Nervous and Confused (Please Help)

[nervousandconfused]

Terri,

I am feeling a lot of anxiety about my current situation and I was hoping that you could offer me some clarity. On 10/4/14 I engaged in unprotected oral and vaginal sex with a girl I didn’t know and did not notice any kind of symptoms after the interaction. On 4/3/15 I engaged in protected vaginal sex (with a condom), and unprotected oral sex with an ex-girlfriend. On July 4th weekend I went on a trip down to the beach with a group of friends and shared a condo. The conditions might not have been the cleanest (shared towels in the bathroom and swam around in the ocean), but nothing too out of the ordinary. Anyways, when I returned from the trip I felt how I usually would after 3 days of heavy drinking. That night when I returned, I masturbated before going to sleep by using my bed comforter. The next morning I noticed some blisters which appeared to coincide with herpes sores that I looked up online. One had actually burst and scabbed over night and the rest were open. I did nothing about the symptoms for a week and actually went back down to the beach the next weekend and swam in the ocean and went about my normal routine. As the symptoms appeared to get worse (spreading of the sores to the base of penile shaft and onto scrotum) I decided to schedule a type specific blood test from stdtestexpress which I took on 7/13/15 and also went to see a doctor the same day after the test who told me that I had genital herpes. He wrote me a prescription for acyclovir and I took the pills for the recommended amount of time until the sores finally healed a few weeks later (during that time I also had a swollen lymph node in my groin). I decided to get another blood test on 9/22/15, which came back negative again for HSV1 and HSV2. Since the sores I have had a slight red patch of skin on the underside of my penis and there now appears to be a smaller red patch on the top as well. What should I make of the negative bloods tests post 50 weeks from possible exposure to HSV2?

[Terri Warren]

What were your sexual contacts like within the two weeks prior to the lesions developing? Are they only what you listed above? None of those seem close to the date of the lesions to me. Were any swabs taken from the lesions on your penis?

The blood test could have missed an HSV 1 infection (it misses 27% of infections) but it likely did not miss HSV 2.

Let me know about my questions.

Terri

[nervousandconfused]

No, the sores were not swabbed bc I told the doctor that I had already had blood drawn for the antibody test and the sores had been present for a week already. I had no sexual contact of any kind in the two weeks prior to the appearance of sores. The last two encounters were 40 weeks(unprotected oral and vaginal sex, one time), and 13 weeks (unprotected oral sex, protected sex with condom) before the symptoms appeared. At time of symptoms my dentist also noticed two canker sores on the inside of my mouth, would this have anything to do with herpes? Is it possible that these sores could be some kind of fungal or bacterial infection from using dirty towels down at the beach and a weakened immune system from drinking? It seems strange that these symptoms randomly appeared after using dirty towels, drinking heavily, and rough masturbation before bed. I am prone to sensitive skin and have had random rashes in the past/excema as a child. What are the chances that the antibody test would be missing antibodies because my body hasn’t formed any (I am 6 feet tall, 160 pounds, and in good physical shape)? And what would be your recommendation for further testing that would possibly be more accurate, and would you suggest that I do that in this situation? I have been blood tested three times for both types of herpes. They were at 41 weeks, 42 weeks, and 51 weeks (post unprotected vaginal sex). And at 14 weeks, 15 weeks, and 24 weeks (post unprotected oral sex). Thank you and I really appreciate your input on the matter, it has been taking over my mind for the past few months and would like to get some answers.

[Terri Warren]

Canker sores are not caused by herpes virus.
This is a rather unusual situation for sure, but I seriously doubt that this is herpes – at least not HSV 2. The screening test for HSV 1 misses about 1 out of four infections compared to the far more sensitive western blot. Our office can arrange for a western blot to be drawn at a lab near where you are to be shipped to the University of Washington if you want to get clarity there. But I will say, even if your HSV 1 antibody test is positive by WB, we cannot know if those symptoms are being caused by HSV 1. But if it is negative you will know for sure they are not.

Terri

[nervousandconfused]

Yes it is very unusual and confusing for me, but thank you for you help. One last follow up question.
I just graduated from college and engaged in plenty of instances of unprotected oral sex throughout the last 4 years. A while ago (I do not remember exactly when) I started to occasionally experience a stinging sensation around my anus whenever I spread my butt cheeks to allow water to hit the area in the shower. I never really thought much of it and just figured that I had a recurrent fissure or something. I have started to occasionally examine the area recently and have noticed one or two areas of scabbing around the anus and some redness towards the tailbone area where the stinging occurs. I was wondering if it is probable/possible that I was infected with herpes and my symptoms appeared around the anus instead of the the penis (although infection entered the body through the penis)? And possibly the symptoms migrated to the penile area when my immune system was low and I caused a lot of sweaty friction in the area through dry masturbation. I want to note that I am a heterosexual male and have never had any kind of sexual contact around the anus at any point in my life. In all your years of treating herpes patients, have you ever experienced symptoms like this with a heterosexual male? I also had a doctor look at the area earlier this week and he just noted some redness and said that it didn’t look like herpes, but didn’t really give me an explanation for the redness. Also, I have never noticed any coinciding symptoms before with the stinging in the shower (other than the occasional itch). But recently I am experiencing some lower back pain, slight groin pain, and my lymph nodes in the groin seem to be harder (but this could be because I keep pressing down on them to check). Thanks and I appreciate this forum, it has been very helpful for me.

[Terri Warren]

It is not necessary to have anal contact to get anal lesions, for sure. I see straight men often with anal issues. With herpes in particular, if the virus comes in through the genitals, it can come out anywhere in the boxer shorts area, it just travels along a slightly different nerve to get to the surface of the skin. Given what you have told me about your anal symptoms, I suppose it would be possible that you already have genital HSV 1 infection and this time it showed up on the penis. I think to try to clear this up, I would recommend a herpes western blot to see if you even have HSV 1 infection. If not, then I think you can leave this behind you for now. Our clinic can order that test for you to be drawn at a lab near you if you like or you can contact UW directly for a test kit to be sent to you. I’m not sure how else you can sort this out. The screening test does miss 1 out of 4 HSV 1 infections. It only misses 2 out 100 HSV 2 infections so I think that’s really unlikely. The thing is, even if your HSV 1 test is positive, you cannot be certain that these symptoms are due to herpes but it would give us the knowledge that you are infected with HSV 1 somewhere and if this happens again, ensure that you get a PCR swab immediately to try to pick up HSV 1.

Terri

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