Uncertainty Despite Testing

[ThePlanes5472]

I am a 24 y.o. Male that had a male sexual partner who had sores on his buttocks. He had a history of Syphillis that presented more similarly to HSV with multiple painful lesions, but he was never tested at the time as the provider felt the symptoms were from syphilis. He had another outbreak while we were together of non-painful lesions on his buttocks that a Dr felt was non-infectious. We had intercourse while he had these lesions and 12 hours later I developed a rash over my whole body except lower legs. 24 hours later I developed a single dry painless lesion on the head of my penis. An urgent care Dr and my primary swabbed for HSV via PCR but neither felt my symptoms were consistent with HSV. I was HSV negative via PCR twice, negative for all other STI’s, and negative for Monkeypox twice. The lesion grew to the size of a quarter but was never painful. It lasted a few weeks. I also had fatigue for several weeks and neuropathic pain primarily in my chest that flared with stress and sun. Months later I saw a urologist who was less convinced that it wasn’t HSV as she said swabs aren’t always accurate. She recommended HSV serology. I just had it done, 9 months after initial symptoms. It was the HSV 1 + 2 glycoprotein specific IgG through ARUP labs. The value was undetectable for HSV 1 and 0.07 for HSV 2. My former partner had the same test done and had a result of 1.26 for HSV 2. I’m Nearly certain I’ve had cold sores as a kid so I’m unsure of the accuracy of my results. I have had no overt further symptoms since the first episode, but several weeks ago I had a small red spot on the shaft of my penis that went away over 3 days. I have also had urethritis since November that has tested negative for all readily testable pathogens. I’m now left uncertain of my status or if I should spend the money to get the WB. I’ve had three negative lab tests now for HSV, but have had some symptoms consistent with it. I’m very confused regarding all of the negative tests.

Thanks!

[Terri Warren]

The HSV 1 IgG misses 30% of HSV 1 infections and the IgG for HSV 2 misses 8% of HSV 2 infections, so you decide if those statistics warrant a western blot for you.
I am really concerned about the lesion on your penis that was not painful. Have you had a syphilis test, at least a month outside of contact with this partner?
Also, your partner may have a false positive at 1.26 – 85% chance that this is a false positive. If anyone needs a blot for sure, it is your partner!

Terri

[ThePlanes5472]

It certainly has caused me quite a bit of distress as it has left me unsure if I am carrying a transmissible illness. I’m no longer with that partner so it makes conversations regarding STI disclosure near impossible with new partners.

I have had several Syphillis tests since then, greater than a month from the initial episode. Besides Syphillis, he also has a history of CMV.

All typical STI’s along with mycoplasma genitalium, hominis, Ureaplasma spp, and GU tuberculosis have also been checked with regard to the urethritis. A CTU and Uroscopy were also done. An ANA and Lyme test were ordered due to joint pain and swelling that developed in the first month of the lesion. But, yes, the lesion is the most disconcerting to me. I suppose it is possible it could be a genital HSV-1 infection? I recognize at this point that it is unlikely that I will find a certain answer, even with a WB.

[Terri Warren]

I’m relieved to hear that you’ve had negative syphilis testing.
And I’m afraid you are correct, a western blot is not going to tell you the nature of the lesion. If it returns, get a swab test for HSV right away.

Terri

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