[Question #10510] Typical HSV genital presentation / testing
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22 months ago
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Doctors, thanks for all you do! Here's my situation:
+About a week ago, went to dermatologist with testicles that were red and kind of inflamed. BOTH testicles were sort of all-over red, irritated. Dermatologist at the time seemed to think this was just irritation, prescribed hydrocortisone.
+I have also been dealing with HPV warts and so have been applying a number of medications around this same time period, including imiquimod. (Although I was not applying any of these medications directly to my testicles, more on fold of groin and shaft of penis.)
+Today, a week after initial visit, I went back to derm because testicle irritation hadn't fully cleared up. While the skin on both testicles had settled down a bit, one patch on right testicle was still a bit sore, and had kind of crusted in a way. Dermatologist did a culture for HSV just in case.
MY QUESTIONS:
1. Does the fact that BOTH my testicles were very red and irritated point away from HSV as a culprit and more toward contact dermititis, something else? Are there other conditions that could lead to sort of scaling/crustiness on the skin in that area that are not HSV?
2. I'm obviously hoping the culture is negative, but given the timeline and my knowledge of these things, a negative result isn't going to really let me breath totally easily. If I wanted to follow up with HSV blood testing, do you have any specific recommendations in terms of time to wait; specific tests to look for or request; etc? I know Western Blot is the 'gold standard' but I just got off the phone with U of W and the process seems...much more complex than I want to pursue at the moment.
Thank you!
+About a week ago, went to dermatologist with testicles that were red and kind of inflamed. BOTH testicles were sort of all-over red, irritated. Dermatologist at the time seemed to think this was just irritation, prescribed hydrocortisone.
+I have also been dealing with HPV warts and so have been applying a number of medications around this same time period, including imiquimod. (Although I was not applying any of these medications directly to my testicles, more on fold of groin and shaft of penis.)
+Today, a week after initial visit, I went back to derm because testicle irritation hadn't fully cleared up. While the skin on both testicles had settled down a bit, one patch on right testicle was still a bit sore, and had kind of crusted in a way. Dermatologist did a culture for HSV just in case.
MY QUESTIONS:
1. Does the fact that BOTH my testicles were very red and irritated point away from HSV as a culprit and more toward contact dermititis, something else? Are there other conditions that could lead to sort of scaling/crustiness on the skin in that area that are not HSV?
2. I'm obviously hoping the culture is negative, but given the timeline and my knowledge of these things, a negative result isn't going to really let me breath totally easily. If I wanted to follow up with HSV blood testing, do you have any specific recommendations in terms of time to wait; specific tests to look for or request; etc? I know Western Blot is the 'gold standard' but I just got off the phone with U of W and the process seems...much more complex than I want to pursue at the moment.
Thank you!
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22 months ago
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Also extra context re testing. I used to have IgG herpes testing done as part of regular std panel. Probably had this test done 5+ times and always firmly negative, no equivocal or low positive results. So hopefully I am less prone to potential false positives which has been my main reason for no longer doing hsv testing as part of regular std workups.
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Terri Warren, RN, Nurse Practitioner
22 months ago
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1. Does the fact that BOTH my testicles were very red and irritated point away from HSV as a culprit and more toward contact dermititis, something else? Are there other conditions that could lead to sort of scaling/crustiness on the skin in that area that are not HSV?
That ASBOLUTELY points away from herpes. Your symptoms sound nothing at all like HSV !
2. I'm obviously hoping the culture is negative, but given the timeline and my knowledge of these things, a negative result isn't going to really let me breathe totally easily. If I wanted to follow up with HSV blood testing, do you have any specific recommendations in terms of time to wait; specific tests to look for or request; etc? I know Western Blot is the 'gold standard' but I just got off the phone with U of W and the process seems...much more complex than I want to pursue at the moment.
2. I'm obviously hoping the culture is negative, but given the timeline and my knowledge of these things, a negative result isn't going to really let me breathe totally easily. If I wanted to follow up with HSV blood testing, do you have any specific recommendations in terms of time to wait; specific tests to look for or request; etc? I know Western Blot is the 'gold standard' but I just got off the phone with U of W and the process seems...much more complex than I want to pursue at the moment.
The IgG test yields many false positive results and I would recommend against it, as does the CDC, as you seem to know already.
The blot process is doable but yes, a bit time consuming. I work with patients all over the US to get this test done and it is surely workable. However, if these symptoms are your concern, I wouldn't bother - they seem completely unlike HSV to me.
Terri
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22 months ago
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Thanks Terri! That makes me feel better.
Re: the IgG test...I know it can generate false positives, BUT i have had this test like 6 or maybe even 7 times, all flatly negative. Would that suggest I'm not prone to false positives?
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22 months ago
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And lastly, in terms of what doesnt seem HSV-like about what I'm experiencing...is it the fact that the first signs i saw were red/inflamed skin on both testicles (pretty much entire testicle area was red and irritated looking)? Even though a few days later there definitely was a smaller isolated patch of skin that was a bit scaly/dry/kinda crusty in a way?
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22 months ago
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And REALLY last question...if i do go ahead and get the IgG test, how long should i wait?
And after that time period, forgetting false positives for the moment--a **negative** result would be pretty reliable?
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22 months ago
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Terri, I think (?) this question is still live, hopefully! Please ignore my other follow-ups, this is the only important one following some test results. Would love your final advice!
To recap:
+I went in initially to dermatalogist with irritation on both testicles--just kind of red, inflamed skin. Doc initially thought it was just something to do with riding a bike, general irritation, etc. Prescribed hydrocortisone which I started using.
+Irritation didn't really go away. I returned to derm one week later for visual exam with different doctor. This doctor swabbed for HSV to rule it out.
To recap:
+I went in initially to dermatalogist with irritation on both testicles--just kind of red, inflamed skin. Doc initially thought it was just something to do with riding a bike, general irritation, etc. Prescribed hydrocortisone which I started using.
+Irritation didn't really go away. I returned to derm one week later for visual exam with different doctor. This doctor swabbed for HSV to rule it out.
+Culture swab came back negative for both HSV1 and 2.
+Returned to dermatologist again (!) for another visual look/2nd opinion. This was on the following Tuesday, so about 9 days after the initial red testicles visit. This derm said that it looked more like dermatitis, based on the fairly widespread area of irritation and how it was healing.
GIVEN all this, here's my plan:
+Return to derm for culture swab if anything similar reappears in the future.
+AVOID doing IgG blood testing for the sake of my own mental health, and since given the above it is probably not warranted.
+Return to derm for culture swab if anything similar reappears in the future.
+AVOID doing IgG blood testing for the sake of my own mental health, and since given the above it is probably not warranted.
What do you think? I mainly want to feel like I'm doing my due diligence, being a respectful sexual being in the world, etc etc, without this consuming me or starting a cycle of obsessive worry over future testing. Am I on the right track?
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22 months ago
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And ONE addendum to the very last summary post. One thing I have noticed the past few days--so, a about 9 days after the initial testicle redness started--is a sort of pins & needles feeling on and off in both feet, hands sometimes, also scalp. Is this ever a symptom of herpes? I've seen conflicting things online. My guess is probably unrelated, or stress, but curious.
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Terri Warren, RN, Nurse Practitioner
22 months ago
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Sorry, I'm in India with intermittent internet access.
The fact that both testicles were originally involved leans AWAY from herpes being the cause of the irritation. Even though the imiquimod was applied in a different location, I think it is possible that some could have gotten on the testicles, don't you? And it would definitely be irritative.
In terms of testing: we do advise against the IgG test due to false positives, but if you continue to be worried, you could just do the western blot. It has no false positives. And yes, return the derm as needed.
Many people who are worried about herpes experience tingling and pins and needles feelings. Anything that happens in the scalp or hands has nothing to do with genital infection, probably mostly true for feet as well.
Terri
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