similar to yours before posting your question.

I understand your discomfort and concern on learning your partner has HSV-2.  However, the odds are strongly in your favor:  it is very unlike you were infected, and your symptoms don't suggest herpes.  I say this with confidence, for two main reasons.

First, the average transmission risk for genital HSV-2, when one partner is known to be infected, is under 1 in 1,000 for each epsiode of unprotected sex.  Your risk probably is lower than that, since the unprotected exposure, after condom breakage, was brief.  (In monogamous couples in which one person has HSV-2 and the other does not, who take no precautions against transmission, on average the infection is transmitted in only 5% per year, i.e. 1 in 20 couples -- and half of all partners never catch it.

Second, your symptoms do not suggest herpes.  You may have read that genital herpes symptoms include burning discomfort.  However, that's because herpes lesions burn; in the absence of obvious blisters and sores, a burning sensation is not an initial herpes symptom.  Also, your symptoms are too diffuse for herpes; if they were the first symptoms of a new infection, they would be limited to a single area of your penis (where sores would soon appear), not "moving around" as you describe.  As you already learned by looking at questions similar to yours, such sensations often are due to genitally focused anxiety.

Those comments cover questions 1 and 4.  2) Onset of initial genital herpes usually is 3-5 days after exposure.  It can take 10 days and rarely up to 3 weeks.  At 7 days you are pretty much out of the woods on this, although you'll have to be on the alert for another two weeks.  3) The initial symptoms usually are red bumps, which within 1-2 days turn into blister-like lesions with clear fluid, which then evolve over a few days into superficial pimples (with pus), then scabs, and then heal over 10-20 days.  Although burning or pain might precede the lesions, it would only be by 1-2 days; in other words, if your burning were due to herpes, lesions would have appeared a few days ago.

So all things considered, you really shouldn't be worried, especially if typical lesions do not appear in the next several days.  In the absence of lesions, you do not need testing; and if I were in your situation, I would continue unprotected sex with my wife with no fear of infecting her.

I hope this helps. Best wishes--  HHH, MD
Avatar universal
Thank you Dr. Handsfield for your insight on the matter. I will continue to monitor as needed.

I would like to make one comment. I have read through the forums extensively in order to educate myself. One thing that sometimes is confusing is the possibility of being an asymptomatic carrier as is discussed in various literature on the web, everything from Center for Disease Control on. In many similar situations you suggest no tests are needed, as in this case due to absence of lesions. However, how does this fit into the notion of testing because of the possibility of being a carrier with no symptoms?

Again, I think this is one area that little light is shed on in all of the forums, and others that are in similar situations as myself may be able to glean some additional knowledge from your thoughts.
239123 tn?1267651214
MEDICAL PROFESSIONAL
This is a good question about something that many people find confusing.  "If asymptomatic herpes is so common, why shouldn't I worry about it if I have been exposed to HSV-2?"  I'm taking this opportunity for a blog-like response that I can save for future use.

Asymptomatic HSV infections are real and quite common.  Still, it is important to not confuse data that result from testing large numbers of asymptomatic persons with the situation following a particular sexual exposure by someone worried about herpes.

Most "asymptomatic" persons with HSV-2 in fact have symptoms of genital herpes, but mild and often easily missed.  When HSV-2 blood tests are positive in apparently asymptomatic people, within a few months about two thirds come to recgonize recurrent symptoms they previously didn't notice.  Second, most people who are particularly concerned about herpes after a known exposure, and are on the alert for symptoms, would notice them.  Thus, when someone like you -- exposed, worried, and hyperalert -- does not develop typical outbreak symptoms, it is highly reassuring.  Although this situation has not specifically been researched, the clinical experience of all experts is that there is a miniscule chance a blood test would later pick up an otherwise unknown infection.  This forum is a good example of this principle.  In the 7+ years of this forum, with situations like yours among the most common questions we get, nobody has ever returned later with a confirmed newly positive HSV-2 blood test result.

Further, the blood tests aren't perfect and sometimes give misleading results.  You could be tested if you feel the need.  But even if you were to have a positive HSV-2 blood test, my conclusion would be that you had asymptomatic HSV-2 infection, not necessarily related to your sexual exposure a week ago, plus some other cause of your genital symptoms.

In addition to all this, it is likely this is not your only exposure to HSV-2.  Ten percent to 70% of all women in the US age 15-40 have HSV-2 (rising with older age and higher in some racial/ethnic groups than others).  Although this particular partner is aware of her infection, most are not.  If you have had, say, 10 lifetime sex partners, you can assume that at least one, perhaps several of them, had HSV-2.  Therefore, this particular event may not carry any higher risk than you already have experienced (and may again in the future).

So those are the reasons why I would not normally recommend testing in this circumstance.  If I personalize the question -- what I would do, or what I would recommend for, say, my son or daughter -- my advice would be the same.  Still, I'm not you, and you could be tested if it would help get you past your anxieties about this.  If you decide to do it, you should have an initial blood test immediately, and a follow-up test in 3 months.  Conversion from negative to positive would indicate you indeed had a new infection (and would prove me wrong!).
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