HSV-2 on Ankle

[bh1401]

I had a recurring blistering rash on my ankle for a few months. The fourth time, I had it typed and it came back positive for HSV-2. I have never had any genital symptoms. The doctor who typed it said that I have genital herpes that is appearing on my ankle and that it IS sexually transmittable. She also said that I likely contracted it from anal sex because the ankle is on the same dermatome as the anus. I went to Planned Parenthood to get a second opinion. The doctor at PP said that I was almost definitely NOT sexually transmittable and that the HSV-2 was isolated to my ankle and there was no reason to believe it’s genital. So one doctor is saying I have an STI, the other is essentially saying I have cold sores on my ankle.

Everything I’ve found online and in academic journals seems to contradict each other when it comes to non-genital HSV-2 lesions.

I don’t really know what else to do. I want to tell my future partners if I do have genital herpes. But, at this point, I’m not sure how to know if there is anything to tell.

I also want to know, if I do have sexually transmittable herpes, how likely it is that I can spread it if I’m using daily antivirals, a condom, abstaining when the rash is present, and have no genital lesions.

[Terri Warren]

Your first doctor is correct. The ankle is in the group of nerves that supply the genital area as well – the sacral nerve group- and they are likely there because you were infected genitally and the virus is now traveling all the way down your leg, on that nerve, to show up on your ankle. I have definitely seen people with genital infection have recurrences on the ankle. You didn’t get infected the first time on your ankle (I mean, why would anyone think that was your primary site of infection), but with recurrences, that’s where they show up. But you are almost certainly infected genitally and should consider yourself infection from the genital area.

This has nothing to do with anal sex at all, don’t know where THAT came from. The anus and the genital are innervated by the same set of nerves.

If you were my patient, I would definitely tell you to disclose that you have genital herpes though you don’t recur there but you could be shedding from the genitals.

Terri

[bh1401]

So, in that case, how easily can I spread it? My first doctor said that the combination of abstinence during ankle-outbreaks, condoms, and daily antiviral (which I’m taking) “essentially eliminate” transmission risk. Is that true?

I’m not asking for an excuse not to tell future partners. But if I’m going to have an awkward conversation with every future partner, I at least want to have some facts on my side.

[Terri Warren]

First of all, the rate of female to male transmission is about 4% per year if no sex with outbreaks (ankle or otherwise), no regular condom use and no antiviral therapy and the partner knows you have herpes and sex about twice per week. If you add daily antiviral therapy and regular condom use it can drop to about 1%. More sex, more risk but still, even four times a week, only about a 2% risk of transmission. I think that is a manageable number.

Terri

[bh1401]

Hi Terri,

Last question. I’m reading some stuff that says genital-to-oral transmission is very rare. How safe is it for my partner if they wanted to give me oral sex?

[Terri Warren]

That is correct. We don’t know exactly what the risk is for transmission through oral sex but we do know that HSV 2 doesn’t like the mouth much at all.

Terri

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