Inflamed Vesicles and Redness

[aneurysm]

Hi there,

I'm male, aged 20 and heterosexual.

Recently I've been dating a girl whom I know has HSV-1. A few years ago she contracted the disease from someone with cold sores by sharing lip balm (apparently) and had a break out. Since then she hasn't had a cold sore or any noticeable breakout although she does have medication for it in case.

About three weeks ago I received unprotected oral sex from my girlfriend (wasn't really thinking I suppose). She did not have any cold sores nor did she recently have a breakout prior or after the sexual event in questions.

Starting last week (about 7 days ago) I noticed tiny white bumps appearing on the shaft of my penis. They appeared to be papules, or inflamed vesicles. The individual "pore" things had swelled, we white and shiny. After some internet research I learned it could be a few things like Fordyce's spot but considering they are appearing I ruled it out. Another possibility was a skin condition that I learned about here actually, lichen (something).

I began to believe it was herpes when last Thursday (six days ago) evening a very quick and intense fever came over me. So far I've had all symptoms -- fever, nausea, fatigue, muscle soreness -- but nothing really intense on my penis until today.

Today I noticed that one (just a single lone) vesicle was very very red and looked almost like a pimple (it's too tiny to judge as an open sore). A few others have begin to have a redness around them as well.

The red vesicles are not grouped but single for now (the grouped ones aren't red). There is no itchiness or pain either, no pain urinating. My blood test indicated I had a viral infection which "elevated my liver test."

My question is, does this sound like herpes, and could I have the viral shedding symptoms but slowly? My symptoms seem different from reports I've read and considering it would be HSV-1 does it make sense that the outbreak has been mild but the flu symptoms have been extreme?

Thanks.

[Edward W Hook, MD]

It is impossible to make an accurate diagnosis over the net but I can advise you about what to do.  For you to be exposed when she did not have a cold sore makes it most unlikely that you have acquired herpes from the exposure you describe but unlikely is not impossible.  The lesions you describe likewise do not sound like herpes but one man's papule is another's vesicle.  On the other hand, the time line you outline is a reasonable one for herpes which, indeed, can be accompanied by the sort of flu-like illness you describe.  Thus, the thing to do is to have the test.  Go see a health care provider and get a herpes swab test; PCR is most sensitive but a culture is probably OK too.  Even if the lesions are healing, if the swab is taken vigorously, the chances of a positive test, if this is HSV, are substantial.  A blood test at this time will be of modest help. If you have antibodies to HSV-1, you may have already had it and not known or it could be from your current process. If you do not have HSV-1 antibodies, this still could be HSV-1, at which time the culture result becomes the thing to believe.

Hope this helps.  Go get a swab test ASAP.  Please let us know what the tests show. EWH

[Edward W Hook, MD]

Getting tested sooner would be better for this to be diagnosed.  The longer you wait, the less likely your swab test will be positive.  

If you have genital HSV-1, your chance of recurrence is low.  Suppressive therapy would not be recommended.  

Much good information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).  EWH

[aneurysm]

Thanks for the reply,

I currently have an appointment in two days for another blood test (something about my liver) and I'll speak to her then about a test.

Perhaps you could clarify some things for me.

If it is HSV-1 (genital infection) what would I expect in terms of outbreaks? Would drugs be necessary as it seems they are with HSV-2?

There is little to no information on genital HSV. The only thing I've read states that it's "not as bad."

Thanks again, you've been very helpful.

[aneurysm]

A quick timeline:

Aug 22nd - Recieved oral sex
Discovered Sept 2nd - Inflamed Papules and Vesicles on Penis
Sept 4th - Fever and illness begins