Informed Opinion from Terri

[migrantmen]

Hi Terri – i need an expert
Male. Already HSV 1 positive: cold sores. bipolar.
7 Sept. Unprotected oral. protected vaginal sex. sex worker in Asia. Removed condom with bare hand then masturbated without washing hands first
17-18 Sept. masturbate several times a day for two days. No lubrication. hand soap to wash area.
19 Sept. notice fire red patches underside of shaft (just below corona) and inflammation with soft fleshy bumps. Some pin size bumps on one patch. Did not look like blisters. No pain, itchiness or sensitivity.
21 Sept. doctor. may be herpes but equivocal. Doesn’t swab area. Orders IGG and IGM test. IGG for HSV 1 comes back positive (expected). IGG HSV 2 negative. IGM negative.
Experience mild chills and skin discomfort (could be anxiety)
23 Sept. another doctor. condition eased. Says: fungal. mentions ‘no blisters’. hmmm
25 Sept. condition pinkish. some flaky skin on one patch that simply brushes away.
27 Sept. email infectious disease doctor. Asks if regional lymph nodes are swollen. No. Says photos of skin don’t look inflamed. trauma. to apply emollient.
29 Sept. fly to UK. Experience puffiness right inguinal ligament. Poke and prod. Note: I had been lifting heavy bags that morning. Inflammation and redness on shaft middling.
30 Oct. Redness and inflammation pronounced. private STD centre. Nurse swabs yet no broken skin. HSV 2 is -ve
2 Oct. Armpit twitching. attend GUM (STD specialist clinic). Doctor checks nodes. not swollen. No herpes test as nothing to swab.
5 Oct. start university. flu. Armpit tender. Flu season. symptom? Low immune?
10 Oct. red blotchy rash on glans. smegma. armpit tender.
12 Oct. A new doctor says ‘fungal’. Orders PCR blood test. idiot
16 Oct. Gum STD clinic. another doctor. Original patches and glans faded but there. ‘this is not herpes’. how so sure given it has been 6 weeks since onset.
Never any pain, tingling, itching, open sore.
IGG test @ 6 week
Sound like herpes progression to you?

[migrantmen]

I would add that I am biopolar. I experience period of hypersexuality hence my lack of judgement and doing this risky thing. The anxiety and guilt weighs very heavily.

[migrantmen]

IGG test for HSV 2 came back negative at 6 weeks. How much can I trust this?

[Terri Warren]

If your antibody test is negative at 6 weeks there is a 70% chance it will stay that way, so very good news there. Also, your symptoms don’t really sound herpetic to me. Are you taking any antiviral medicine now because if you are, it could impact the antibody testing results. Also, you have clinicians who can see this telling you that you don’t have herpes which is great. If I had to guess, I would say you are going to stay negative.

Did you get an IgG test in England? If yes, may I ask how? People are always having trouble with that.

Terri

[migrantmen]

Hi Terri,

Thank you for your supportive response.

I am not on antivirals.

I went to the GUM clinic again today as I was still concerned about the small patches (which look like scar tissue) that are on the shaft under the corona (a loose skin wrinkled area), ‘fleshy’ bumps along vein there (not inflamed now), and the more recent glossy redness/pinkishness on the glans and foreskin (which I read online can be balanitis and that herpes can cause such, although I may be misinterpreting the link between the two).

The GUM doctor was a senior consultant and said this is not herpes.

I brought up how it had been four weeks since the most severe redness and inflammation, as well as how I had read that herpes can present as simply inflammation and redness without some sore/s (however mild) or pain or itchiness or tingling.

He said its likely there would still be some more defining skin evidence (beside what I have had), and the latter is wrong as there would be something like that.

I would add that it had been previously mentioned by another doctor at GUM that with genital herpes there would be ‘progression’ (?).

I still remain anxious as I read about the inaccuracy of clinical diagnosis + the most skilful clinicians didn’t get to inspect until 3-4 weeks post initial flare up.

I am thinking a 12 week IGG test will be quite conclusive. I may do another earlier one e.g. 9 weeks to also anxiously check if there’s been any change since 6 weeks.

An anxiety concern is how much my HSV 1 could ameliorate an outbreak/seroconversion.

My questions:
a) Can skilled STI professionals get a sense if there was a herpetic condition this late?
b) Could you expand a little on how the symptoms do not seem herpetic to you?

Thank you for your sensible and reasoned knowledge on such matters.

ps. IGG tests can be conducted in England through private STI health check providers where nurses collect samples at general clinics. Expensive. The GUM clinics do not provide IGG test.

[migrantmen]

If you would like to know specific of IGG test providers please let me know.

[Terri Warren]

You know, these are tough questions because 80% of people who have herpes don’t know they have it. Wouldn’t you think that if everyone had remarkable symptoms, then everyone would know they had it? Which means some people don’t have remarkable symptoms. So in answer to your question, if someone presented late in a new infection to me, I could say this didn’t look like herpes to me but they might have herpes anyway. I think your doctor can say this doesn’t look like herpes legitimately, of course, but does that mean you don’t have herpes? I don’t think we can say that. The symptoms that you do describe do not sound herpetic to me. Wrinkled skin, fleshy bumps, shiny redness? Not herpes symptoms.

I think a 12 week test would be fine.

Yes, if you could post info on private STI providers, that would be great. I get lots of concerns from people in the UK who cannot find this testing. Thanks

By the way, you owe for another subscription.

Terri

• This reply was modified 7 years, 5 months ago by Terri Warren.

[migrantmen]

Hello

A service in the UK is Better2Know which has a network of 150 partner clinics. Nurses at those clinics collect samples and send to the lab. The nurses themselves are not trained in STI.

https://www.better2know.co.uk

They do all tests, including IGG for herpes.

Sorry for asking the 4 questions rather than the allocated 3, I didn’t realise I had.

[Terri Warren]

thank you so much for that reference – I don’t mind the extra question given your help!

Terri

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