Boyfriend and Herpes Questions Continue

[asil04091964]

Dr. Handsfield, sorry to revisit you so soon.  I am still hanging on by a thread with my bf.  We are now only engaging in my performing oral sex on him and his finger stimulation of me.  Our love continues despite this.  He is now telling me the following:
1.  On occassion, say one in 10 days, the left side of his scrotum itches like crazy for a day or so.  He cited last Saturday and then again yesterday.  It appears to be the whole left side of his scrotum.
2.  Yesterday, he showed me 2 very small red spots on his penis immediately behind the head (same time his scrotum was itchig).  They looked red under the skin and were about 3/8 inch apart and maybe 1/4 inch in diameter.  He said they had been there about 3 days and today he tells me one of them is gone for the most part.  No itching on the spots and if I rub my finger over them you can't feel them.  If I stretch out the skin on the penis, the red spots almost disappear but it looks like there might be a circle around them with white dry skin immediately surrounding the red.
3. It has been 7 months since we have had vaginal sex but I have performed oral sex on him several times.  
IGM 1.2 at 9wks. IGG neg 9wks.
?'s
1.  What to make of the scrotal itch on and off?  Herpes likely/possibility?
2.  What to make of the red places I describe?  Herpes likely/possiblity?
3.  Do you recommend he get another IGG test and if so are the places like PrivateMDLabs.com reliable?

Any advice you can provide will be greatly appreciated. I know he is very anxious about this.

[H. Hunter Handsfield, M.D.]

It's probably safe to have any kind of sex with your partner, and oral sex probably is safer than vaginal intercourse.  But I cannot guarantee transmission won't occur.


That will have to end this thread.  I won't have any other comments or advice.  Take care.

[asil04091964]

An update to you.  He had another type specific hsv2 igg test.  it came back negative as you predicted.

Is it safe for me to perform unprotected oral sex on him since I have genital hsv2 and he appears to be clean down low?  Doesn't this make it unlikely that I would have hsv2 orally and therefore unable to transmit anything else to him?

Thanks.

[H. Hunter Handsfield, M.D.]

Valtrex has virtually no side effects; people take it for years without any problem.

Your GP may be correct; the infectivity of genital herpes probably declines with time, and I agree that 20 years after your initial infection you may not have much viral shedding and little potential for transmission.  Unfortunatley, this has not been studied carefully and I cannot give you any more precise information.  But my advice to your partner remains the same:  mellow out; this isn't worth so much anxiety.

Thanks for the kind words about our advice.  Take care and good luck.

[asil04091964]

Doctor Handsfield, thanks for your compassion.  I know he loves me but he is really freaked about this.  I am also freaked about taking valtrex.  Are there any studies you can point me to that discusses the side effects?  

Lastly, my GP told me that since I have had this so long (20 years) that she doesn't think my virus is very strong and therefore not very contagious.  Does this sound right as the virus and it's ability to infect decreases over time.

Thanks for compassion and if he tests I'll let you know the outcome.  You're very good.  I wish you were in the East and not Southwest :)

[H. Hunter Handsfield, M.D.]

I can't recommend specific treatment, not knowing what he has.  If I correctly understand, his scrotal itching is localized to one side -- but jock itch usually involves a wider area, such as the entire groin on both sides, the entire scrotum, etc.  So some other kind of dermatitis might be more likely -- and there are many non-STD genital area rashes.  OTC creams for jock itch are harmless, so it may be worth a try -- but at the risk of delaying proper evaluation and care, which in turn will just unnecessarily prolong your mutual concern.  I would far rather he seek professional attention.  His symptoms and your concern have gone on long enough, it seems to me.

Based on all we know so far, I don't recommend any further HSV testing at this time.  My standard advice to couples in your situation -- one with genital HSV-2, the other uninfected -- is that they follow the prevention strategies I noted above; be on the lookout for typical genital herpes symptoms in the uninfected partner (which he does not now have) and get checked out if and when they occur; and that in absence of symptoms have an HSV blood test once a year to check on the possibility of asymptomatic transmission.  And otherwise more or less just go on with life without any concern.  Most couples in your situation have no trouble with this sort of approach.

I'll be happy to comment further if you want to report back the results of your partner's visit to a health professional; or if despite this advice he has another HSV blood test at this time, I'll comment on the result.  Other than that, there's not much more I can offer.

[asil04091964]

For his benefit as he is with me as I type this.  

Do you recommend further IGG testing in his case?  Also, should he try some jock itch medicine (OTC) for the scrotal itch?

Thanks.

[H. Hunter Handsfield, M.D.]

Welcome back.

Before replying to this question, I read through our discussion last November.  In addition to the following comments, I suggest that both you and your partner very carefully re-read the entire previous thread.  

Among other things, please take this to heart:  If you and your partner truly care about each other and see your relationship as mutually committed and likely permanent, transmission of HSV should be a minor consideration.  I am sad to hear that you have so limited your sexual expression with one another.  Nobody should let an impersonal virus, with mostly trivial medical effects, so rule their lives that it interferes with romance, commitment, and rewarding sexuality.  I'm not a relationship expert, but if that continues, my bet is you'll be apart someday soon.  It sounds like your partner (or maybe it's mostly you -- I'm still not sure which) is much too concerned about HSV transmission.  Most couples who really care would take common-sense precautions against transmission, but otherwise would just let it happen.

I forget whether you are taking suppressive antiherpetic therapy, e.g. valacyclovir or acyclovir.  If so, and if you and your partner were to consistently use condoms and also avoid sex whenever you have a noticeable outbreak, the likelihood is he would never be infected.  You could even safely dispense with the condoms periodically, e.g. if you decide to get pregnant, and still expect to avoid HSV-2 transmission.

As for your partner's symptoms, we covered this pretty well last time.  At least twice I said "herpes doesn't cause itching or irritation of the penis or scrotum except when there are overt herpes blisters or sores.  As for [herpes of] the scrotum, 'almost never' is a bit strong.  It can happen but is uncommon."  And you yourself wrote your understanding that "There are many causes of genital itching, including dermatiits, fungal infection (jock itch), irritation from sweating, pubic lice (crabs), scabies, and others; or just increased anxiety", and that in your partner "All these are far more likely than herpes."

The "red places" on his penis also do not sound like herpes.  Combining both this symptom and his scrotum symptoms with his negative blood tests, it is exceedingly unlikely that he has been infected.  Finally, if he continues periodic HSV-2 blood tests, I recommend he do it in conjunction with personal medical advice from an experienced health professional -- either find an STD expert or see a dermatologist to assess both the scrotal itching and penile spots, and to do a blood test.  But if he decides to get tested on his own, it really doesn't matter which online test site he uses.  It's more important to select one with an affiliation with a reliable lab, such as Quest or Labcorp.  Both of these large national labs use highly reliable HSV blood tests.

Unlike your previous thread, we're not going to get into another prolonged discussion.  You're just going to have to 1) accept the overwhelming evidence that your partner has not (yet) been infected; and 2) get a balanced perspective about genital herpes and stop letting it so rule your relationship.  Life is too short for that sort of response to herpes.

Regards--  HHH, MD