Hello Doctors. I am a twenty year old male. On September 18th I had unprotected sexual intercourse twice with a female. I got tested for all stds a week later. Everything was negative but chlamydia. My partner also tested positive for chlamydia, but did not do a blood test for hsv 1/2 because she is afraid of needles. As far as she knows she does not have either hsv, but she has never been tested for it. Also, I regularly get tested so she must have given me the chlamydia. 

The big thing that has worried me is one small red bump I noticed on the upper right side of the shaft of my penis 17 days after the sex (possibly 18/19 but not sure). I may have dabbed some topical solution on it, but honestly cannot remember. A few days later I noticed that it had opened up into a tiny (sore maybe?) at the top. It then scabbed over. This happened over the course of six days at the most, but may have been four or five. Although it did not look like a typical herpes, the fact that it opened up and scabbed over really freaks me out. 

My questions to you are:

1) Does this sound like a typical herpes outbreak? This never blistered up. It looked more like a pimple as opposed to something superficial, however it still opened up and scabbed over. Should I be worried about it?

2) I was tested at 8 weeks, and everything came back negative. I was also tested this week, which is three months since the incident. I know that most doctors say between 12-16 weeks. If my test comes back negative should I get tested again at four months or let this go? 

So did you just have unprotected intercourse or did you also receive oral sex from her? 
It doesn't sound like a typical herpes outbreak, no, but I always get a little bit concerned if people tell me they have an open sore on their genitals.  Also, 17 days is very late for new herpes to show up.
It's also very good that at 8 weeks, you were negative for HSV IgG is that correct?  Or did you do IgM?  No IgM!  Only IgG.  If your newest test comes back negative, I would say with a rather high degree of certainty that you don't have HSV 2 infection.  Of course, if this ever shows up again you should go right in and have it swab tested. 
It sure would be nice, since she already has one STI, if she would agree to be tested, wouldn't it?

Terri
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I also received brief oral sex from her each time (probably about 2-3 minutes each). I remember Dr. Handsfield said that most cases are actually typical, they just might be mild, since this didn't turn into a blister could it still be herpes? If my test comes back negative should I still be worried about hsv 1? Also, I have tried to get her to go but she refuses. I don't think she is worried about herpes at all because she probably doesn't understand how mild and unnoticeable it can be. And yes, the test was Igg. Lastly, how long does an initial herpes outbreak usually last for? Thank you! 

An initial outbreak lasts 1-3 weeks and I would expect something a bit more dramatic than what you describe if you've never been infected with either type.  So the IgG test misses 30% of HSV 1 infections so I can't give you complete reassurance about this.  Did you use a condom for the oral sex? 
Let's see what the latest test shows, OK?  Then we can talk a bit more.

Terri
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Okay I will make sure to let you know the results. Before I go I'm just curious what do you mean by it being more dramatic if I had never been infected by either kind before? If I have hsv 1 would an initial hsv 2 outbreak not look bad? Also, if I have been tested 4 times since last march (march, may, September, November) and gotten each back as negative is there still a good chance I could have hsv 1 and not know it?  Thank you again so much for your time 

Maybe dramatic wasn't the best word - just more lesions, spread out over a greater area of skin.  And yes, if you already have HSV 1, you might not even notice anything when you got infected with HSV 2.  In my experience, once the IgG test misses and HSV 1 infection, it continues to miss it.  That might not be true every time, but I would say it happens most of the time.  It's just not a great test, the IgG for HSV 1, in terms of picking up all cases.  The good news about the test is that once it is positive >3, it isn't necessary to do any confirmation testing, like with HSV 2.

Terri
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Hi Dr. Warren,

Good morning,
With 95% certainty, you do not have HSV 2.  And yes, it doesn't matter where you might be infected with HSV 1, the test misses it.
It sounds to me like this bump is not herpes, for many reasons, not to mention a negative antibody test.  I think you can move on with great certainty.

Terri
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