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Hello Dr. Warren,
I’m a male. I’ve had two sexual partners. The first was protected sex with unprotected oral. It was a one time thing and it happened late November/ early December. I got STD tests done, however, much later found out they did not include HSV. My second partner and I began with protection but after STD tests decided to stop using protection. She had a similar situation to me actually and had protected sex with someone early/mid November. One time thing same as me. Her tests did include HSV and she tested negative for both HSV-1 and HSV-2, however, her test would have put her about 4 weeks after exposure and the blood test probably did not do any good. Now to my problem.
Late January: Friday I shave with a razor, on Saturday, after having sex she and I both notice a strong fish odor coming from her. and she decides to make a gynecologist appointment, as the following days she has a white discharge, but did not have other symptoms typical for STD’s. Around Tuesday or Wednesday (3-4 days after having sex). I begin getting what I describe as an “Icy-Hot” feeling in my genitals, thighs and sometimes even feet. A feeling I have never felt before and if I had to localize it anywhere in the genitals I would say I felt it most in the scrotum/upper thighs. I told the girl about it and she told me it was probably anxiety as I had been very worried and bugging her that I had something. Now, that started on Tue/Wed. Following Saturday, the feeling is still there and now 3 or 4 red bumps show up along with a bigger raised bump on my scrotum almost where it meets the shaft. I had an Ingrown hair (that I could see the hair in) near there so I didn’t worry about it at first… I wake up the following morning and the small red bumps are gone but the bigger one is still there. With the Icy-Hot burning feeling still there (It’s worse when I’m sitting down or going to sleep) and this bump; I’m starting to think more about HSV.
Tuesday I go to the doctor and she takes a look at it says its foccilitus and said it looked a little irritated had I been picking at it which I admitted to. I asked her to run a full STD panel including a IGG blood test. The doctor prescribed me doxycycline for the infected hair, my UTI that I tested positive for in my urine test and for what she thought might be chlamydia (pending test) to explain my icy-hot feeling.
Later on after research I realize I should have gotten a swab test done (guess doc didn’t think it was necessary) and decide to go to a different doc because a weird looking scab showed up close to the area. It was about the width of a hair and the length of a tip of your finger, there was no redness surrounding it, was not raised or anything, just looked almost like a paper cut or maybe a fingernail cut? There was never an open wound leading up the scab because I would have noticed (being paranoid and checking myself 4 times a day). The bump had not changed really. I did try to pop it several times with a lot of pressure and the following day it had a small scab on it.
The new doctor swab tested it by basically breaking my skin until it started bleeding and sent me on my way. The girl went to her gyno the same day. She got a pap-smear and doctor said she had nothing that looked like HSV and told her to stop taking scented baths.
All STD results came in negative including swab, except my HSV-1 came back low-equivocal. The RN actually said negative till I probed and she said well its equivocal actually but nothing to worry about. This test would put me about 7 weeks almost 8 weeks since my first exposure. The icy-hot burning feeling eventually dies down after being around for about a week and a half to almost 2 weeks. I try to move on and focus on work and chalk it up some kind of bacteria/fungus that got in my pores after shaving. I basically stopped taking the doxycyline after the feeling stopped, I finished maybe 1/2 the dose. Still think I have HSV and I just waited to late on the swab and to early on the blood test. Now my questions
Is it typical for a paper cut lesion to appear in the primary outbreak on the scrotum?
During the initial outbreak does the burning (What I describe as Icy-Hot) or prodrome feeling last up to a week; sometimes longer and encompass a large area or is it generally localized?
Wouldn’t 5 days be to long for an accurate swab test? Basically I got a false-negative?
Thanks
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I think if the clinician looking at it thought it was likely folliculitis, then it likely is. That is what it sounds like from your description, actually as well as the fact that it was near a shaving time. No, the primary outbreak is not normally on the scrotum or look like a paper cut. The first outbreak, if symptomatic, is different than that, both in location and appearance.
If your partner has neither HSV 1 nor HSV 2, this would likely not be a primary infection unless she has not had time yet to seroconvert, based on the dates of her last experience prior to you.
I think 5 days is pretty far out to swab, yes. I think you should finish the doxycycline.
Also, the fishy odor is likely either trich or bacterial vaginosis. Was she checked for those?Terri
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The equivocal test can mean a couple of things:
1) yes, it could mean that you are in the process of making antibody and you are going from a negative value to a positiev one, and you had your blood drawn as you were passing through the equivocal range.
2) a more likely explanation is that you are actually already infected with HSV 1 and because the test is poor at picking it up (misses 10-20% of infections), the test is showing a slight reaction.
3) the other possibility is that you are completely negative for HSV 1 and the test is reacting to something else in your blood sample.This does not look at all like a paper cut lesion that you read about.
You have one more question on this subscription.
Terri
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1.) With dealing with symptoms such as pain/burning/tingling etc. How often are these symptoms present even when there is no visible sores? Would it be unusual for them to last for a week?
They can happen without lesions, yes and it could last a week but that would not be common, for usre.
2.) Say with my given history. One time sexual encounter 3 months ago. Protected sex, unprotected oral. (Don’t know her status) and current sexual partner negative for HSV-1 & HSV-2. If a re-test does show a positive HSV-1 result as opposed to equivocal. Do I then come to the conclusion that my symptoms of mild discomfort at head of penis and icy-hot feeling in thighs and scrotum are attributed to a new genital HSV-1 infection received from my exposure 3 months ago?
No, I think that is a huge jump. I think you need confirmatory test since your HSV 1 is kind of variable.
3.) How common is an outbreak consisting of one lesion/sore?
That can happen, yes.
4.) If I have already been positive for HSV-1. How likely is it to obtain HSV-1 again in a different area from a different person?
Extremely unlikely
5.) If I do test positive do I then start disclosing as if i’m positive for genital HSV-1? Since I don’t have a positive swab in either area couldn’t I risk spreading my Genital HSV-1 infection to others if it’s not oral? Should me and my GF start using protection until its confirmed?
Experts do not agree on this question – some encourage full disclosure. Others don’t because more than half the population has HSV 1. How long have you and your partner been having sex without condoms. If it has been a while, adding condoms now may not be very helpful. Plus we don’t know if you are infected yet, correct? You should do what makes both of you the most comfortable.
Terri
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If you were my patient, I would swab test this for herpes yes. Having said that, I think it is more likely from a change in weather or it could be angular chelitis. The thing is, if the antibody test is negative for HSV 1, it is certain with about an 80-90% accuracy but that’s not great. A western blot is better for HSV 1. So in terms of answering the accuracy at 8 weeks, you need to take into account the lack of sensitivity of the test for HSV 1, so I guess I can’t really answer that for you. The lack of sensitivity of the screening test applies to both of you.
Not everyone who gets a new infection has symptoms right away so it isn’t impossible that you could have acquired this years ago and just having symptoms. I just can’t say! You need lab testing
Terri
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The HSV 1 result is difficult to interpret but could certainly be a false positive. Are you certain you are reading the result correctly? It would so unusual to have exactly the value that is the cutoff for positive! The difference between the two numbers (if they are correct) is not significant.
The picture does not look like herpes to me.
Terri
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Well, if it is actually 1.10 then it is just barely but technically positive. So two things could be going on here with your HSV 1 value:
1) it could be a false positive since it is just barely over the cutoff point
2) you really do have HSV 1 and test test is just barely picking it up. The HSV 1 screening test is not great. So once again, if you really want to know your HSV 1 status, the western blot is the way to go.The cutoffs are the same for HSV 2 as they are for HSV 2, even though they are not listed on your lab form, which is pretty odd that they are not.
If you decide to do the western blot, we can help you at the clinic to obtain this with a blood draw near you or you can contact the UW lab directly to have a kit shipped to you and your health care provider can draw it and ship it back to UW.
If you are really sick of not knowing what is really going on, that is my suggestion.
Your subscription has run out of questions. If you have more, feel free to renew.
Terri
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Well, false positives are sometimes DUE to a cellular protein tripping the test artificially.
Having an outbreak, typical or otherwise, does not indicate infection.
Yes, I would say in your situation oral infection is more likely than genital infection. But it would be good to know if you have HSV 1 at all if you are worried about your new partner acquiring infection from you.
Terri
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I’m not making myself very clear and I’m not sure how else to put it. My understanding is that 1.1 is a positive result on this test. Not sure where the equivocal is coming in except your prior test? Equivocal is neither positive nor negative. It is equivocal! However, the screening test could also just be missing a very firm HSV 1 infection that the western blot would pick up.
If you were HSV 1 positive (regardless of location) and she is HSV 1 negative, then you might consider taking daily antiviral therapy to reduce the risk of infecting her.
Terri
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Your two values are very close together and are basically the same except their classification, which is what I think we were going back and forth about. The LabCorp values sometimes are higher, yes, but not every time I am discovering.
I have many discordant couples for HSV 1 where the infected person takes daily antiviral therapy. I would say it is not very common to get it in both locations at the same time but we certainly see it.
Terri
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