How Does Herpes Look Like And What Is The Possibility Of Getting HSV From A Person With No Active Cold Sores?

Posted on Tue, 21 Jan 2014

Question: Is it possible to contract HSV-1 on the genitals from a person who has zero symptoms and hasn't had an active cold sore in years? What does herpes look like?

Answered by Dr. Dr. Kakkar (31 minutes later)

Hi. Thanks for posting your concern at XXXXXXX If the person is infected but does'nt have active herpes he/she can still transmit the virus because HSV is constantly being shed asymptomatically even if the person does'nt has active herpes but the chances are definately less of acquiring herpes in such a case. Herpes presents clinically as multiple, grouped erosions OR ulcers on genitals. take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (36 hours later)

Please review my photos. I had unprotected intercourse with a female on Nov 10th and protected intercourse on Nov 24th, with a quick second of unprotected oral. She is negative for all STD's except HSV1, which she claims was a rash on her forehead she had many years ago and a few times in her childhood. I tested for IGG 2 weeks after the last exposure once I saw this odd looking irritation on penis. That came back negative. I tested for IGM at 3 weeks while this lesion was there and that as well came back negative. Im so confused. The lesion itches tremendously before it arrived and I had penis pain throughout the day for a few days before a doctor prescribed Cipro which eliminated the pain within 24 hours. So now no pain just this lesion. What could this be. I am negative for both HSV1 and HSV2 up to this point and fear I contracted this girls HSV1 even though she had no symptoms. What does this look like? Why isnt it going away. It remains flat but to this point has not completely vanished. I was told to apply lotrimin (Anti-fungal) but that does not seem to work. I am getting iGG tested next week (5.5 weeks from last exposure) but could you please provide insight on what you see? This lesion has never caused pain, just itches before being raised and irritated.

Answered by Dr. Dr. Kakkar (10 hours later)

Brief Answer: Eczematous dermatitis Detailed Answer: Hi. Thanks for posting the pictures and providing additional information After looking at the pictures you provided it does'nt seem to suggest herpes. I could not see any vesicles or erosions. It looks an eczematous lesion/dermatitis and since you suggested that it was itchy, it favors the diagnosis of dermatitis. According to you this lesion has been persisting since 3-4 weeks. Primary herpes is very painful and their is lot of burning and discomfort, and the lesions if untreated can persist for 3-4 weeks. Recurrent herpes is not that symptomatic as compared to primary herpes since the patient has developed immunity against it and the lesions even if untreated persist for 5-7 days and resolve. Considering all these points, i would like to keep the possibility of Eczematous dermatitis and would advocate application of a moderately potent steroid like fluticasone twice daily for 2 weeks. I would still recommend that you go through the test IgG. The first IgG you did was too early for it to become positive given that you did 2 weeks after the last exposure , IgM negativity does'nt totally rule out herpes. take care regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (1 hour later)

Thanks for the response Dr. Kakkar. I tried looking for vessles even at its most irritating point but could never see them. I even tried manipulating this lesion (I know not too now) and only blood would surface. No puss, no discharge, and never any pain associated with the lesion, just a severe itch prior to its arrival and tad during. Is this common in your experience of herpes?? A lesion such as this? I tried looking online but the photos are too aggressive and resemble nothing of my condition. At 5 weeks if my iGG is negative, should I be content with the result and move on or should I retest at 3 months? I currently have no itch just a flat smooth dark area where the lesion is. Please advise.

Answered by Dr. Dr. Kakkar (1 hour later)

Brief Answer: Nothing like Herpes Detailed Answer: Hi. The pictures of yours don't look anything like herpes. It looks more like an erythematous eczematous lesion consequent upon scratching IgG on an average become positive in most of the cases within a month of infection though to be on the safer side you can retest at 3 months. take care regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (8 hours later)

Dr. Kakkar, please have a look at my new photos from today and at this lesion. Please tell me if you still believe this is not Herpes. I want to get this swabbed, but there is no fluid to swab. It's not a little smaller than a pea but an obvious lump. I get IGG tested again tomorrow, but want your input again and if you believe I could and should attempt to have a culture swab done. Please advise.

Answered by Dr. Dr. Kakkar (7 hours later)

Brief Answer: Wait for a day or two Detailed Answer: Hi. The new pictures show a little change in the lesion. It is raised, red and i could make out out some early vesiculation specially when i Zoom it (though it is very doubtful in the photographs). A physical examination would have been ideal in case of such a doubt. The best thing which you can do for the time being is wait for a day or two, because vesicles must develop distinctly if they are going to, by that time. If they do, it is herpes clinically and a type specific IgG test would confirm it. Swab culture can be done from the base of vesicle, that is a confirmatory test but i would advice that you wait for a day or two to see if vesicles develop. take care regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (21 hours later)

Dr. Kakkar, sorry for the influx of photos, it's actually quite embarassing, but clearly I'm concerned over this situation. Please see my updated photos within 24 hours of my last, which were raised and very slightly releasing a clear liquid. This was very minimal, like very tiny driplets. Not sure of what. The lesion never hurt and after applying Selsun Blue (shampoo) to the lesion (read this online for treatment of dermatitis) the lesion is literally 95% gone. Is this typical of herpes? I mean the turn around time was quick and the only thing left is a slightly dark area where it originally was. What are your thoughts? Would vesicles typically appear because they clearly have not in my case? Never have.. I took a IGG herpes test for HSV1 and HSV2 today 5.3 weeks exactly from last exposure. I'm hoping this, accompanied with a negative IGM will confirm I do not have the virus. Would you agree? What are your thoughts on my photos and the progression of this once lesion? Happy New Year and thank you for your professional advice. I defintely need answers and not reassurance. .

Answered by Dr. Dr. Kakkar (4 hours later)

Brief Answer: Waiting for IgG test Detailed Answer: Hi. The lesion is definitely regressed from what it was yesterday and it i looking as it was on day 1. Selsum shampoo contains selenium sulphide which is an anti-fungal. It is not recommended to be applied on the delicate genital skin. Anyways, all that said, I would still wait for the IgG test report in case of clinically doubtful herpes because it was never a full blown episode/typical episode in your case. The doubtful lesions which i could see yesterday could have been a truncated episode/mild episode of herpes (i hope it is not) and i don't think selenium sulphide is responsible for the regression. Note:-Recurrent herpes which is mild, may sometimes even go unnoticed. Do tell me the IgG report whenever it comes. I hope it come out to be negative. Happy New Year to you too. take care regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (7 hours later)

Dr. Kakkar, I recieved my IGG herpes results and they were both negative. Please review my results below and provide your feedback. 1st IGG test- Dec. 10th (2 week post exposure): - HSV 1 Type Specific - 0.29 - HSV 2 Type Specific - 0.06 2nd IGG Test - Dec. 30th (5.2 weeks post exposure) - HSV 1 Type Specific - 0.31 - HSV 2 Type Specific - 0.08 * Both types went up .02 since December 10th. Anything to make from that? Aside from retesting at 12 weeks, am I in good shape? What are your thoughts? Thank you!!!

Answered by Dr. Dr. Kakkar (12 hours later)

Brief Answer: Negative IgG is good Detailed Answer: Hi. Thanks for the test reports. Negative IgG test after approx 6 weeks of last contact, more or less rules out Herpes genitalis. take care regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar