Sores/Lesions

[concerned_dude]

I've read conflicting descriptions of herpes symptoms. Some lead you to believe that symptoms can be so mild as to go unnoticed, whereas others seem to say that in hindsight symptoms should have been recognized.

I had a possible exposure about 10 days ago.  I haven't had any visible sores/lesions, but I have had some itching and one place in particular that feels like a mild ant bite near the base of the penis (although there's no visible indication).  What's concerned me is that I was diagnosed with ocular keratitis, which I've read can be caused by a viral infection such as herpes.

Two questions in particular:

(1) What are the odds of having acquired herpes if there are no visible sores?  (Absent a blood test which sadly is months away from being taken, it seems like the only conclusive symptom is lesions.)

(2) Does the keratitis have any bearing on the situation?  I've read you can transfer the infection during the initial outbreak, but if there are no sores (and if one doesn't make a habit of touching his genitals and then his eyes) could it be transferred?

Thank you.

[concerned_dude]

It does. Thanks.

[Edward W Hook, MD]

Before I get to your question, let me address the underlying concept.  Like any illness that occurs in humans, there are a spectrum of manifestations of genital herpes.  Some persons get very severe initial outbreaks and experience frequent recurrences while others have less several outbreaks, both in terms of discomfort and duration.  Most of the persons who get herpes and are unaware of it have missed the diagnosis, attributing there genital irritation and lesions to chaffing, yeast infections and a broad variety of other things.  Since herpetic lesions go away over time, these too resolve and then persons have HSV but don't know it.  In your case, you are looking for possible lesions and would be unlikely to see them.  A small proportion of persons can get HSV and have no lesions but it is quite uncommon.  Now, on to your questions:

1.  Without lesions, your symptoms are non-specific and far more likely to be due to anxiety than HSV.  Remember, even if your partner had HSV, most exposures do not lead to infection.  The odds are in your favor.

2.  herpes can cause kerititis but if you were examined by a trained health care provider who made the diagnosis, they almost certainly would not have missed HSV.  I would not be concerned.

Hope this helps.  EWH