I am sorry to find you returning to our site once again.  From the looks of things, you continue to worry that any variation in appearance or sensation that you experience on or close to your genitals is a reflection of an STI from your earlier, very low risk exposure.  This is overkill.  As Dr. Handsfield said in his original reply “t sounds like your partner is unlikely to be infected with HIV or STDs. Even if she was, you went about the event with maximum sexual safety. It is virtually impossible you have HIV, and your symptoms don't sound like it.”  This statement hold for other STIs as well.   Further, you have compounded your problem by searching the internet for an explanation of your perceived symptoms and abnormalities. This too is overkill and will mislead you far more often than it will be helpful to you.  I urge you to move forward from here, to not test further, and to believe the test results than you have.

With that preamble, on to your questions:

1.   How confident should I be for my negative 4th generation HIV test at 25 days given my circumstances?  Would you recommend retesting?

I would urge you to accept these test results, there is no need for additional testing.

2.   How confident should I be for my negative syphillis test at 2 days shy of 6 weeks?  Would you recommend retesting?

I would be completely confident in these results.

3.   Does this sound like herpes to you?

No, not in the least.

4.   If this is indeed a secondary infection, would another IGG test done tomorrow pick it up?   If I do it tomorrow it will be 1 day shy of 7 weeks.

I'm not sure what you are referring to as a "secondary" infection.  This term typically means an infection of a lesion or area that already has a problem associated with it.  For instance, when a cut gets dirty and infected, this is referred to as a "secondary" problem because it is occurring in addition to (i.e. secondary to") the original cut.  I would not think an IgG test will be helpful

5.   Is there any other STD that I should be concerned about?   I understand condoms are not super effective against STDs transmitted by skin to skin contact.

I really would not be worried about STIs of any sort in your current situation.  Condoms are highly effective for preventing STIs but sometimes do not prevent infection of areas that are not covered by the condom.  Most STIs occur however in the regions that condoms typically cover.

Hope this helps.  EWH

1.   The scenario you describe is most unlikely.   You are suggesting that you acquired HSV-2 but did not have a primary outbreak, then had a recurrent lesion.  With all respect to your PCP, if the lesion that concerns you was due to HSV-2, your HSV-2 IgG would have been positive. 

2.  See above.  If you had a recurrent lesion that was "missed" I would expect your HSV-2 IgG to be positive.

3.  HSV recurrences do not necessarily have to occur at the site if the initial outbreak although that is the typical occurrence.

I really think that continuing to worry about HSV-2, or any other STI for that matter, is not productive.  EWH

I suspect that if your PCP knew of your other recent negative IgG test, she would have stated that it was most unlikely that the area you noticed was due to HSV.

With a negative IgG at 6 weeks is most unlikely that the area you noticed six days later was HSV.  I would also not anticipate that your blood test would change over a period of 1-2 weeks in your situation unless it became falsely positive as does happen not uncommonly. 

If you are going to have the lesion swabbed, my advice would be to be sure that the test performed is a PCR type test, not just a culture which is far less sensitive than PCR.

I'll keep the thread open for your test results.  EWH