Possible False Negatives

[WorriedinFL]

Hi Terri,

I am a male 33 years old. Last August/September I had protected vaginal intercourse with a 34 year old woman who has confirmed HSV2 which she acquired at 16. She is not on daily suppressive therapy as she does not experience many outbreaks. We had protected sex approximately 4 times over a period of two weeks before deciding to discontinue our relationship. After about 2 weeks I developed a rash in my groin folds between my legs and pubic area on both sides which I was concerned was HSV. I went to urgent care on 9/30 and was diagnosed with a fungal infection for which I was given an anti-fungal/steroid cream. I used the cream for approximately 2 weeks after which I developed a stinging sensation in my urethra and flat, red bump rash on my penis head. I went back to urgent care and was given a urine culture test which came out negative. I was given 7-days of antibiotics and told to use the anti-fungal/steroid cream for another 2 weeks on my penis head as the rash looked fungal. I was still concerned about HSV even though the doctors were not, so I got a blood test through Quest at 5 weeks which returned negative HSV2 0.04. I continued to have rash like symptoms for which I was seen again on 10/31 by a different urgent care. They gave me a different anti-fungal cream and another 7-day course of antibiotics and did another blood test through Labcorp which came out negative <0.91 for both HSV1 and 2. This was at approximately 8 weeks. Still having weird symptoms (groin itching, lower back/buttocks pain, burning sensation on scrotum and anus) and hoping to put the fear of HSV behind me I had another blood test through Quest at 12 weeks which returned HSV2 <0.09. I had a physical with my PCP on 12/15 and told him about my ongoing issues. He ran another blood test through Labcorp which returned negative HSV1 and 2 <0.91. This last result was at approximately 15 weeks.

This morning after showering I felt a stinging sensation on my foreskin and upon examination I found a cut like sore which was only really visible when the skin was stretched. The skin on my penis and groin has been extremely dry since using the steroid cream and I did masturbate yesterday which may have resulted in a cut or irritation. However, I made an appointment today with a dermatologist to get the cut swabbed as I’m really nervous about it. The rash on my penis head never blistered and never was open cuts or scabs (skin remained intact). It still persists to this day and I think is a result of using the strong steroid/anti-fungal cream on such a sensitive area. I’m really trying to move past my fear of having HSV, but every little issue seems to bring the nerves back.

What are the chances that all 4 of my blood tests have been false negatives?
Is there a chance that if I do have HSV I may never show antibodies in my blood?
What would you recommend at this point as far as testing?

[Terri Warren]

I think you do NOT have HSV 2. Your blood tests are very consistent and the ELISA test for HSV 2 is quite good – picks up 97 out of 100 cases when you wait long enough to be tested from a concerning sexual encounter. 15 weeks is reliable. Your fungal infections sound like just that – fungal infections, not unusual with all the antibiotics you have taken.

As for HSV 1, do we even know that is a risk? Have you been tested previously for HSV 1? Have you ever in your life had a cold sore

I don’t recommend any more antibody testing at this point. Wait until we talk a bit more.

Terri

[WorriedinFL]

Thank you for your insights. I had not previously been tested for HSV 1 or 2 until this whole matter started around the end of September. I do remember getting sores on/around my lips as an adolescent that I thought at the time were HSV 1 so I was surprised when my HSV 1 test returned negative. Regarding the antibiotics, the fungal infection actually happened prior to taking any courses of anti-biotics and I was concerned as I’d never had a fungal infection on my groin before. It was this rash/infection that I went to urgent care for that I was initially concerned was a possible HSV 2 initial outbreak.

I am reassured that you don’t think that I have HSV 2, however I’m still trying to do everything I can to figure out why I continue to have strange health problems that I never had prior to this sexual encounter (lower back pain on right side, burning/itching feeling on anal area, stinging in tip of penis, difficulty sitting for long periods of time, occasional shooting pains in right buttock, occasional burning pain in right lower abdomen). I’m currently on antibiotics again as my urologist thinks I may have prostatitis which is causing the issues listed above, although I’ve never had a positive urine culture. I’m now at 20 weeks post my last sexual encounter.

Based on these symptoms, would you recommend any further testing (Westernblot)?
Do you agree that the above could be caused by Prostatitis?

Thank you again for your help.

[Terri Warren]

I definitely agree that prostatitis could be the cause of your problems. It does require a long course of antibiotic therapy, normally.
The antibody test for HSV 1 is not great and misses 1-2 out of 10 infections. The western blot would be better at picking up HSV 1 infection, if you want to know about that.

I would recommend the western blot if you have trouble believing the negative screening test.

Terri

[WorriedinFL]

Thank you again for your insights. It’s great to have a reputable and knowledgeable voice about these issues. To finally put this behind me I would like to arrange to get a Western Blot. I’ve read here that there may be issues arranging the western blot in Florida.
How would you recommend that I go about getting the test done?

[Terri Warren]

We can help you with that. It is not inexpensive but please call Rene in my office to discuss this. She can help you.

Terri

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