[Question #140] Need help!

113 months ago

I had protected vaginal sex and unprotected oral sex on July 16th. When finishing, I realized a bit of vaginal fluid on the lower part of my abdomen that I wiped away. I did shave my pubic hair a few hours prior to this exposure. About 5-6 days later, I noticed a sore on the base/almost top part of scrotum area. I assumed it was from shaving. It had clear fluid and had 2 hairs inside of it. On July 26th evening, my inguinal lymph node on the same side got swollen. Next day I went to the doctor who did NOT swab, he simply looked and said it didn’t look like herpes and he prescribed antibacterial cream and it went away in a few days and did not scar. He also prescribed doxy which made the soreness of lymph go away but the lymph node was still present and didn’t go away fully (I can still feel it now and bothers me). We ran a full STD panel and herpes 1/2 IGM which came back negative. On August 17th, we ran another STD and IGM test which also came back negative. On August 31st, ran a IGG and IGM test and HSV 1 IGG came at 20.3 and HSV 2 IGG came < .91. Around this time, my throat was also painful on both sides for about 2-3 weeks so I took a Z pack – made soreness for most part go away. On September 16th (9 weeks after encounter), I did yet another STD test and IGG and IGM and HSV 1 IGG came at 1.90 (positive) and HSV 2 IGG was .14 (negative) BUT the combined HSV 1+2 IGM AB came positive – which is scary. My questions:

1. Is it likely that I got HSV 2 from the vaginal fluid that was on my lower belly and may have seeped into a cut from shaving? Forums/sites are conflicted on whether the fluid would transfer HSV2 – many say no, many say yes.
2. Do the numbers I presented give any hint that maybe I don’t have HSV 2 – would a low # at 9 weeks be indicative of that? I do plan on testing at the 12 week mark – can I count that as pretty much conclusive? Need some reassurance.
3. I don’t recall ever having HSV 1 or cold sores – is it possible that I contracted HSV1 genitally and possibly orally?
4. Why would my HSV1 index be so high during the initial test and then drop down to 1.9 a few weeks later. Does it mean anything?
5. I’ve developed anxiety and my throat has been hurting and developed shortness of breath that is still present now. Can this be herpes related (larynx sores?) or more so the anxiety? Would oral herpes symptoms last that long?

6. The biggest concern is the lymph node swelling - I was convinced that i have something as a result of that and the timing - since i've never had a lymph node swell in my entire life. Could this be related to something else and how long does it take for me to not have any pain from the lymph node - it seems to be pressing up against a vein or something that has been an annoyance.

Thanks!

H. Hunter Handsfield, MD

113 months ago

Welcome to the forum. Forgive the delayed reply -- our goal is to answer questions within 24 hours. However, Terri Warren just requested that Dr. Hook or I reply, since she apparently has answered the same questions on her clinic forum, and she thought you might appreciate a response from someone else. However, it is unlikely you will hear anything from me that you didn't hear from her.

In general, HSV is not transmitted by superficial, fleeting contact. Just getting infected fluid on skin is not sufficient. Usually the virus must be massaged into the tissues -- which is why initial herpes lesions almost always occur at the sites of maximum friction during sex, such as the penis head or shaft in men or the vaginal opening or labia minor in women. Getting vaginal fluid on your lower abdomen carried little or no risk of infection. Second, the IgM HSV antibody tests are notoriously unreliable. Herpes experts never order them, and I always recommend ignoring the results when done. In particular, they are prone to giving false positive results -- which is the most likely explanation in your case. The negative IgG test is far more reliable and the only one that matters. To your specific questions:

1) In addition to the comments above, you have no particular reason to believe your partner has a genital HSV infection; or if she does, that she was shedding virus at the time of your exposure. In theory, shaving nicks might increase the risk of transmission, but the chance still was very low.

2) Your test results indicate it is highly unlikely you were infected with HSV2, as indicated by the negative IgG result at 9 weeks. You can expect another negative result at 12 weeks. (Even better, wait until 16 weeks for even more certain results.)

3) Half of all adults have positive HSV1 antibody test results. There is no way to know the anatomic site of infection unless there are symptomatic outbreaks. However, even if you have genital HSV1, probably you'll never have symptoms and never transmit it -- so it really shouldn't matter. (Genital HSV1 is a very different problem than HSV2.)

4) Variable numbers in different tests are meaningless. In fact, the very same specimen tested several times could give widely varying numerical results. The number itself says nothing about the duration of infection, severity, frequency of outbreaks, etc.

5) These symptoms don't sound like herpes, and certainly are consistent with anxiety. In addition, whenever someone suspects his or her own symptoms have an emotional or psychological origin, usually s/he is correct.

6) You indeed must have "had something" to cause the apparent lymph node inflammation. But almost certainly it wasn't herpes. Your own initial assumption and your doctor's apparent diagnosis -- that you inflammation (probably folliculitis) from shaving -- is the logical conclusion. Pain or mild swelling of a previously inflamed lymph node can last many weeks. In fact, the persisting discomfort is strong evidence AGAINST HSV; herpes lymph node inflammation is unlikely to last more than a couple of weeks.

All things considered, I am confident you don't have genital herpes, and certainly not HSV2 from the exposure a few weeks ago. For additional reassurance, I suggest you go ahead with a follow-up IgG test at 16 weeks. You can expect it to remain negative. Definitely do not have another IgM test.

I hope this has helped. Let me know if there is anything not clear, or if you find any apparent disagreement with the advice you already had from Terri. Best wishes and stay safe.

HHH, MD

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H. Hunter Handsfield, MD

113 months ago

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