[Question #1138] Followup Questions #927 #986

55 months ago
Hello Terri,

Recap: About 10 weeks ago, I engaged in a mutual masturbation and I found lesions on my penis glans 10 days later. I went to see a NP right away. The viral cultural came back negative and I'm high positive for HSV1. The lesions started to improve before I began taking Valtrex, and healed completely within 5 days without scabs and pain. I saw an urologist for the lasting rash and bladder pain about 4 weeks after the initial symptom. I was told I had yeast infection and bladder spasm due to stress. Clotrimazole cream and Flomax worked really well.

I am seeing a new person recently, and I told him about what I had experienced. I'm glad I did, and he seems fine about it. When I'm about to leave the excessive worries behind, I noticed tingling/burning cold sores on my lip which I've never experienced. The PA I was able to find last minutes put me on Valtrex, and I didn't bother to have another swap cause it's neither PCR nor type-specific. I feel down again and have many questions on my mind.

1. What is it more likely to happen to me? Could I have both OHSV1 and GHSV1 from 10 weeks ago or could the cold sores be my initial HSV1 outbreak?
2. I read gay men have more OHSV2. We had deep kisses during last 2 weeks. Is another IgG test still redundant?
3.  I read you said antibodies prevent one to get same type of infection at another location and I also read elsewhere only an established (6m-1yr) infection does. Assumed I caught HSV1 10 weeks ago, would IgG > 5.0 prevent me from getting it at another location or HSV2 at the same location?
4. If I was your patient, will you recommend suppressive therapy or you would give it more time?
5. I asked the person I’m seeing to get tested. If he also has HSV1 and doesn't know the site of infection, what precautions shall we take for oral and anal sex?

I can’t imagine going through this without you and I really look forward to hearing your insights again. Thank you.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
55 months ago
Sorry, this got lost in the older posts.
You have a high HSV 1 antibody level, right, so we know that this isn't a new infection with HSV 1 causing the cold sore rather it is likely a recurrence.
1.The cold sores could be your first outbreak but not your first infection because you already had HSV 1 antibody
2.I'm not clear that gay men have more HSV 2 - I suppose that's possible- but I don't think it is necessary to retest for HSV 2, given your previously described sexual situation.  Has the new partner had herpes antibody testing?
3.  Yes, your previous HSV 1 infection would be very protective against you getting HSV 1 in a new location.
4  Your suppressive therapy would be for HSV 1 - you might have a discussion with your new partner about their cold sore history or previous history of herpes testing to see where to go with this.  If you have a partner who is negative for HSV 1 and 2, then you may want to consider suppression.
5  OK, just saw this statement.  If you are both infected with the same type, I don't think you need to take precautions against new infection as this is so unlikely but I can't tell you that it is impossible just very unlikely.