[Question #1671] Herpes? Balanitis? HSV-1 Genital Exposure

45 months ago
Recently had a girl perform unprotected oral on me, and she had a cold sore. Dumb move; didn't see it until after. I know from an IGG test a while back that I'm negative for both HSV-1 and 2.
About a week later I go to the doctor, he gives me a shot of rocephin and 10 days of doxycycline. I was allergic to the rocephin and had to be given a steroid shot to counteract the hives it produced. This was all done preventatively and I wasn't tested. Also after reading here and CDC, I'm not sure why doxycycline was his first choice, or why he gave me a 10 day script for it. 2 days into the doxy, and around 8-9 days after exposure, I notice the head of my penis is looking red/splotchy. I notice it mostly after a shower, and chalk it up to heat.
Exactly two weeks after the exposure, I got testing at a clinic for gonorrhea, chlamydia, syphilis and HIV. All came back negative. I still had 3 days left of the doxycycline to take, and I took it until it was finished.I finished the doxy pills about 6 days ago. Yesterday I went to the dermatologist, because The redness was more pronounced, and it even looked slightly white in places. Glans is also ashy/dry when I'm erect (never had this problem before). Google said that could be balanitis. After a quick visual, he gave me an anti-fungal cream and a mild steroid cream. I'm circumsized and have never had a yeast problem in my life. Logic just keeps telling me that this HAS to be bacterial and not a yeast problem.Through all of this I've had no burning urine. I felt like I had some completely clear discharge off and on, but it isn't consistent. Regardless, there has been no abnormal discharge that pictures show of gonorrhea and chlamydia. And while I've been checking myself I've seen no classic herpes blisters.

1: Can I trust the gonorrhea and Chlamydia test even though I was on doxy at the time of the test?
2: Could NGU cause balanitis even without discharge?
3: Could this be caused by herpes under the glans of my penis? How would I know?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
1.  The doxy is adequate to treat the chlamydia but not gonorrhea if you happen to have that but the Rocephin is enough to treat it, if you had it.
2.  NGU doesn't really cause balanitis - fungal infections do mostly but you could also have a drug reaction to the doxy.  Or it could be the heat of the shower as you suggest.  I guess your dermatologist agreed that a fungal infection is most likely. 
3.  Herpes lesions would look quite different than what you are describing, to me.

Have you ever had a cold sore?

Terri
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45 months ago
I've never had a cold sore and I was negative on an IGG test a while back for both HSV types.
The dermatologist didn't do more than glance visually, no looking with a light, no magnification or anything.  I'm afraid that he made an assumption that it was fungal. 

I'm especially terrified of the steroid cream, because it will cause a bacterial infection to worsen, and I've heard that steroids can trigger a herpes outbreak. Now that I'm three weeks out, am I correct in thinking I'm "safe" from the typical initial outbreak that people get? I'm terrified that the cream will cause me to have a terrible reaction and break out with my (possible) newfound herpes infection.

1: I'm not sure I was clear in my question (Sorry!), would doxycycline somehow skew the test results and give me a negative, or can I believe that the negative was accurate for chlamydia and gonorrhea?
2: In the absence of visible blisters or canker, and discharge, how safe is it to rule out syphilis, herpes, NGU and other orally acquired STI's for this balanitis?
3: Would it be safe to apply the anti-fungal and see what happens?
4: How much faith could I put into a negative IGG blood-test for HSV-1 and HSV-2 at 6 and 12 weeks post exposure? I keep seeing conflicting numbers.


45 months ago
I just want to be sure my follow up questions have been seen. Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Doxycycline would not skew the herpes test, no, not positive what you are asking here.  If you had chlamydia, it would probably skew that test if you took the test after starting doxycycline, as it would be treating the chlamydia infection and the chlamydia test would then might be negative.  I think i the absence of visible symptoms, herpes is really unlikely and I think syphilis is also unlikely as well.
I think it is absolutely fine to start the medication.  In my many years of practice, I found fungal infections pretty easy to diagnose so even your doctor didn't take a long time to evaluate you, it seems a very reasonable diagnosis.
At 12 weeks, I think the HSV 2 test is about 95% sensitive, and the HSV 1 test is about 70% sensitive.  The HSV 1 test is clearly not as good as the HSV 2 test.

Terri
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45 months ago
Sorry, what's in my head isn't translating well to text!

basically, if I go get retested, how likely would it be that the gonorrhea and chlamydia results will still be negative? For example, is it possible the doxycycline somehow suppressed the DNA test, making it negative, but I actually do have it (possibly because it was resistant to the doxycycline, but it still relieved some symptoms for a while).

How would you know that it is a fungal balanitis and not bacterial without taking a sample?

In a recent post, Dr HHH said you were part of a recent study that showed HSV-1 igg was closer to 95% accurate. Is that false?

Would herpetic balanitis have obvious herpes blisters accompanying it on the glans?

Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
If you get tested again, the chlamydia test should be negative because, if you ever had it, the doxycycline would have cured it.
Candida balanitis is classical looking - very typical presentation.  But I guess one cannot be 100% certain without a lab test which I almost never did because candida balanitis was so typical looking and antifungal medicines cured it.
I think you might have read that incorrectly - it is HSV 2 that picks up about 95% - HSV 1 test is about 70%
Herpetic balanitis is quite uncommon in my experience, without lesions on the penis shaft as well,  and the lesions look quite different from candida balanitis.

Terri
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