[Question #1014] Herpes 2? Please help.

49 months ago
Hello, 

I have a question about genital herpes and I was wondering if I could maybe get some insight from an expert. 

Around 6 weeks ago I had protected vaginal sex with a csw in one of those Asian massage parlors. The condom remained on and intact throughout the entire duration of the event but the next few days/weeks I started noticing symptoms: 

Day 2: "icy hot" like burning sensation all over my genitals. This lasted for about 3-4 days. It moved from penis to scrotum and back again. 

Also on day 2 I developed a very painful/burning rash in the crease between my groin and thigh.   It was very red and had a bit of an odor to it. I had it swabbed/scraped and tested at an urgent care by my house and it turned out to be positive for bacterial strep. It also really started to clear up after I used some cream the doctor prescribed.

This lasted for a couple of weeks. On day 3 I broke down and went in for herpes testing (I know it would be too soon to tell now) but it came back positive for hsv 1 igg, negative for hsv2 igg, and positive for HSV 1&2 IGM. 

In the past 6 weeks I have not noticed any of the typical bumps/lesions or any other symptoms of hsv 2. 

Here are my questions:
Do my described symptoms sound anything like an initial outbreak of Hsv 2?
What does the positive IGM mean? Could it just be a coincidence or is it a strong indicator that I am HSV 2 positive? 
Does my lack of lesions or other obvious symptoms for 6 weeks mean that I am most likely negative?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
49 months ago
No, your symptoms do not sound like an initial outbreak of HSV 2.  The location of first infection in men who have sex with women is most often the shaft of the penis, not the grease between and leg and body.  The IgM should never be done to try to diagnose herpes - the CDC says that very clearly.  The test has many false positives and in my practice, I have yet to see someone who has a positive IgM seroconvert to also a positive IgG.  It's a terrible test and scares people and some major labs have now completely stopped ordering it - kudos to them. 
You used a condom, your rash was correctly diagnosed, treated and resolved and you've had no lesions.  I would be absolutely shocked if you had genital herpes - shocked!

Terri
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49 months ago
Thank you Terri. I first started looking for help on Medhelp and I was advised by the moderators that you were the person to speak with if I needed more reassurance, so I am so grateful that you answered my question (not that I wouldn't completely respect Dr. HHH or Dr. Hook's answer as well). 

The nurse at the clinic called me on the phone and literally said; "you have tested positive for herpes 1&2 and you need to be treated, have a nice day!" So I went in and paid $30 to speak with the doctor on staff only to find out the IgM doesn't actually mean I have HSV2. The only reason I needed to be "treated" was for HSV1 (and who cares about that??). 

It seems the rash in the crease has returned in the exact same spot as only a little are of raw appearing skin. I went to my dermatologist and she said it's probably intertrigo which is a relief. 

I have heard from other sources that I should not do another blood test for HSV2 until I see some obvious symptoms, such as the painful lesions. Would you agree with this? I would like to avoid another test if I don't need it simply because of the cost. Thank you so much for your time and help,  I really do appreciate it.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
49 months ago
That sounds like terrible care to me - so much wrong there from the wrong test to the wrong attitude to lack of education - you name it.
Are you treating the raw area again ?  With what?  Is it changing?  I don't think you need to retest but I sure would like to see this area clear up and resolve.

Terri
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49 months ago
Terri, the rash looks to be improving. I initially treated it with Clomtrimazol and Betamethasone Dipropionate cream 1%/0.05%. The dermatologist gave me Alcortin A but i think the first one works better. 

I am having some other symptoms however. There is a lot of information online but none very reliable. I am having burning sensations in both my hands and feet. Is this a symptom of herpes simplex 2? Still no blisters or lesions on the penis or anyone else, but the last time I experienced this was about 3 weeks ago when the rash was clearing up last time. Is this the herpes virus moving around my body or is it something else? I ran this question by Dr HHH in one of my last questions and he seems to believe it has nothing to do with herpes but I would love to know what you think. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
49 months ago
No, the herpes virus doesn't move around as your describe.  While burning in your feet could be from herpes, less likely and not in your hands - totally different nerve group.  The thing about the medicine you have applied - if this was herpes the steroid medicines you are using would make it worse.  Steroids take away the cellular immune response and when used, let's herpes flourish so I would not expect the rash to improve with these medicines.

Terri
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