Primary Outbreak Mild Symptoms Autoinnoculate

[Mild Symptoms]

Hello, approximately 4.5 weeks ago I had sex with someone whom I recently met. We used a condom during the protective intercourse but there was unprotected oral sex and some genital to genital contact that did not involve a condom. We had sex over the course of two days. To my knowledge I have no history of either HSV1 or 2.

On the 11th day after the encounter I noticed a small red patch near the tip of my urethra that appeared to have 3 small dots forming a triangular pattern, the patch did not itch at all and was slightly less sensitive than the skin around it. The vesicles were neither painful nor itchy, nor have been any other symptoms I’ve had since this began.

When I discovered the patch I scheduled a doctor’s appointment, and in the period between scheduling the appointment and meeting with the doctor the patch expanded and the dots appeared to breakdown into vesicles (I’m using that term in ignorance, they appeared to be symmetrical, very small, rounded upraised patches of skin with an indentation in the center). On close examination over the next several days there appeared to be a small white patch at the base of the vesicles, at this time I noticed another red patch on the shaft of my penis.

The doctor examined the red patch and said that without pain and given the size of the vesicles it couldn’t be herpes, but took a swab of the vesicles regardless. The swab was a cotton swab and she did not make any effort to break the or collect fluid (there wasn’t any fluid to collect). This test and a battery of other STI tests came back negative, this was 16 days after I had sex. One large point of concern for me was auto-innoculation, and I talked to the doctor at length about my risk of this and she said that I could only auto-innoculate myself if I was immunocompromised.

Over the next week I had been very nervous and was compulsively checking my penis and washing my hands, but eventually calmed down somewhat. The red patch continued to expand, vesicles similar to the other original ones popped up on a red patch of skin I hadn’t originally noticed on the indentation beneath my urethra on the underside of my penis. Additionally, a brown patch of skin began to form on the center of my glans that appeared to have similar vesicles, this patch turned red when exposed to water. Very tiny red dots were visible across my glans.

During the follow up appointment the doctor said that there was still nothing to worry about, she said that the symptoms were too small and that I would be experiencing pain if this were herpes. Recently I saw the same patterns of vesicles appear on my fingers, and I believe on my upper lip. These are slightly different, they are usually pink and barely distinguishable from the normal skin color around them, and are on closer examination they seemed quite extensive and appear in herpetiform clustering all over my arms, upper torso, fingers and hands. From afar the vesicles are very flat and appear to just form a pink layer of skin (I’m normally very pale, so it is easy to mistake this skin for my normal skin color). Many of these patches are barely visible and I only notice them because I have observed the progre

Recently my penis has begun to experience a ‘tugging’ feeling, internally, and when examined the spot that has the tugging feeling will usually have a new crop of vesicles forming. The same thing has begun happening on my thumb and index finger. A doctor at a walk in clinic indicated that the rash on my chest and arms appears to be a viral rash but that they did not think it was consistent with herpes. Neither doctor seemed to examine the skin closely. I have had slightly itchiness when urinating that has come and gone since this began, and the skin around my penis beneath the glans has turned pink, as has the skin around each of my fingers. I have not had flu like symptoms or any non-visual symptoms.

I don’t understand what this could be other than herpes. I am very concerned that I have extensively auto-innoculated myself, or if not at the very least spread around viral cells before I have sufficient immunity to prevent further infection.
Questions:

1. Does this sound like herpes?
2. Can I have auto-innoculated myself?
3. It has been 3 weeks since I began having symptoms, 5 weeks since the encounter, how long should I wait before a blood test?
4. Can you have vesicles that are sufficiently small such that they are painless?

[Terri Warren]

No, this does not sound like herpes to me. I think you are using the word vesicle in a way that likely doesn’t support what vesicles are. They are water blisters that have a tense surface and break. Do you really have water blisters in all of those places? I think at least on of the providers that you have seen would think it looked like genital herpes if that’s what it was. Herpes lesions are most definitely distinguishable from the skin around them. They usually, with first infection, hurt some. They are not at all flat, they are raised and distinct from the skin around them. I don’t believe you would see them in all of the locations that you are describing either – not torso and arms and if they were on your hands I think you would definitely be having discomfort. Also, I don’t think that the symptoms would last for three weeks without changing – if they were herpes, they would definitely be changing over time from water blister to ulcers in the skin to crusts. Herpes lesions with a first infection are just not so small they are painless, normally speaking.

Have you ever in your life had a cold sore on your lip?
Have you discussed your concerns with the person you had sex with so that they may get tested and then you can know if you really have risk?

Terri

[Mild Symptoms]

I should’ve mentioned earlier that there are small ovular bubbles visible under the fingers in my skin. I initially suspected that it was herpes because, although I had not developed any visible blisters that I was aware of, the patterns in my skin look very consistent with the appearance of the skin that is not part of the erythmatic base on images of herpetic whitlow that I’ve looked up online. I realize that my symptoms don’t appear to be traditional herpes because they are avowedly not painful and have not yet turned into large blisters. There is a slightly uncomfortable tingling sensation in one of my effected thumbs this morning and on closer examination there appears to be a flat blister on that thumb underneath the thumbnail, spreading out beneath that is a cluster of “vesicles” that are reddish-purplish and upraised from the skin. I think that I am in the early stages of having an outbreak.

I also should’ve mentioned that the red spot on my penis has since turned pink and more or less faded back into the skin, the larger spot on my glans has remained as it first presented although it is increasing difficult to see. The skin on my fingers and penis is behaving differently than the skin on the rest of my body. Everywhere else it appears on my body it looks like pink or white groupings of skin, most prominently visible when there are red or dark dots in the centers of the symptoms to which I was earlier referring as vesicles. There are other spots on my skin where they just appear to be contiguous patterns of white or pink skin.

I have also not had a fever or any other typical signs that my body is reacting to a viral infection, with the exception of a sore neck for a couple days which I assume could just as easily be attributed to how I slept. What if my body just hasn’t had a serious immune response yet and has therefore not produced anti-virals that would force the virus into blisters.

I have not had cold sores before, although it’s possible that I have had HSV1 for a long time and not known about it. My current girlfriend (with whom I am in an open relationship) tested herself when I began describing what I was experiencing, and she came back with a low-positive for HSV1, we are doing long distance and seeing other people so we have not had any contact since this began.

The person with whom I had sex took a blood test a couple weeks later which she said came back as normal, however she’s very sexually active and has had something like 10> partners over the last year. I know that it would be a limit case, but it seems possible that she slipped into the 10-20% of cases that come back false negative, or that she hasn’t sufficiently serroconverted from her last encounter which was about 7 weeks before we had sex.

How extensive can auto-innoculation be?

If I have infected my fingers as well, will I shed asymptomatically from them the same way I would from my genitals?

You’ve said that it wouldn’t normally be painless, since so many people don’t know they have herpes, couldn’t it just be that many people experience the symptoms painlessly and practictioners have a selection bias in which they are so used to it being associated with the 20% of the people that come to the clinic with painful symptoms that they have a hard time recognizing the cases in which it does present atypically/painlessly?

Couldn’t the absence of blisters just mean that my body is taking longer than normal to develop an auto-immune response and that in 2 weeks my hands/genitals are going to be covered in blisters?

[Terri Warren]

yes, all of that is possible.
If you have bubbles under the skin of your fingers, then these definitely sound like blisters to me and you should be seen right away for a swab test of your fingers for whitlow. From you initial description it didn’t sound as though you had blisters but now it definitely does! Please – go and have them was tested, hopefully using the PCR vs. culture, as PCR is 3-4 times more sensitive than culture.

If this does turn out to be whitlow, you will not shed asymptomatically from that area – only when you have an outbreak because the skin is too thick to shed.

In response to your question about pain – not everyone has pain with herpes but most everyone that I have seen with herpes has some discomfort when the lesions are swabbed, even if the lesions, untouched, are not painful.

I doubt that in two weeks your hands and genital are going to be covered with blisters, but I so hope you will go see someone to evaluated your hands NOW due to the bubbles under the skin that you describe.

I’m not clear what you mean about your body’s antivirals forcing your body into blisters. It is actually a lack of an immune response that allows for initial blisters but as the immune system (is that what you mean by antivirals) gets into gear, the lesions tend to come less frequently. I guess I”m just a little confused by your question.

I am also concerned about what you describe as the skin lesions with red centers. Do they look like targets? If yes, it could be an immune response to herpes called erythema multiforme. You might want to look up pictures of that and see if yours look similar.

You have one more question to ask on this subscription.

Terri

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