[Question #1650] STI Risk and Testing

44 months ago
Testing
44 months ago
Drs.,

You can go back thru our prior correspondences to get a bit of back ground.         Since I last spoke to you I have taken a 4th generation HIV test at day 25 which was negative.    Due to the holidays, I figured 28/25 days statistically wouldn't make that big of statistical difference.   I accepted that and moved on.   I also  took 2 separate chlamydia/gonorrhea tests well within the window which were also negative.

Fast forward to 5.5 weeks after exposure.    I developed dry skin on my thighs right up to the groin area.   I put some lotion on it.  A day later I felt a burning sensation.    After a search of google for burning thighs, one of the possible causes listed was herpes.      I examined my genital area but didn't see any rashes/lesions.    Nonetheless, I order an IGG herpes test for HSV-2 along with a syphillis (might as well get em both done).  This was 2 days shy of 6 weeks post exposure.    I didn't bother checking for HSV-1 because I already have cold sores.     Both tests came back negative.    I understand the syphillis test is conclusive at 6 weeks (not too worried there), but the HSV-2 IGG test at 6 weeks would only pick up approximately 70% of new infections.

A week later (yesterday), I found a red spot on my penis near the head.    It was on the underside and is usually covered by the foreskin (I am uncircumcised).      Its not easy to find unless one really looks.  There are several tiny bumps(they don't look red) in that red area.   I may  have seen it before, but not really sure anymore.  Out of caution, I went in to see my doctor who took a look at it and said it may be herpes.    If so, its a secondary infection since its only on  1 side and very mild.  She's 80/20 that its not, but to reassure me, she's ordering a IGG for HSV-2.    She diagnosed me with some skin condition for my legs (I can't remember but the 2nd word started with a C), but all I heard was possible herpes.

My questions:

1.   How confident should I be for my negative 4th generation HIV test at 25 days given my circumstances?  Would you recommend retesting?
2.   How confident should I be for my negative syphillis test at 2 days shy of 6 weeks?  Would you recommend retesting?
3.   Does this sound like herpes to you?
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.
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.

Sorry, but this has been quite an ordeal.



Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

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


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44 months ago
Thanks for your prompt reply.

In all honesty I haven't been too worried about most of this stuff since my negative 4th generation  HIV test with the possible exception of HSV-2.    Only because that is one of the ones that can be transmitted via skin to skin contact.  

To clarify - I meant my PCP thinks that if it is HSV-2 its a recurrent lesion, not an acute/initial one.      My brain is in a fog, so typed secondary by accident. Even though she's 80/20 that its NOT, but she wants me to take the IGG for peace of mind.   No, she does not know that I already took one a week prior that I ordered myself.

1.   What weight or what view would you give to my PCP's opinion?  

2.   To clarify - my question # 4, if what she saw is a HSV-2 recurrent lesion (I may have missed the acute one during first 10 days), would an IGG antibody test  now be positive?    Meaning, if it's still negative, my current symptoms/lesion are not HSV-2 related.    

3.   Also, the area where this "lesion" is, is an area that is covered by a condom.     I remember you said that the acute lesion would be at a spot where the virus entered the body via an uncovered area.    But what about if this lesion is a recurrent one?  Meaning, would it be possible that it occurs at a different spot?

Thanks.   I'm trying hard to move on from this.









Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

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

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44 months ago

Not exactly.

I'm not suggesting that I did  not have a primary outbreak.  But from what I've read,  people with HSV-1 (me) who gets infected with HSV-2 might have had primary outbreak that was not very noticeable. That is, the HSV-1 antibodies masked or muted the primary outbreak.  I did complain about discomfort on my genitals right around the 5-10 day mark and then it went away.  

The recurrent lesion is in a spot that is not very easy to see.    Its essentially on the foreskin on the underside of the penis.    I am uncircumcised.   You would have to pull it all the way back and sort flip the penis over to see it.   If I had a minor primary lesion I can see why I missed it.      

What she told me yesterday was that if what she saw is HSV-2 related, my Igg test that she ordered for me, which I took today, (7 weeks) at her office would be positive and I believe that echoes your sentiment as well.     I'm also getting it swabbed.        

What I was confused about  was my test from last week (6 weeks) that I ordered myself (my PCP is unaware of this - had she been aware I am not sure if it would have changed her 80/20  diagnosis).  This test was  thru labcorp and was negative.    However, this was before I noticed the lesion.

So, my last question is - if my IGG at 6 weeks was negative, how likely is that a "lesion" found approximately 6 days later is HSV-2 related.   

There's really nothing much more to add.  Thank for for you re-assurance.     If you keep it open another week, I'll report back with my results.  
Edward W. Hook M.D.
Edward W. Hook M.D.
44 months ago

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

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