GHSV1+, concerned about new GSH2 infection

[mranonymous]

Hello!

I have had GSHV1 for 8 years, confirmed by western blot. I take generic Valtrex, but usually episodically. I have always had frequent outbreaks, usually on my butt or legs, and rarely on my penis (last time there was 2 yrs ago that I recall/noticed). I have never tested positive on IGG tests, even after 8 years. I always have to take a WB test to confirm I have HSV1. Also, I never had a cold sore in my life, so I’m pretty sure I only had it genitally.

So: on 10/21, I had an encounter with a woman. I performed unprotected oral sex on her, fingered her a little two. Then she performed protected oral on me (I practice safe for that, and I had taken medication that day, no symptoms either). I don’t believe her saliva touched me when she took it off afterwards. I may have touched myself briefly, and she may have touched herself before putting the condom on, but can’t recall. I cleaned up and showered soon after. I took more medication that night and the next day. I don’t know her status and haven’t talked to her.

On 10/25 I noticed spots on my glans, which looked like the beginnings of an outbreak. The following day it looked worse, more like that initial outbreak 8 yrs. ago. They looked like tiny bumps red/rashy and possibly fluid filled, not painful or itchy, but since I had to leave town for work yesterday for the week and couldn’t get it swabbed, I’ve kept taking my meds. Last night it was looking better, and better today still, but still there. I haven’t had any symptoms in my mouth yet. I’m not circumcised.

I know that the only way to really know is lay off the meds and get tested after the window, but I guess what I’m wondering is how likely is it I picked up HSV2 from my encounter, and if I did, how does the previous infection change that scenario? I would chalk it up to my original infection, but the fact I had taken so much meds, the the rarety of getting an outbreak there, and my encounter are worrisome.

Thanks for your time!

[mranonymous]

Update: I am experiencing urethra irritation now, and the lesions are still present; I can’t recall urethra irritation since that initial HSV1 outbreak.

Also, thinking it over, she did touch herself before putting the condom on, and she struggled to put the condom on me (it was a little too small, not bragging I think I’m average). What I am worried about is that she might have gotten some vaginal fluid on my penis, and the tight condom rubbed it into my skin. She was a little rough in performing the oral. That said, this doesn’t look like a friction irritation, and it showed up 4 days later.

Sorry for the addendum, I just want to give you a clear picture.

Thanks again!

[Terri Warren]

So to be very clear: a western blot can only tell you if you have HSV 1 infection, not where. If you have never had a swab test from a lesion on the penis, then you cannot know the location of your infection. Also, HSV 1 genital infection rarely recurs so what you are experiencing on the butt or legs may well not be HSV 1.
Nothing that happened in the encounter, from your description, puts you at any real risk of acquiring HSV 2. The touching does not present a risk.
What you describe on the head of the penis sounds more like balanitis than and HSV outbreak, but I don’t know for sure. Look up some pictures and see what you think

Terri

[mranonymous]

Thanks for your reply Terri.

I believe I have GHSV1 because I had an initial outbreak of small fluid filled painful blisters on my glans after that initial oral encounter 8 yrs ago. They recur rarely on my penis, but do sometimes. And I know that without a positive Swab test in hand that isn’t “proven”, but I did have another outbreak of a cluster of painful, watery blisters that appeared on my upper thigh 2 years ago. They crusted over, scabbed and healed about 10-14 days later. That bunch of lesions looked just like the photos I’ve seen on dermatology sites, but was 4 years past that initial exposure so I figured it was type 1 and I’ve had 2 WB tests since that only showed type 1. The smaller outbreaks I get on my butt/legs often follow tingling/itching. I know it isnt “proof” but they are definitely recurring and really happen a lot if I eat nuts and chocolate. But any way, let me ask you this:
let’s say I do have GHSV1, and that I did get GHSV2.
Is there any info (or your clinical experience) on simultaneous types infecting the genital tract? I’m worried what that would be like, outbreak and shedding wise. I’m still taking my meds (1000 to 1500 mg/day) as I am traveling for work the next couple of weeks and can’t afford to have symptoms. I plan to let up after Thanksgiving to see what happens,and persue testing. That said, I am having prodrom symptoms (like burning/irritation like that first experience), and it seems to ebb and flow after taking meds (I take 500 mg/ 8 or 12 hrs)

I looked up balantis, and it kind of looked like that but the bumps were definitely full of fluid, and have almost disappeared in the last week on the meds.

I kinda hate to ask this, but do you accept photos to see what’s going on? I’m sure you get that alot, and even though you are a medical professional and have probably seen more wieners than Oscar Meyer you’re still a lady so I don’t want to cross a line.

This forum probably would be great for a pervy pic collector!

[Terri Warren]

It does indeed sound like you have genital HSV 1 infection but we cannot be absolutely certain without a swab test.
I would be happy to look at photos IF you become a patient of mine via videoconference but not otherwise – really crosses a line to do it on this forum
But you do make me laugh!

Terri

[mranonymous]

Thanks Terri, I try to always to find humor in any situation. I may look into becoming a patient especially when I am ready to pursue a WB.

That said, I had two more questions, so I went ahead and paid again.

1. If a person becomes newly infected with an HSV virus, does getting on suppressive therapy as soon as possible reduce the number of overall nerves that the virus is able to infect before the body is able to generate antibodies to fight the infection? I’ve been taking 1000 mg of Valtrex each day since the lesions showed up, and while I know that I have to stop in order to get accurate testing, I am worried to have another outbreak while I am traveling for work, and I am wondering if staying on meds for a month or two until my immune system responds might reduce overall outbreaks long term, if I did pick up type 2.

2. In those rare cases when a person has both types genitally, how does having both affect shedding rates & outbreaks?

Thanks so much!!

[Terri Warren]

1. If a person becomes newly infected with an HSV virus, does getting on suppressive therapy as soon as possible reduce the number of overall nerves that the virus is able to infect before the body is able to generate antibodies to fight the infection? I’ve been taking 1000 mg of Valtrex each day since the lesions showed up, and while I know that I have to stop in order to get accurate testing, I am worried to have another outbreak while I am traveling for work, and I am wondering if staying on meds for a month or two until my immune system responds might reduce overall outbreaks long term if I did pick up type 2.

No. That has been evaluated and it doesn’t appear that going on suppression immediately after a new infection makes a difference with future recurrences.

2. In those rare cases when a person has both types genitally, how does having both affect shedding rates & outbreaks?

Since HSV 1 genital infection is rarely shed, the shedding would be the rate of HSV 2 shedding. HSV 1 should have little input into the shedding rate if someone is infected with both types genitally.

Terri

[mranonymous]

Good morning Terri,

I believe I have a couple of questions still, and an update, so I may as well ask your input.

My partner in this encounter was able to get tested, and contacted me with the results. She tested positive for HSV-1 (I didn’t get the number) and positive for HSV-2, 4.93. She said that Quest labs performed the test and she made sure to ask for IGG as I had asked her to do. She said that her last encounter before me was about 9 weeks prior to ours (10/21). She said that as she thought about it more, she did have some tingling/irritation in her vaginal area on 10/21 before our encounter, but didn’t think anything of it, and didn’t see any sores then, but said she has had a few bumps she thought was acne or some irritation in her groin before.

I pressed her to ask if she thought that if perhaps she had touched/fingered herself before putting the condom on before giving me oral, and she said yes she had, and may have wiped some fluid on my penis before putting it on. Like I said, the oral was rough, and if rubbing it into skin is a way to get it, then her performance would fit the bill (I was sore afterward, definitely needs to work on her technique!)

1. So, as I understand it, 4.93 is pretty high on her part, so she likely has it. Given this information, do you think that changes my chance of having picked this up? I haven’t had another outbreak on my penis, but I have had persistent itching/burning in my groin and the sensation of crawling under my skin since then, and lower back aches. Some small sores have appeared on my butt and lower back over the weekend, but are mild. I got tested for bacterial STDs last week, all negative. I had some burning sensations around my mouth, but no lesions or sores.

2. Lastly, I stopped taking valtrex on 11/9 to start building antibodies. I know the testing window is at least 12 weeks, but should I wait at least 12 from the initial encounter on 10/21 for 11/9?

And thanks again for your help!

[Terri Warren]

1. So, as I understand it, 4.93 is pretty high on her part, so she likely has it. Given this information, do you think that changes my chance of having picked this up? I haven’t had another outbreak on my penis, but I have had persistent itching/burning in my groin and the sensation of crawling under my skin since then, and lower back aches. Some small sores have appeared on my butt and lower back over the weekend, but are mild. I got tested for bacterial STDs last week, all negative. I had some burning sensations around my mouth, but no lesions or sores.

I just don’t think the experience put you at risk so her HSV 2 index value has little to do with it. Her touching herself then touching you is really not a risk factor.
Do you think the buttocks lesions could be folliculitis? They sound that way to me.

2. Lastly, I stopped taking valtrex on 11/9 to start building antibodies. I know the testing window is at least 12 weeks, but should I wait at least 12 from the initial encounter on 10/21 for 11/9?

You should wait from the most recent encounter, not the first encounter.
terri

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