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Dr. Tim, MD
Dr. Tim, MD, Board Cert. OB/GYN
Category: OB GYN
Satisfied Customers: 950
Experience:  General OB/GYN, complicated obstetrics, complicated GYN
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I have a blood test scheduled, but I have a picture and

Customer Question

Hello, I have a blood test scheduled, but I have a picture and would like to know if this looks like genital herpes. I have never had an outbreak, been married for 10 years one partner, no discharge, no smell, no clusters just these white lesions that started itching and burning when I urinate.
Submitted: 2 months ago.
Category: OB GYN
Expert:  Dr. Tim, MD replied 2 months ago.

Thank you for the question and I am happy to help!

Please answer the following questions so that we can sort out the likelihood that this is herpes:

1. When did they appear?

2. Were there any other symptoms at the site such as pain?

3. Have you noticed any blisters?

4. Do either you or your partner get oral cold sores?

I cannot see where the picture is attached but perhaps work on this from your end first.

Dr. Tim

Customer: replied 2 months ago.
This week they appeared, no blisters, he has no symptoms however he gets oral cold sores. This is am absolutely first for me
Customer: replied 2 months ago.
I have never had anything like this in my life no other symptoms no fever no headaches no other pain
Expert:  Dr. Tim, MD replied 2 months ago.

Thank you for the follow up information - this is very helpful. Here is some basic background information:

1. Herpes virus (HSV) comes in two forms - HSV1 AND HSV2

2. HSV1 is typically associated with oral cold sores and HSV2 is associated with genital sores (they are basically the same thing in different locations

3. HSV1 can be associated with genital sores AND HSV2 can be associated with oral sores

4. When HSV1 is associated with genital sores, the recurrences can be extremely infrequent

5. There can be transmission of oral HSV1 to the genital area with oral sex

6. He can have viral shedding of the virus from the oral area even in the absence of a visible lesion

When I review the picture, my first impression is that this definitely looks like a resolving herpes outbreak (it is a shallow ulcer with a surrounding red base). I have seen many patients with herpes and this is exactly what it looks like but I have also been wrong in the past as well. But given what I have explained above, I do not want you to jump to any conclusion about your husband or infidelity until you have all of the facts. Here is where you go from here:

1. Await the results of the HSV titers - if they are positive for exposure to either HSV1 or HSV2 in the past, then the most likely explanation for the sores is herpes

2. Assuming a stable relationship, the most likely source of transmission is viral shedding from your partner from an oral lesion

3. The MOST effective way to determine if this is herpes is to directly culture the sore but this is more effective slightly earlier in the process than you have shown me in the pictures.

Let me know if this answers your questions.

Dr. Tim

Expert:  Dr. Tim, MD replied 2 months ago.

Hello - just checking to see if you have any more questions. Please let me know if this answered your questions. Have a great day.

Dr. Tim

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