Mixed message anxiety

[Antman7]

Thanks for this service. Mine is another of those confused by mixed messages about tests and diagnosis. I’ll try to keep the story clear. In March 2014 I foolishly had sex with an escort – she put condom on me as soon as I was erect, there was no bodily contact with my penis before that; she mostly performed oral on me and then I had brief vaginal sex – literally only seconds and I did not fully insert my penis. About two months later I had some redness and what looked like tiny spots or blisters on my foreskin just below the head of the penis. I suffer from recurrent thrush that is often tricky to treat, and the area that was red was where I typically have the most evident thrush symptoms, so I wasn’t sure if this was thrush-relate or herpes. I went to an NHS STD clinic the next day (I’m in the UK) and the doctor gave me a confident diagnosis of genital herpes. She took a swab but it came back negative – I realise that these often give false negatives. She gave me anti-viral tablets which I took for a week – by which time the symptoms had much declined. I had a full suit of other STD tests all of which were negative. I’d had to delay the chlamydia etc for a couple of weeks as I’d been on antibiotics for a tooth abscess not long before the symptoms. When I went to get the results about a month after the first visit to the clinic I had some more spots/blisters in a different area of foreskin and penis – the nurse practitioner swabbed them but said she thought it looked more like thrush. It came back negative for herpes.

While I was devastated with the news I gradually got used to my new status. However, I was frustrated that we cannot get an igg blood test on NHS – the doctor was adamant anyway it made no difference what type it was – but it did to me! Partly because I know genital HSV1 is likely to be less severe, but mainly because I know my wife is HSV1 + through cold sores; I belatedly realised that I could have caught it through unprotected oral sex with her. Eventually I decided to get an gig test and pay a hefty fee privately. This was about 6 months after the possible exposure via the escort. To my astonishment rather than showing me which type I was positive for it came back negative for both – and very clearly negative. I did some googling and was rather surprised to find reputable sources stating that visual-only diagnosis was wrong in about 20% of cases! I decided that’s what must have happened.

Cut to now: I’ve had quite bad thrush symptoms for about 3 weeks; they reduced with canes ten cream for a while but have come back. (My wife also had some – cleared very quickly with anti fungal pessary). The sorest area is just where the original blisters were, thigh there is a band of red much of the way around the foreskin, and on and off some little red pimples on the head of my penis. Following yet more googling, I was a bit alarmed to hear that igg tests are only 80-90% sensitive for HSV1; rather more reassured at the 97%+ for HSV2. I asked a GP (online) for advice and he basically said assume you have got genital hsv, regardless of the test – the clinic doctor is unlikely to have got it wrong. Yet the stats to my mind argue against that! Given that to my knowledge we don’t have the Western Blot test in UK, even privately, I’m left with these questions:

1) Should I have another igg test in case the last one was a freak result?
2) Fully understanding you can’t give a definite diagnosis by e-mail, on the basis of your expertise and experience what do you think is most likely to be going on?!

Many thanks

[Terri Warren]

I always always go back to the contact that is worrying people – what kind of exposure, for how long, with or without condoms, professional sex worker or not, country they live in if possible. So there is nothing in your contact with the escort that worries me even a little bit. Zero. Fast forward to the exam you had cone that resulted in a visual diagnosis of HSV. You’re correct – even among experienced STI clinicians, the diagnosis by exam only is wrong 20% of the time. You had a foreskin and the environment underneath it, and I would be that the number increases because of things like fungi that grow there and can cause skin ulcerations. Also,your symptoms did not appear until 2 months later? That’s way late, way way, late, for a new herpes outbreak due to a specific encounter.

The screening test for HSV 2 (the main concern with intercourse with a sex worker without receiving oral sex, vs. HSV 1) is quite good and I think you can be comfortable with that. But the HSV 1 is not as good, that’s right. Did you receive oral sex from her? If not, then I”m not very concerned about HSV 1. Plus you could definitely have it from your wife and her medical history. So even if the test misses1-2 out of 10, does that really matter in your particular situation?

Terri

[Antman7]

Thanks Terri
I had oral from the escort, but entirely protected by condom throughout. I’d be very sure there was no contact with areas of the penis not covered by the condom.

My big worry was HSV2 because of the danger of passing it to my wife, so HSV1 is less concern as I think I’m right in saying she shouldn’t be able to contract it genitally as she’s had cold sores since childhood.

Do I take it that you’d not advise me to pay for another igg test?

Thanks

[Terri Warren]

That’s correct – I think if the test was going to pick up the infection, it would have picked it up by now since your contact was almost a year ago. When, in relationship to the contact, did you get the testing again? If it was at least 16 weeks later, that’s about as good as the test is going to get, in terms of accuracy.

You have one post left – if you have another question or comment, feel free.

Terri

[Antman7]

Thanks Terri
Just checked my test result e-mail: it was about 27 weeks after the contact. The igg figures were 0.114 for HSV1, <0.5 for HSV2. I won’t waste my money on repeating it!

Given that I’m now entirely comfortable that I haven’t got HSV2 and pretty sure I haven’t got HSV1 either, I wondered if you had any advice about how I should best deal with the recurring thrush symptoms, other than the canesten cream and extra care re hygiene. Might I also/instead have some kind of allergic problem going on? The internet seems full of miracle cures for fungal problems that seem rather like snake oil to me! And I have to say that I’ve not had much confidence in GPs’ advice with the thrush-type problems – they seem less informed about it than I am now!

Thanks once again for your clear and sensible advice. I feel like my experience at the STI clinic was very poor as far as the doctor was concerned – she had no interest in my history and just seemed to run the equation ‘escort contact + genital sores + herpes’ taking no account of the nature of the contact or whether other factors might explain it. (The nurses were much more helpful and sympathetic btw!) Your attention to the particulars of my case is most reassuring!

[Terri Warren]

Have you tried oral medicines for the thrush? Sometimes Diflucan can be helpful when topical medicines just aren’t doing it completely. And you might have to do a few times.
Twenty seven weeks is a great plenty!!
The test for HSV 1 is less sensitive – it misses 1-2 out of 10 cases of HSV 1 but I”m not clear how much you want to worry about that one.

We’ve completed all of your post. I think you’re doing great! But if you end up with more questions, feel free to renew your subscription.

Terri

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