I am a gay male, 50s, with multiple previous partners. (I am HIV-negative and have never had unprotected anal sex.) In August, I developed a small, painless, slightly elongated cluster of vesicles on an erythematous background near my coccyx; the cluster went up to but did not cross the body midline. My doctor prescribed valacyclovir, including ongoing suppressive therapy. The vesicles crusted over and resolved. There have been no other symptoms of any kind, and no recurrence so far (seven weeks).
Two days after onset, viral cultures were negative for HSV1/2 and zoster. HerpeSelect IgG antibody tests were negative for HSV1/2 (both ratios zero). Unsurprisingly, zoster antibody test was positive. Six weeks later, HSV antibody tests were still negative, but with a slightly nonzero value for the HSV2
ratio. (The later tests were nine weeks after the most recent unprotected oral or protected anal sex, though I engaged in mutual masturbation and anal fondling a few days prior to onset of symptoms, six weeks before the later tests.)
I plan to take the HSV antibody tests again in another month. Meanwhile, my doctor says I probably have genital herpes, but possibly not (the vesicles could have been from zoster instead, even though they were painless). Do you concur?
I've abstained from all sex since the onset of symptoms. Assuming I do have herpes, what sexual activity, if any, can I engage in without risk of transmission when no outbreak is present? (Mutual masturbation, for example? Giving oral sex?) What sexual activity can I engage in with very low risk of transmission? Am I right to assume that the virus can be shed from my penis or anus, and not just from the site of the past outbreak?