[Question #1508] Herpes?

45 months ago
I had an unprotected sexual encounter 15 weeks ago with a woman of unknown status both vaginal sex and oral given and received. I have tested negative for all std's at the relevant window periods and again at later intervals to confirm to rule these out. I developed a small ache in my left testicle at 5 days post exposure which lasted for one to two weeks and progressed into shooting pains in testicle on one particular night which kept me up all night. This was accompanied by a generally uncomfortable feeling in the groin area and a slight burning feeling above my right knee. No swollen nodes and exhammened by a dr on numerous occasions. A small lump on the testicle was discovered but was suspected to be a thickening of the epidermis, ultrasound confirmed no problems. I took a type specific blood test for herpes at 3 weeks, negative for both tested again every week since and have returned negative results for both types every time.  Thinking I had herpes in started to take aciclovir for around 2-3 weeks at 8 weeks post exposure and have had no pains since but a few days after I stopped taking it I got about 10 spots on the inside of my left thigh and a couple on my right thigh. Dr said they were not herpes and just looked like normal spots maybe from changing soap or something. They were painless, not clustered, not really raised, were red with a small white centre. These lasted for about 3-5 days, I swabbed two of them for a pcr test both negative. I have also sent about 4 urine samples for pcr testing, again all negative. I have had no pains etc since the 8th week and am now at 15 but still testing negative. My question is, do I have herpes? Why is it not showing up on the blood tests? Will it ever show up on the blood test? The dr's think it's all down to anxiety, some said mild staph infection, another said mild folliculitis. Should I continue testing? Am I safe to continue having sex?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
If you are testing negative on the IgG (please be certain it was that test and not the IgM test), at 15 weeks post exposure, there is about a 95% chance that you are truly negative for HSV 2 (compared to the herpes western blot).  I would also expect any herpes lesions to show up on the penis first, not on the thigh first and your description of the lesions sound nothing like herpes.  The fact that a doctor saw them and said there were not herpes is also very significant.  Also, I would expect herpes lesions to be a bit clustered, raised and tender.  Perhaps you have folliculitis on the thigh or a fungal infection?  Also, herpes does not cause testicular pain.  You took acyclovir for 2-3 weeks total?  It can impact your antibody test but I think 15 weeks is likely long enough to wait as I would ask people normally to wait 12 weeks from exposure for IgG testing, 16 weeks for western blot.  No one can tell you that there is a 100% chance you didn't get infected with herpes, but I surely don't think so!  

Terri
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45 months ago
It was definitely an igg type specific antibody test, I have had them from two separate labs,  they do not give a numeric count, just say positive or negative.  I have also had an at home rapid hsv2 test which was negative at 14 weeks.  The pcr swabs I took were taken about 4-5 days after the spots appeared so I know these are not very accurate.  how accurate is a pcr swab? I'm told the virus dies off outside the body, so wouldn't it die off on a swab on the way to the lab? Also is it true some people will not get a positive blood test ever or for at least 6 months? Thanks for your previous prompt reply.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
PCR does not depend upon live virus.  it looks for the genetic material of herpes which does not require live virus.  Culture does require live virus, on the other hand, which is why PCR is so much better than culture.  
I have had 9 people in 33 years of practice who had positive swab tests and negative western blot tests.  The IgG misses about 5-7% of HSV 2 infections and about 30% of HSV 1 infections, compared to western blot.  

Terri
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45 months ago
Thanks for your time, with the western blot test not available where I live I guess there is no way to know for sure, I have ordered swabs which I will keep at home so if I get more spots I can get a sample straight away.  I will take another blood test in a couple of months, if this is negative and I have no more spots appear can I assume I am negative? It's an awkward position to be in, I think I have it, but all testing and drs say otherwise, I just don't want to chance infecting someone else. And testicular pain is definitely not a sign of heroes infection? It seems strange that it appeared a week after the encounter and the spots a few days after I stoped taking aciclovir. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Bacteria cause testicular infections.  remember that there are bacterial infections that are you not routinely tested for in an STI screen - particularly mycoplasma genitalium so if your testicular pain continues, you might consider speaking with your provider about treatment.  There is no routine testing available yet for M. Gen. 
Again, I think with 95% certainty, you don't have HSV 2.  That's a very high accuracy rate for a test, I think.

Terri
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