HSV1 location uncertainty

[arno]

Hi Terry, here is my situation. My IGG tests have consistently come back positive for HSV1 and negative for HSV2. About a year ago, I got what was obviously a cold sore on my lip for the first time in my life since I have been aware of herpes, so I know that I have HSV1 at least orally.

However, I am a little concerned that I may also have genital HSV1. Around two years ago, I had an unprotected sexual encounter with a woman that I did not know very well, and I currently have no knowledge of her sexual health/status. After this encounter, I noticed many negative changes in my sexual health. The most alarming is that I feel what I believe to be nerve pain in my genitals, buttocks, legs, feet, basically from the waist down and on a regular basis. On a few occasions, there have been some visual symptoms on my penis, but the doctors that I have seen have been confident that they are not herpetic, and usually there is a good explanation for the visual symptoms (rough oral sex preceding a lesion, irritation from creams or lotions, etc.). Fearing that I had contracted HSV1 or HSV2 genitally, I was tested several times via IGG over the course of a year. At one year post exposure, I was still HSV1+ and HSV2 negative, so I’m pretty sure that the HSV2 possibility can be ruled out.

Also I’m negative for all other STDs.

In order to gain more insight into the possibility that I may have HSV1 genitally, I did a months worth of PCR swabbing from Westover heights, at around 9 months post-exposure. I was given four vials and i filled each of the vials with a weeks worth of swabs. I spread it out though so that the weeks were not back to back, and for two of the weeks I felt OK, and the other two weeks I felt not so great (I even had some mysterious redness for one of the vials). Anyways, all the vials came back negative for both types.

To me, given all of the test results, it seems unlikely that I have HSV genitally. I am wondering though, for people who do have HSV1 genitally, what are the chances that PCR swabbing for a month would yield a positive result? I am having trouble shaking the HSV thoughts, but I still feel like I have weird symptoms that are focused on my genitals and involve the nerves below my waist. From what I’ve read, it almost seems like I have constant prodrome symptoms without obvious outbreaks. What do you think? Thanks in advance for your answer!

[Terri Warren]

My guess is that you have only oral HSV 1. The swabbing not extensive enough to pick up genital HSV 1 infection, however, since it is shed infrequently and would require swabbing for several months perhaps to get a positive.
I think you should believe that you have HSV 1 orally and live that way until and if you get a lesion genitally that could actually be swab tested. It is very possible that you have had HSV 1 since childhood and you know now for certain that you have it orally. Having it in both places happens but is not all that common.

Terri

[arno]

Hi Terry, I have some new info and a follow up question.

I have started seeing someone new and we have been having frequent and somewhat prolonged protected sex i.e. much more sex than I am used to. I have noticed that my foreskin gets sore and irritated almost every time we have sex, maybe one in two times. There hasn’t been any blistering, but there do appear to be some red spots on the inner foreskin that when stretched out look more like blood capillaries, and they always follow the small veins that run along the inner foreskin. Usually, my penis will start to hurt a little during sex, and the pain will pick up throughout the day, and more or less be gone by the next day, but the redness will persist for a few days. It is worth noting that I went to the doctor when the redness was at its worst and the doc said that it did not look like herpes and that I probably overused my penis.

Having read lots of scary information on the the internet, I’m a little concerned that I could have HSV1 genitally and that it is being triggered by friction. Just to remind you, I am positive for HSV1 but have had a cold sore on my lip before.

I’ve done PCR swabbing with you before, and I am interested in doing some more rounds of swabbing now that I have consistent symptoms. What is the best way to go about this? Is there any way to do the swabbing and drop the specimens off locally? I was a little concerned about sending the specimens back to you on ice as I was worried that that might degrade the quality of the sample. Thanks!!

[Terri Warren]

I really don’t think your genital symptoms are HSV 1 but you can certainly swab again if you like. If you want to do this locally, I suggest that you talk with your health care provider about the way we do it and see if they would be willing to do it with you. The specimens do not need to come back to us on ice. Research shows that the PCR samples are very stable for years at room temp.

Terri

[arno]

Hi Terry, I have been using aquaphor to treat the irritated area and yesterday I noticed this pimple on my inner foreskin area. It looks very much like a typical pimple, the head is white and not clear. It doesn’t hurt either. I’ve noticed that the aquaphor leaves behind a white residue so I’m hoping that it just a pimple from a clogged pore or something but obviously I am worried. Also worth noting: I received oral sex the night before noticing this, and I also just tested negative again for HSV2. Thanks

[arno]

Here is the image…

[Terri Warren]

This does look like a simple pimple to me but if you have concerns about it or it changes, you should see your own provider for an in-person opinion.

I don’t know what aquophor is or what kind of side effects it has so I really can’t respond to what side effects it might have.

This was your final question on this subscription. If you have more questions, feel free to renew your subscription.

Terri

[arno]

Hi Terri, thanks so much for your input, and I renewed my subscription. I went to the doctor yesterday and she was not alarmed by this, but I insisted that she take a PCR swab… waiting on the results.

I would be OK doing the swabs via your clinic, especially if I don’t need to mail the specimens overnight and on ice. If I were to collect a weeks worth of swabs in one vial, would I need to keep the vial refrigerated throughout the week?

What would be the next steps to getting swabs/vials from you, would I need to make a phone appointment? Your clinic should already have my info on file…

Thanks again

[Terri Warren]

You would not need to mail them overnight and you can just send them back with a gel pack, not a freezer pack. Yes, you could do a whole week in one vial and you could keep it in the fridge during that week to prevent overgrowth of lots of bacteria or yeast during a whole week.

If you have sent us swabs before, you can drop a note to sharon@westoverheights.com asking for more swabs and she will check with me for approval.

Terri

[arno]

Hi Terri, the PCR swab from the pimple in the above image came back negative for both types.

two questions for you:

I noticed immediately after sex the other day a small red spot on the shaft of my penis which upon closer inspection looked like a tiny cut. It was right next to/right under an fordyce spot. Later that day it turned into a small pimple which I then popped. A tiny bit of blood started to flow from it and then a tiny scab formed. The next day, the pimple appeared to reform. Does this sound anything like a herpes lesion to you? Fortunately, I had received the PCR swabs from your clinic, so I was able to swab this.

How often do you see people who complain of herpes being triggered by friction (in particular, sexual friction)? If you do see these people, do these people ever have HSV1 genitally? Also, how is the herpes aggravated? in other words, does the friction lead to a full on outbreak with blisters, or just prodrome symptoms?

Thanks!

[Terri Warren]

this sound not sound like herpes to me, no. But the PCR should give us an accurate answer.
Yes friction is a trigger for some people, and yes, even people with HSV 1. Some go on to have an outbreak and some only have prodrome.

You have one question remaining on this subscription, Arno.

Terri

[arno]

Hi Terri, an update from me: I sent in two PCR vials to you earlier this year, each with five or so swabs from suspicious lesions and they came back negative. Also, the pimple from the above post was swabbed at my doctor’s office and also came back negative. I am still HSV1+ (oral, confirmed via IGG) and HSV2- (last tested for HSV2 in April).

Anyways, I still have some troubling symptoms that perhaps you could shed light on.

1) My biggest issue is that 9 times out of 10 having protected intercourse with my girlfriend, my penis will be quite sore for usually a day or two afterwards. This soreness is accompanied by burning/shooting pain in my buttocks, hips, back of thighs, lower back, and even bottoms of my feet. I feel that these more generalized symptoms are more or less constant, and they are made much worse after having sex. As far as the sore penis goes, using adequate lube seems to help somewhat, but it is still not a great solution.

2) Another issue is that from time to time I have visual symptoms on my glans, inner foreskin, and sometimes scrotum. Just today, I noticed maybe 7-10 tiny red dots spread out over a 1 square centimeter area on the glans of my penis. The skin surrounding the red dots is not enflamed, and the area does not really hurt, although it feels quite tender when my underwear rubs against it. Usually the visual symptoms I have are small areas of redness… there has never been any blistering or intense localized itching or pain, although I would say that I feel generalized itching and pain on a day to day basis. Also, within the last week, I developed a small red patch of skin on the side of my scrotum. The patch did not develop any blisters, was slightly itchy, and the skin on the patch looked very smooth and shiny. The patch disappeared after 2 or so days. Usually my visual symptoms disappear in 1-2 days.

I’ve spent that last 2.5 years worrying that I have HSV1 genitally as well as orally (I have definitely had a classic cold sore precisely once, and I frequently feel prodromal symptoms in the spot where I broke out), and I’m not sure what it will take to make up my mind. In the last 2.5 years I have sent you roughly 40 PCR swabs from the genital region and I haven’t ever had a positive result. I have one more question regarding the PCR swabbing:

3) How robust is the PCR process against contamination? I ask because for a while i was applying vaseline to my penis (provided some relief). I was doing this at the time I was swabbing, but I always made sure that the area to be swabbed was clean and vaseline free before swabbing. If there was residual vaseline on the PCR swab, could it possibly affect the outcome of the test?

Thanks so much 🙂

[Terri Warren]

None of those penis symptoms after sex sound like herpes to me. That just isn’t how herpes works.
The PCR swab is quite robut and if you removed the vaseline, we should get an accurate swab. I don’t feel that will impact the test, no.

Don’t you think it is time after 40 swabs to let this go and move on?

Terri

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