HSV Questions/Follow Up Testing?

[anonymous205]

Hello Doctors,

Quick background, I am a 29 year old male --- this past year, I had dated a woman who had genital HSV2 for about 4 years. We dated about 10 months, she took daily anti-virals, and we had both protected and unprotected sex throughout the 10 month relationship. Of that time, she only had 1-2 breakouts in which we avoided sex (she advised she gets prodrome tingling and her breakouts are recurrent in her vagina, she never had them anywhere else, they are also pretty minor)

My last unprotected intercourse was 10 weeks ago, which after that we reverted back to protected intercourse (by my request, no other reason), our last protected intercourse was 6 weeks ago.

As you guessed by my presence on the forum, I am a diagnosed OCD, and take anti-depressants, and I am hyper anxious, prone to health anxiety. Throughout the whole relationship, I would examine myself, but never notice any blisters or sores on m penis.

During the last month of the relationship, month 10, I had a baseline blood test conducted, which turned out to be negative. Due to my nerves, I am scheduled for another blood test tomorrow.

1.) If test comes back negative, would you advise that I need to get additional testing given my circumstance
2.) Again, as far as I am aware, I have not seen any blisters on my penis, but I have been getting nervous as I have notice some red spots (not raised or blistery, yet) on my upper inner thigh, in the groin area, could this be the beginning of an initial outbreak,  is it typical to get an initial outbreak in this area, or anywhere else if I never had one on my penis?
3.) How long would it take before these spots turn into blisters, for example if there is no change by this time tomorrow are my fears getting the best of me
4.) Finally, I keep reading about atypical/mild or asymptomatic symptoms, could it be that I had a mild symptom that I missed? Again, as far as I can tell I never had any blisters and had a negative baseline test

[H. Hunter Handsfield, M.D.]

I'm sure you're just looking too closely and noticing minor variations in normal penile skin.  Herpes lesions would never be so subtle that you need to look closely or use a flashlight to see them.  Stop examing yourself, accept the reasoned, science-based reassurance you have had, and stop worrying.

And stop searching the web; "it is all very confusing and frustrating" only because you are making it so.  Here is what I wrote in another thread a few months ago:

"Indeed the internet can be dangerous for anxious persons with unexplained symptoms.  Perhaps you're familiar with Nate Silver, who has become rather famous for his political predictions (http://www.fivethirtyeight.com).  He has written a book about statistical issues in everyday life (The Signal and the Noise, Penguin Press, 2012).  Here is a quote from it:

"'...[consider] what might happen if you put a hypochondriac in a dark room with an Internet connection.  The more time that you give him, the more information he has at his disposal, the more ridiculous the self-diagnosis he'll come up with; before long he'll be mistaking a common cold for the bubonic plague.'"

That will end this thread.  I won't have any additional comments or advice.  Do your best to move on.

[anonymous205]

Thank you doctor,

I had my blood test completed Friday, I will post update this week, the NP said my overall risk is low but of course only time will tell. Also whatever blemish on my thigh was just that and is now gone.

But bad timing --- as of yesterday morning, I noticed the tiniest of bumps on the middle shaft of my penis, very very hard to find, it seems to be by itself, there is no redding around its base, nor is it fluid filled, (it doesnt even look a blister, or even a pimple, more fleshy colored but shiny when i put a flashlight on it), I have to stretch the skin to find it, ever so slight raised but visible.

Given a negative baseline test 11 weeks ago, with no prior symptoms on my penis, does this sound like an initial outbreak? There has been no change in size or color since yesterday morning, it is all very confusing and frustrating since I keep reading about variance, not sure if it is just something else, non herpetic related, etc.

Thanks

[H. Hunter Handsfield, M.D.]

Thanks for the clarification; sorry I misunderstood the timing.  My advice would be to wait to be tested until 4 months after your last unprotected exposure; or if you want to be especially careful, 4 mo. after the last exposure of any kind.  FYI, you needn't apologize for being tested on account of OCD; it is entirely rational and reasonable for partners of persons with HSV-2 to be tested once in a while, or if the relationship ends.  But there's no hurry.  Your overall risk was low, for the reasons discussed above.  And a "small not raised pink blemish" on the thigh isn't at all suggestive of herpes.

[anonymous205]

Thank you doctor for your prompt response, couple of clarifications if I may:

The first blood test I got was at 10 months of a 10 month relationship while i was still with my partner, not 10 months after my last unprotected exposure, i was just trying to establish a baseline... guess i worded it wrong, sorry for confusion...

my last unprotected sexual session with her was exactly 10 weeks ago, and my last protected session was 6 weeks ago.

I would say half of the relationship we used condoms, the other half we didnt, but again towards the last month.

regarding symptoms, getting a better look at it under the light, it appears to be a single, pinkish blemish, small, not raised, on my left thigh...it is directly to the left of my genitals, left thigh

thanks again

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

You don't need any more testing than you have had.  The evidence is already conclusive that you are not infected with HSV-2.  By itself, the negative test result at 10 months is over 95% reliable.  When we also add the low risk of transmission from a partner on suppressive therapy, your care in avoiding sex during outbreaks, use of condoms for many (most?) sexual exposures, and your lack of symptoms that suggest herpes, there is no realistic possibility you were infected.  To your specific questions:

1) You don't need the test you are planning on, and certainly none after that.

2,3) The symptoms you describe are not suggestive of herpes -- not even a remote hint.  The locations are wrong; initial herpes would be on the penis, not the thighs etc, and recurrent herpes lesions are almost always on only one side of the body and occur in a small, localized area each time -- not in the scattered locations you describe, and not on both sides of the body's midline.  Second, any "spots" that might be herpetic would be red and would evolve into blisters within a day or two, and then would heal within 1-2 weeks.  Obviously you have nothing like this.

4) Is it possible you had mild symptoms you missed? Sure. But as noted above, you would not have that AND have the negative blood tests.

So do your best to stop worrying about it.  You should not mention your past exposures to future sex partners.  There is no chance you have HSV-2 and no chance you will infect anyone else.

Best wishes--  HHH, MD