BF with genital lesions

[anonymous92]

Hi Terri,

I’ve been doing lots of reading on your question forum over the past week. Thank you for all your help. Here’s a little background on my situation:

I have been in really wonderful, monogamous relationship with a guy for the past year, and we have unprotected sex – oral and intercourse. We each got tested before being intimate without protection but didn’t know herpes wasn’t included, like so many others. He got his first ever fever blister maybe 6 months ago– a small white blister barely noticeable on his lips, and he had no symptoms elsewhere on his body. He started a new job a little over a month ago, and as such I think his stress levels are a little higher than usual but nothing I can outwardly notice. Anyways, he caught a bit of a head cold: stuffy nose and another fever blister on his lips, no fever or fatigue. Around the same time, we noticed what looked like a tiny scrape on the shaft of his penis. It wasn’t blistered, just a tiny circular area of raw skin (maybe .5mm in diameter) that we think maybe scraped on his jeans’ zipper when he was taking it out to pee somewhat carelessly during a day of drinking. It wasn’t raised and it scabbed over in a day. Two days later after the initial cut (or what I think was a cut) had surfaced and healed, a tiny cluster of 4 raised bumps (~.5sq cm total area) appeared maybe 1/2 inch further up. He went to the clinic where they scraped off the tops of the bumps for a herpes culture. We don’t know if it is a typed culture or not. No pain, no blisters (although he got the tops scraped off the same day so who knows if they would’ve blistered), just really itchy. They looked a little like healing ulcers but they never scabbed over after the scrape test, they just have sort gone from red, raw-unhealed skin to flat, healed, red skin. He had also used a new soap that day.

I myself have never had cold sores or fever blisters or any symptoms of genital herpes, although I think I might carry HSV-1 because my nanny growing up would kiss us all the time with them, I’ve kissed my ex boyfriend on the lips when he had active cold sores (on the side of his mouth without the sore- not directly on it- stupid I know), and shared drinks with people with cold sores.
We are obviously waiting anxiously for his test results and I plan to get blood tests despite not having any symptons but in the meantime, my questions are:

1) Can you help me wrap my head around the timing of this all? We get intimate a year ago, shortly after ditched the condoms. Have lots of regular sex (mult x daily). Six months in he gets his first fever blister, no other symptoms elsewhere on his body. Six months after that, (last week) he gets a fever blister and blisters on his genitals at the same time. – With all the unprotected sex that we’ve been having, what can explain this initial outbreak on his genitals occurring a year after we first became intimate and no such outbreak for me? If one of us gave it to the other, wouldn’t we have noticed a year ago when we first became intimate? I wholeheartedly trust this guy, and neither of us have been unfaithful. We have each had multiple partners in the past though. Could he have been carrying a dormant virus around that is just surfacing now and has not infected me/is dormant in me? Could I have been carrying it around and only just now infected him?

2) Is it possible he transferred his oral HSV-1 to his genitals by touching his hands to his lips and then touching his penis where the cut was? I’ve read in some of your responses here that if you get HSV-1 in one location (i.e. lips) that the antibodies your immune system produces will prevent you from picking it up in a new location (i.e. genitals), and that you can’t really autoinoculate after the first outbreak (he had no genital symptoms when he had his first fever blister 6 months ago), but also in other posts you say its possible to have HSV-1 both orally and genitally. Could you clarify please?

3) If #2 it’s not possible, what’s the likelihood that he had HSV-2 lying dormant and he just coincidentally had his initial HSV-2 outbreak while having a recurrent HSV-1 fever blister episode?

3) How do I go about getting a lab request for the type specific IgG tests?

[Terri Warren]

Either of your could have had herpes for years and are just noticing symptoms, yes. Without IgG testing, it is very difficult to say what’s going on here. The lesions on his penis do sound like herpes to me, yes. It is possible that you acquired HSV 1 from your previous partner, gave oral sex to this new partner and gave him HSV 1 genitally as well as giving it to his mouth with kissing. Again, that is all speculation. I seriously doubt that he inoculated his penis from his mouth. What I meant about having it in both locations is that you acquire it in both locations at the same or close encounters. One does not need to have sores necessarily the first time they acquire infection. So the lesions could be HSV 1 or HSV 2 and it is very important that he contact the provider who did the swab test and be certain typing has been added to the lab request IF the swab test is positive.

You can both get IgG type specific antibody tests from a number of sources online. I often have patients use healthcheckusa.com. Remember NO IgG testing!!

Please feel free to ask two more questions.

Terri

[anonymous92]

Hi Terri,

Since writing you last we have had a nightmare of a time gaining some clarity over my partner’s test results. After reading your reply from my previous question, my boyfriend immediately called the clinic to say that his culture needed to be typed if it turned out to be positive for HSV. He was assured by the nurse that it would indeed be typed – all of their cultures for potential HSV are. Eleven days later a nurse calls him with results, says the culture from his scraping tested positive for HSV but low-and-behold, no typing. He went back in to the clinic 2 days later (was out of town for weekend) to have it rescraped and to get an IgG blood test. The doctor he saw this time was surprised and very apologetic that someone dropped the ball and hadn’t typed it in the first place, and took out a scalpel and rescraped the blisters to send back out for typing (this was about 9 days ago, almost 2 weeks after his first culture). The doctor also told him that they dont test for just IgG by itself, and that the blood test they administer is a both an IgG and IgM test for both HSV-1 and 2.

My boyfriend got the results today, but sores had apparently healed too much by the time the 2nd culture was done and it did not pick up enough to detect hsv, let alone type it. With regards to the IGG blood test, the nurse over the phone said that he was positive for HSV-1 and negative for HSV-2, but when he asked for the actual numbers, she gave him his HSV-1 IgM result (1.09). He finally gave up and went in person and got the lab print out, and we are having some trouble interpreting it. It seems they only gave a “positive” or “negative” response for the IgG testing but gave actual numbers for IgM. He tried calling the lab to ask for his actual numerical IgG results but was told that they can’t release information to patients, so he is currently trying to get a hold of his doctor to ask him to contact the lab on his behalf. I have attached the results but removed all identifying things from the photo (names, etc). Could you please let me know what these results mean to you and if there is any way we can get some definitive, final answers from this blood test?

I on the other hand ordered my IgG test from healthcheckusa and my results are positive for HSV-1 (23.7) and negative for HSV-2 (<.90). I’ve been racking my brain to think of a time i’ve ever had any HSV-1 symptoms, and remembered that after giving my high school boyfriend oral over 10 years ago, I woke up with a cluster of about 5 tiny ulcers on the inside of my lip. I have always gotten canker sores in my mouth since I was little whenever i’m sick, so I did not think much of it, as these were exactly like canker sores. But now that I think about it it seems likely that this was an initial outbreak of HSV-1(and kinda stupid that I never thought about this before), since they were all in a cluster right next to each other and I wasn’t sick or anything. They cleared up in the same amount of time as a canker sore usually does for me, around 5 days. Correct me if I’m wrong, but I think I read in one of your other forum post responses that it’s possible for an initial outbreak to manifest like this? Anyways, like I said, no other noticeable symptoms since then. I also remember that my high school boyfriend and I did not have sex for the first time for a long time after this particular encounter, and when we did we always used condoms…so if it was HSV-1 that I got orally from his genitals, I only got it in my mouth and by the time I was ever exposed to it by genital-to-genital contact from my high school boyfriend (if at all, since we used condoms) I had likely already started building up antibodies from the exposure to my mouth and so I could not catch it that much later on in my genital region? Or is that just wishful thinking? Regardless, I have never had any symptoms at all in my genitals and just this one (possible) outbreak in my mouth.

Is it safe to say based on the attached blood test results that the outbreak my current boyfriend had on his genitals was HSV-1? And if so, since I have already tested positive for HSV-1, does this mean I cannot catch genital herpes from him, since I either already have it with no symptoms or have it only in my mouth?

Thank you again so much for all your time, and so sorry I wrote so much! Just looking for some closure here. I look forward to your response.

[Terri Warren]

So if you are only positive for HSV 1 and you haven’t had any other sexual contacts besides him in the past 4 months and he hasn’t had any other partners in the past four months, then I think you can safely assume that his genital lesion is HSV 1.

The sores inside your lip are unlikely to be your first infection with HSV 1 because HSV 1 isn’t shed from the penis very often and these sound more like canker sores to me. But it could have been herpes, really hard to say at this point.

It seems like the most likely situation is that he may have acquired HSV 1 from you both orally and genitally, likely very near the same time. But again, we can’t know for certain because he has no baseline antibody test.

There is a lot to cover here and I may well have missed something – feel free to ask your final questions.

Terri

[anonymous92]

Thanks Terri.

So assuming his genital lesions are HSV-1 and since I have already tested positive for HSV-1, does this mean I cannot catch genital herpes from him since I either already have it with no symptoms or have it only in my mouth? I’m just trying to figure out the implications for our future sex life. We have not been intimate since the start of this whole thing as we dont know if we should move forward with condoms, suppressive therapy, etc. or if we can go back to our no condom, oral contraceptive sex as long as we are monogamous and have the “same thing” but maybe just in different places (HSV-1).

And if I gave it to him, does this mean I was shedding asymptomatically? Is this something I need to worry about in the future when sharing drinks with people, etc? I have had maybe 6 long term relationships now in which we were intimate (unprotected oral and sex with & without condoms) and no partner has ever gotten cold sores/genital lesions from me.

[Terri Warren]

Yes, that’s correct. If you both have HSV 1, it is extremely unlikely that either of you would acquire HSV 1 in a new location on your bodies. If you did give it to him, which we have no idea if you did or didn’t really, you shed virus. but then everyone with herpes sheds virus so that is not a surprise. There are no known cases of transmitting herpes from an inanimate object. However, I do suggest that people not share lipsticks or lip glosses, just because they stay warm and dark and moist.

Though no one has told you that you have transmitted herpes to them either orally or genitally, that may not be accurate. Seventy percent of those with HSV 1 infection report no symptoms or HSV 1. Also, since most of the population already has HSV 1, they may already have it and have no symptoms. It’s not quite as clear cut as one might think.

This was your last question on your subscription. If you have other questions, please feel free to renew

Terri

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