Condoms and preventing transmission

[Lazarus]

Hi, my history is that I had one first painful outbreak and since then only irregular mild, painless outbreaks (just red rashes). All the outbreaks have been in the same place – the tip of my penis. I have never (at least to my knowledge) had any symptoms elsewhere.

Am I correct in thinking that using a condom should be very effective in my case in preventing transmission, because my outbreaks are all on the penis tip (which would, of course, be covered by the condom)? I haven’t been able to find anything on the physiology of HSV-2 shedding and whether you can transmit the virus from anywhere in the genital region or just the area where you have outbreaks.

[Terri Warren]

May I ask how you were initially diagnosed with herpes? And when you say you have had painless red rashes after that, where were they located?
Condoms reduce transmission by about 30-50% depending upon the study that you read. Antiviral therapy taken daily reduces the risk of transmission by almost 50%. Virus can be shed from the shaft of the penis, with or without symptoms, even though most of your outbreaks are on the tip of the penis.

Do you have other questions for me?

Terri

[Lazarus]

Thanks. I have never been diagnosed, but I think I do probably have it.

The first outbreak occurred four days after having unprotected sex with a stranger (incredibly stupid, I know). It wasn’t a blister, but it felt very painful under the foreskin, so I think it was probably a small cut instead. At the same time I had this, I also had the tell-tale tingling sensation. With the help of some lemon balm, the outbreak cleared up after just a few days so I didn’t get it checked out as I should have done.

About two months later I felt the nerves tingling again, and sure enough I had another outbreak – but this time it was just a cluster of painless red rashes on the tip of my penis. I did get these swabbed after a couple of days, but too late I think as the test came back negative. I haven’t had the prodrome since, but similar red rashes suddenly appear (always on the tip of my penis and always painless) and then disappear quite quickly (sometimes in a few hours). Strangely, they sometimes disappear when I bathe. I am sure these are recurrent HSV outbreaks and not caused by friction from sex etc (I am abstaining at the moment!).

It is difficult for me to get tested because I’m not in the US and they don’t do blood tests for herpes here. The only way to get it done is if you go to a private clinic and it’s very expensive – and I’ve heard they are not 100% reliable in any case. I suppose I could get another swab done as soon as the red rashes appear, but they vanish very quickly.

Is it true that the virus will normally travel the same route if you always have outbreaks in the same place? If this is the case, condoms should really help in preventing me transmitting the virus (this is my main concern now as the HSV isn’t causing me any pain). If it’s only present in the penis then it would be some reassurance that I can substantially reduce the risk of passing it to a future partner.

By the way, does the fact that my tingling prodrome has stopped mean anything other than the virus has become less effective now my immune system has learnt to tackle it?

[Terri Warren]

Honestly, this does not sound like herpes to me. I have almost never seen a new case of herpes be only on the head of the penis without accompanying lesions on the shaft of the penis. And the red rashes that you describe that go away so quickly are definitely not at all consistent with herpes. I doubt that there is any advantage in getting them swab tested for herpes.

In my mind, you have decided, probably based on internet information or talking with others, that you have genital herpes with no accurate diagnosis.
Do you think it would be possible for you to have your blood drawn some place where you live and send it to my clinic and we could send it to a lab for testing? We would use western blot. I guess that you could just life like you have herpes forever but in this case, the evidence is just not strong enough, in my opinion, for you to live that way. At least I wouldn’t, if I was in your situation with the symptoms that you describe to me.

If you did have herpes, condoms would reduce transmission, yes.

Terri

[Lazarus]

Thanks Terri.

If I could ask one more question: What other STDs or other conditions might cause the tingling sensation at the same time as outbreaks on the penis glans? This is what made me think I have HSV.

The nerve tingles were very obvious and very distinct. I have only had them twice – and on both occasions I had an outbreak. This can’t really be coincidence, especially as the first one occurred a few days after I’d had unprotected sex.

Although no blisters were present, I understand symptoms can manifest as a painful cut instead. This was like a very sharp paper cut (so painful it was difficult to retract the foreskin).

The second outbreak, I had very obvious red (but painless) sores on the tip of the penis (again, at the same time as the tingles). Every outbreak since has been a milder version of this – a few red rashes appear on the penis glans without any apparent obvious cause such as friction etc. I don’t get the tingles any more.

I may have been a bit misleading in terms of how long the red rahses last. I have known them to disappear after just a few hours but more typically it’s probably between 12-48 hours and they slowly fade (although sometimes vanish completely when I bathe).

I was surprised when you said that you had virtually never seen anyone with an outbreak just on the head of their penis and not on the shaft. I understand most outbreaks in men do occur on the glans. Perhaps with me it is quite mild. From what I’ve read there seem to be a range of different symptoms, so I can’t think that the absence of lesions on the shaft would automatically rule our herpes.

Thanks for your suggestion for the Western Blot test but I don’t think it’s practical as I live abroad.

• This reply was modified 6 years, 7 months ago by Lazarus.

[Terri Warren]

I have certainly seen men with an outbreak on the head of the penis. What I have not seen is a primary infection with only lesions on the head of the penis. Honestly, the rashes that you describe sound like balanitis which is normally not caused by herpes. And the time these rashes last is more consistent with candida balanitis than with herpes. It is not correct that most outbreaks in men occur on the glans, most occur on the shaft of the penis.

I understand that it is expensive to be tested where you are, but don’t you think it would be good to know if you really have herpes before living as though you do?

Our clinic facilitates obtaining western blots if you decide to clarify your situation.
If not, best to you. I hope at some point you can get an accurate diagnosis.

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Terri

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