[jkjkjkjk42]

hi terri.
i posted a question last month but i think it got lost in the many questions you receive.
no need to answer those.
but i do want to ask a different question.
to summarize: 15 months ago after protected vaginal sex and unprotected oral sex, i developed a small area of redness that never blistered or ulcerated. it resolved in about three days.
i had negative western blots at 4 months and 6 months post encounter.
i have had very tiny areas of redness develop after the initial one but almost every one of those has been seen by a dermatologist and each time they were certain it wasn’t herpetic. at my pushing, three times they did an hsv pcr- all negative and i had one negative culture.
i still find it tough not to check myself frequently and when i do i of course see things that are likely completely normal- fordyce spots, blood vessels that worry me.
i’ve had an initial intake for cbt for ocd and i’m waiting for them to schedule me for therapy.
given all the above time, testing, and atypical nature of the first rash, i know that it’s almost or even completely certain i don’t have herpes.
would you agree with that?
but i know herpes can be tough to diagnose and can present many years after exposure so i’m just not sure if i can feel safe not closely monitoring myself.
given all my negative testing what if anything should i be looking for that would prompt me to see a doctor?

[jkjkjkjk42]

sorry. just to add..
what’s making me realize that this is anxiety driven is that when i started i though i had long established oral hsv1 but now realize that what i was seeing were probably pimples.
had i actually had recurrent hsv1 orally which is very common i would be shedding more often than genital hsv1 infection. and i know you said you’ve never seen a confirmed transmission of ghsv1 to ghsv1 and even the risk of transmitting ghsv1 to someone else’s oral area is probably lower than transmitting it from oral to oral.
is that all somewhat accurate?

[jkjkjkjk42]

thank you.
Thank you also for your patience. i realize that my predominant problem here is anxiety.
i’ve finally put away any anxiety about having hsv2. the combo of the negative blot and that despite carefully paying attention for 14 months i’ve never had a blister, sore or anything else means that the chances of hsv2 are astronomically low.
i’m still a little worried about genital hsv1. ive had anything that i was suspicious might be herpes looked at by a dermatologist and i’ve also had 2 negative pcr swabs.
i realize this makes it exceedingly unlikely i have hsv1. but i have also read that genital hsv1 can occur infrequently or not at all or that a first recurrence might only happen more than a year out. so i guess i also see that while my anxiety is mostly driving this what i’m afraid of isn’t impossible.
i know the blot should be my last test but do you think i’m also at a point where i should totally see this as anxiety related? i’m seeking counseling regardless.
how often have you seen a first recurrence of genital hsv1 more than a year out?
how often did you personally see blot negative hsv1 genital? did those folks have more than one swab that was positive?

[jkjkjkjk42]

hi terri,
thanks for all your help last year.
i waited and since i couldn’t kick the concern, had a western blot.
it was negative for both hsv1 and hsv2.
is there any data on how sensitive the blot is for hsv1 and hsv2?
i think i saw that you recently wrote it was 96% sensitive for hsv1? is that correct? what was it compared to?

[jkjkjkjk42]

Hi Terri,
Thanks again for all your help.
Just got the results of my latest IgG and at 100 days it is negative. I know you said 12-13 weeks was ok. But I waited a little longer for certainty.

To review:
After protected sex I noticed an area of redness near the base of my penis on one side that never blistered or ulcerated and cleared in three days.
Of note, I went for an aggressive run in cotton underwear the day that happened and the underwear bunched on that side and the redness fit exactly the shape and slope of the underwear seam.
In the weeks since, I’ve had several episodes of achy testicular pain and tingling. I’ve also had a sense of irritation in my penis twice that lasted a few days.
I’ve never seen any blisters or ulcers. A few times I’ve seen a very small area of redness in the same general area of my penis that never ulcerated or blistered and each time cleared in less than a day. I showed the area to a dermatologist and my PCP and neither thought it was herpetic.
I did have about 28 pills of valtrex over about 17-18 days but none now for about 11 weeks and have had a total over 80 days off of valtrex.

I do believe I have oral HSV 1. But tested negative.

My questions:

1. Any value in additional IgG testing or is this now a negative that’s likely to remain that way?
2. When do you actually recommend Western blot testing to your patients to rule out a false negative? I.e. Are there circumstances other than patient peace of mind that prompt you to suggest it? Or is it always patient driven? Would mine be a situation where you would recommend it for anything other than peace of mind?
3. I know that this is tough to say online but given the negative IgG, the lack of blisters/ulcers, the fact that it was a one time exposure with a condom, a possible other explanation for the initial rash what do you think the odds are that I was infected with a new genital herpes infection?

[jkjkjkjk42]

Hi Terri,
I’m still planning to test again at 12.5 weeks. But I got a little inpatient and tested at 10.5 weeks too. It was again negative. It’s also been negative for HSV1 though I’ve always had oral cold sores. I haven’t had any skin lesions that lasted more than a few hours. But I have had fairly diffuse genital pain/tingling. It comes and goes and lasts for a about a day or two once every couple of weeks. Last night it was uncomfortable enough that it woke me up several times.

1. Have you noticed any correlation between folks who test false negative for HSV1 being more likely to be amongst the much smaller group who test false negative for HSV2?
2. I read somewhere that labcorp and quest use different assays. All my tests have been at lab corp. do you ever advise testing with a diffferent assay?
3. I’m assuming that the rate of seroconversion over time is non-linear and asymptotic making it possible that I could still seroconvert in the next two weeks but much less likely than the two weeks between say weeks 4 and 6 post exposure. Is that accurate?
4. Have you seen frequent genital pain and tingling in GHSV like I’m having without overt lesions? From what I’ve read the frequency and lack of association with skin findings is atypical.

[jkjkjkjk42]

Thanks Terri. I was at less than 0.9 again at 8.5 weeks.
After reading other posts, I did stop the Valtrex about 4 weeks before the most recent test. I believe I had a total of 10-12 days of treatment dosing and a few days of suppressive therapy.
Would that change the greater than 70% chance of remaining negative at week 12? Is that still when I should next test?
The redness never turned into anything else and I’ve still not had anything that could’ve been a lesion (just a red bump) that lasted more than 12 hours and the initial redness that lasted about 3 days but never formed vesicles or ulcers though I was on Valtrex.

[jkjkjkjk42]

Thanks again for all your help. As an update, the area of slight redness never ulcerated, raised or formed vesicles. It’s not tender to friction. It looks like a couple of small capillaries on the surface of the penis.

[jkjkjkjk42]

Hi Terri,
Thanks for your reply and for all that you do. I purchased another round of questions because I will likely want to run my follow up tests by you. I am planning to go for the next IgG on Monday which will be 8.5 weeks after possible exposure.
My question is if I should go to my MD for a possible swab. On 10/15, 10/16, 10/17 in the evening my penis felt a bit irritated. I had a brief 5 minute episode of numbness at the tip as well. Nothing else really. Yesterday (10/19), I noticed a very, very small area (1/8 inch) of very light redness that is only apparent with very close inspection and disappears when I lay down. It isn’t tender to the touch. It isn’t warm and there are certainly no blisters that have developed and no ulcers. I have a feeling that if I went to the MD they would likely dismiss it. What is the value of the swab after what might have been a prodrome and with only a slight small area of possible redness? Can you see an outbreak with just a slight area of redness, no other symptoms and no blistering or ulceration? Even with very close inspection, now at 8 weeks out I have never seen a blister or an ulcer. Does that mean anything?
Also I saw you mention a new study showing that consistent condom use reduces transmission risk by 96% and separately that the risk of male-female HSV2 transmission with sex twice a week without protection but with suppressive valtrex is about 5%/year. Is there any way to think about those two numbers together to estimate the risk of transmission with always using condoms and with Valtrex?

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