Possible oral and genital HSV 1

[ctconcern]

I have been reading many of your similar threads.  Thanks for the good information.  Here is my situation.  About three weeks ago I went to a strip club where I wound up giving cunnilingus to one stripper, and receiving fellatio unprotected from another, not planned but irregardless.  About a week and a half after this I noticed what I initially though were cold sores inside my mouth, as I had those before.  Still, I sensed this was different as previously cold sores seemed to dissipate not worsen.  What felt like cuts started in the back of my tongue and seemed to spread to the front.  With additionally one small clear/white bump on my top lip.  I went to see my physician and he said I had Herpes, though regrettably no culture was done. I was put on one week of acyclovir.  The oral infection began to improve and hasn't been too severe.

About 2 and 1/2 weeks after the initial encounter, and one day after I stopped the acyclovir I notice what appeared to  be small bumps along the ridge of my penis (not widespread but located there), appearing to be herpes.  These seemed consistent with pictures I'd seen online and appeared after I had recently masturbated.  Since both my encounters were oral, albeit with two separate women is HSV 1 the likely culprit in both cases?  I should note that prior to my initial diagnosis I had touched my mouth to examine the sores and may have later touched other areas.  While I plan to get this most recent outbreak I appreciate your input.

Lastly,  I have informed my significant other about both occurrences and she has been very supportive.  Are their precautions I should be taking in terms of daily antiviral, use of towels etc.  I already plan to use condoms until I get a blood test done.

We also have a young daughter who I worry about kissing or infecting with anything, although I have been diligent with my hand washing since.

[Edward W Hook, MD]

Welcome to the Forum.  I will try to help but more information is needed.  Reading you post, it seems that you have had cold sores in the past.  Is this correct?  If so, you are not at risk for acquiring HSV-1, the virus you would be expected to get from receipt of oral sex.  Thus if your oral lesions were HSV, they may well have been a recurrence, not an infection acquired from your performance of cunnilingus.  Your doctor did not help things by not testing your lesion.

As for your genital lesions, these do not sound like HSV.  Genital HSV lesions do not remain bumps long, instead ulcerating soon after they appear. Further, I would not expect HSV lesions to appear a day after completing acyclovir.  My guess is that what you have notice are normal parts of your penile skin, given the location possibly what we call pearly penile papules.  I would suggest you have a knowledgable health care provider, perhaps a dermatologist take a look.

Interpreting a blood test may be difficult but it may help.  I will be happy to comment when you get your test results.  EWH

[Edward W Hook, MD]

Thanks for the follow-up  I agree with the assessment provided by your provider. take care. EWH

[ctconcern]

Dr. just wanted to give an update.  Today I saw my primary care physician.  He agreed the bumps were not HSV or any other STD, but normal part of my anatomy.  To be safe I did a urine test for gonorrhea and chlamydia.  Without symptoms he didn't see the need for an HSV specific test and without the initial swab from the clinic I went to he said the sores may have been caused by something else or were likely HSV 1, which I may have had all along.

At this point I am feeling pretty good, and with no symptoms is there anything else I should be concerned about given the exposure I described?  Thanks for your help.

[ctconcern]

Good luck.  I never had any painful urination.  Hopefully in your case as mine this is just part of the normal anatomy.  I think a bit of anxiety and lead to seeing things, as I am not typically closely examining myself and unless I look closely under light I don't see anything.

[ctconcern]

I won't post again until I get some results.  Thanks for the assistance.

[ctconcern]

I will be into the doctor tomorrow; also for the blood work and will report results.  One quick question in the meantime.  In addition to the ring around the top of the penis I am not sure if there isn't a similar bump at the opening of the penis.  Is this still unlikely herpes given the treatment and timing?  This could be just me looking for something that's not there.  Thanks again.

[Edward W Hook, MD]

Thanks.  

A blood test sooner than later may be helpful as if your type-speciic, IgG blood test such as the HerpeSelect for HSV-1 is positive it would suggest that you already have HSV-1 and your oral outbreak was arecurrence rather than a new infection.  EWH

[ctconcern]

I should clarify.  This particular oral outbreak seemed different.  I can't really be sure if I've had cold sores before.  I know I have had canker sores previously.  The acyclovir did seem to help though, so cold sores is likely.  I plan on following up and will keep you posted.