Unsure about test results

[Cesar1]

About a month and a half ago, I shaved my penis and when the hair started to grow back I noticed what looked like hard pimples (boils I guess), they couldn’t be popped. Eventually they turned into sores. About a week after that, I woke up with a sore throat, and then a few days later I had a fever and a couple of days after the fever, I noticed what looked like HSV2 symptoms. There were blisters around one of the sores and then two other very small patches of what looked like little blisters, but they weren’t as noticeable. I never had any pain (very itchy though) and the sores were all around base of my penis, where I had shaved. Initially a doctor diagnosed it as folliculitis and gave me oral antibiotics but I wasn’t convinced so I went back for HSV blood testing. I’ve never had a cold sore or anything but these symptoms were troubling. The second doctor who saw me also didn’t think it was HSV either but agreed to test me anyway, as per my request. When the results came in, the doctor diagnosed me as positive for both HSV 1 and 2 based on the IgM results. The results are as follows
IgM HSV1 – 1:80 (positive)
IgM HSV 2 – 1:40 (positive)
IgG HSV 1 – 0.47 (negative)
IgG HSV 2 – 0.25 (negative)
The results are from a HerpesSelect test.
The doctor told me that the results indicated a recent infection so I thought maybe my girlfriend was a carrier but she got tested a week after I did and she is only positive for HSV 1, not 2 (she tested positive for type 1 last year as well, but negative twice for type 2). The last time I was with anyone besides my current girlfriend was 8 months ago, two times (same person but once protected and once unprotected, the unprotected encounter was 9 months ago). I would think my IgG levels would’ve shown up as positive by now if I’d contracted it from that encounter 8 months ago. I’m wondering if it was a bacterial infection related to shaving or if maybe I did recently get type 1 from her. Not sure if it matters but I have had both chicken pox and mono in the past. A recent infection of both type 1 and type 2 doesn’t seem to make sense given my exposure but obviously I’m not a medical expert. Thank you in advance for taking the time to answer.

[Terri Warren]

Your symptoms sound like bacterial folliculitis to me. And it think the timing suggests this as well, with your shaving. Can you look and see if there are hairs coming out of the bumps? IgM testing is NOT recommended to diagnose genital herpes. There are many many false positives on this test and it really gets confusing for patients. Your IgG test for HSV 2 is solidly negative Since your most recent partner is HSV 2 negative and you’ve not had sex with anyone else for 8-9 months, it does not make sense that you have HSV 2 infection. You were wise to check this out further.

The screening test that you had done is not as sensitive for HSV 1 as it is for HSV 2. It misses about 1-2 out 10 cases, so it is possible that you have HSV 1 infection, despite the results of the test. Since your partner has HSV 1, that’s a consideration. It is possible that the lesions you are describing are HSV 1, though the timing of shaving has me leaning a bit more in that direction. Even if you did a confirmatory herpes western blot, which is far more sensitive for HSV 1 than the screening test you did, and you were positive for HSV 1, that doesn’t mean these bumps are caused by HSV 1. Does your current girlfriend get cold sores? I am a little bothered by your comment that the bumps changed into sores. It is good to hear that neither doctor who visually examined you thought your bumps were herpes.

Terri

[Cesar1]

Yes initially the bumps were all around hairs although some of the blisters that appeared did not necessarily have a hair follicle sticking out but the sores did. To be honest I can’t say conclusively if the bumps turned into sores by themselves or if it was from scratching, because they did itch. My girlfriend has never had a cold sore, she only assumes she’s positive for type 1 based on the two tests she’s had done. Do you think it’s worth retesting in 3 months or do you think these IgG results are conclusive, at least as far as HSV-2 is concerned? It just seems that 8-9 months of no elevated IgG levels would seem to indicate no infection but I also don’t want want to be cavalier about this.

[Terri Warren]

I think you can be quite secure about the HSV 2 result, yes.
Again, we don’t know if this might have been HSV 1 or not. If you do retest in 3 months, it would be to look for HSV 1 antibody not really HSV 2.

Terri

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