Antivirals affecting HSV2 seroconversion?

[ConcernedConfused]

I will try to keep this timeline brief & with important info. Test results & questions to follow

June2012: Give a partner genital HSV1 during beginning of my likely primary oral infection, which was inside of mouth and I thought to be a bad canker-sore until it worsened. Tested positive for HSV1 via culture at this time. Given supply of Aciclovir to take during future oral HSV1 outbreaks.

Nov 11 2014: Unprotected insertive anal sex with promiscuous partner

Nov 13: Itching noticed inside tip of urethra and throughout genital area

Nov 15: Full STD panel, results negative

Nov 16: Notice first red spot just inside penis urethra. Leave country to area without sophisticated healthcare system for 6 weeks

Nov 17: Itching has progressed to moderate to severe pain at head of penis/inside urethra. Begin to take 800mg/day aciclovir (6 days post possible exposure) because suspect HSV2

Nov 18 to Dec 30: Following symptoms persist, although seem to be helped somewhat by aciclovir. They are worsened by masturbation.
Itching through anogenital area, pinching feeling and pain at urethra, redness of entire penis and scrotum (especially exacerbated by masturbation), red dots inside urethra that appear in the exact same location, tingling/twitching/numbness throughout legs but especially in feet, intermittent pain while urinating

Dec 30-Jan 25: stop aciclovir, symptoms begin to worsen in early January in conjunction with me coming down with a severe respiratory infection. Entire penis/scrotum eventually becomes very sensitive to touch and turns angry dark red color for almost a week. Urinating is most painful during this period. Two mornings in this period presented milky discharge from urethra (only discharge I’ve had from this condition).

Jan. 25-now: Begin taking aciclovir again, symptoms improve but genital itching, pinching at tip of urethra, and persistent but reduced red spots at same spots inside urethra continue. Masturbation still causes entire penis & scrotum to turn an abnormal and uniform red color.

Testing:
Feb 5 (12 weeks post possible exposure): Full STD panel, results negative

HerpeSelect IGG test:
HSV-1: Greater than 5
HSV-2: 0.16

Questions:
1. What are the chances I have contracted HSV-2 but am seroconverting very slowly because I took antiviral medication for 8 of the 12 first weeks of my potential infection?
2. What other conditions could potentially cause the symptoms I’m describing?
3. I know it is unlikely, but is it possible I was infected with HSV-1 genitally despite my previous confirmed oral HSV1?
4. What other screening methods would you recommend to determine if I have acquired HSV-2? The doctor I saw last week said my small red spots inside my urethra were not good candidates for a viral culture.

Thank you for your time and for providing this service.

[Terri Warren]

Your symptoms sound far more like a bacterial and/or fungal infection to me, right down to the milky discharge and reddened appearance and itching. STD tests done look for things like bacterial infections that are not gonorrhea or chlamydia. Other bacterial infections are common after unprotected anal sex. Have you taken any antibiotics in the course of things? Have you tried any anti fungal medicines?

So tell me how many days altogether you think you took acyclovir, in total?

Terri

[ConcernedConfused]

I have not taken antibiotics or antifungals.

I have had a small amount of discharge on only two days out of the 80+ days I have had symptoms, and not within the first 45 days of having symptoms.

I think I’ve taken acyclovir for at least 55 out of 85 days since potential infection. Can that amount of antivirals delay seroconversion significantly beyond the 3-month range?

It would be great for this to not be HSV-2, but some symptoms are just so troubling–acyclovir seems to have some positive affect on symptoms, the red spots inside my urethra that persist/reoccur in exactly the same places (perhaps the place of viral entry, which would explain not having had sores on the penis shaft), the significant tingling/numbness in legs & feet that is often most acute at same time symptoms in genitals are most severe, the severe pain in urethra during initial “outbreak” that has since subsided with subsequent symptoms more like itching/pinching in urethra.

How should I go around looking for other possible diagnoses? Should I seek out an STD specialist/private STD clinic?

If it’s possible that I

[Terri Warren]

Yes, 55 days of antiviral therapy could definitely impact your time to seroconversion. What you are doing by taking antiviral therapy is preventing or reducing viral replication. If that is successful, less virus is “visible” to the immune system to make a response. If there is less or no virus to see, the immune system doesn’t know it needs to mount a response. That is a very lay explanation, but does that make sense to you?

I don’t agree with your assessment of the red spots in the urethra being somehow a placeholder against lesions on the shaft of the penis. Most men get herpes with an exposure to the urethra as well as the shaft of the penis and they still get penile lesions.

If you want a reliable antibody test, you will need to consider your use of antivirals as a potential problem.

Terri

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