What are the chances I am positive?

[anon3333]

Feb 19 I had unprotected sex with someone that has HSV2 (condom broke). She said she had it several years and no recent OB’s. Afterwards I had various symptoms that seem to be uncorrelated but there is a chance.

– No lesions, no pain urination, no discharge
– during the first 2 weeks I was treated for orchitis (burning pain in testicles and tip of penis). After antibiotic treatment this went away.
– I have been dealing with a sore throat for a few weeks (no fever, headaches) however it’s gotten better the last few days. We did not have oral sex.
– slight inflammation of the meatus and some clustered reddish/dark spots on the glands that are still ongoing (painless). One doctor said this was balanitis since I am uncircumcised. I have been applying anti-fungal cream and coconut oil and it seems to be slowly improving but it is difficult to tell.

I did a PCR BLOOD test (which I am not familiar with but the doctors seem confident with) & IGG test 14 days after which both came back negative. Recently I did the IGG/IGM test (31 days after). IGG results came negative (0.21), but IGM came back positive at 1.31 (I am aware that IGM is not necessarily reliable). I have been tested for every other STI and everything has come back negative (in addition to throat swabs).

The doctors are recommending that I start antiviral treatment. I am returning from Thailand in 10 days, and my primary concern is not infecting a sexual partner that I have back home in case I do have it.

I have requested another test (IGG/IGM) since they are adamant about moving forward with treatment. Results should come back in another couple days.

Based on the information above what is the likelihood that I’ve contracted HSV2?
Should I disregard the doctor’s advice based on the IGM results?
Should I move forward with antiviral treatment anyway to reduce the likelihood of transmission? Will this have an impact on future testing? Should I try applying Acyclovir for the spots?

[anon3333]

Hi Terri,

A few other things I would like to note:
1. The dark spots seem to completely disappear at times, then it will reappear. They are painless and I am still trying to figure out what triggers the reappearance (maybe after a shower or when it gets wet?).
2. 3 days the after the exposure the burning sensation began. However I noticed that this was right after I had played several hours of basketball outside in hot weather with tight spandex. I thought this could have caused it, since all the STI tests came back negative. My understanding that orchitis and HSV2 is not correlated (bacterial/fungal). I went on strong Cefriaxone IV drip for 7 days which cleared this up.
3. I can’t find any resources on PCR blood test – but the doctors seemed to be very confident with the results. Would a test like this be appropriate 14 days after exposure? Is it worth doing this test again?

[Terri Warren]

A blood PCR test should never have been done. Herpes is not in the blood stream normally and no one recommends doing this test. your provider misunderstood how PCR testing should be done. PCR for herpes is a swab test, not a blood test. It is a shame that the test is even available for use except in the case of perhaps disseminated infection in a neonate or severely immunocompromised individual.
The likelihood of getting HSV at a single encounter that was at least partly protected is, in itself, really low.
The dark spots are not related to HSV
The IgM test is totally useless and is being discontinued in the next two months by labCorp and Quest and has been already discontinued by the Mayo Clinic lab
Clearly,the provider that you saw is not up to date on appropriate herpes testing and I think prescribing antivirals to someone with your symptoms and type of contact is not necessary

Terri

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