[Question #1699] Question

43 months ago
I recently went to do a routine STI test a few weeks ago.  One of the ones that tests for everything, including IGg antibody tests for HSV1 and HSV2.  Initially I was very happy that everything came back negative, with the one exception of showing positive antibodies for HSV1.  At the time, I had no real concerns about it because I vaguely remembered having sores on/in my mouth at a younger age & how generally common it is.  Then I started reading online about how it could be either oral or genital and I started to worry & dissect all of my past sexual history (I am a man if that matters).  About 5 months ago, I had unprotected vaginal sex with a woman, but with absolutely no oral contact whatsoever.  About a week later I had a small painless red bump not on my penis, but about 1/4 an inch away on my pubic area, which went away within a week.  It did not itch whatsoever and almost didn't realize it was there and I've had no symptoms since.  I've been in contact with the woman in question and she told me she gets tested regularly at Planned Parenthood and has never had any problems.  From all if the reading I've done on your site and others, it seems like genital to genital transmission of HSV1 is quite rare, but not statistically impossible.  In thinking about the sore, it reminded me of sebaceous acne that I've had other places on my body (back, chest, face), and gave me no pain or discomfort whatsoever.   I know that you can not be 100% definitive in your answer, but am I likely overblown in my fears that it could be genital to genital HSV1 transmission.  Your input and expertise are very much appreciated
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
If you have ever had a cold sore, then you will always have antibody to HSV 1, even if that was as a child.  The bump you describe doesn't sound herpetic to me - an adult male with no antibody to either HSV 1 or HSV 2 and newly acquires HSV 1 genitally would like have symptoms 1) on the penis itself and 2) might well be more than one small bump - more like several bumps.  And yes, genital to genital transmission of HSV 1 is uncommon.So yes, I think your concerns about HSV 1 are likely overblown.  If you get one again, you should have a professional look at it and swab test it is they think there is any way it could be herpes, by it's presentation.

Please let me know what other questions you might have.

Terri
---
43 months ago

Terri,  Thank you very much for your reply.  It is very comforting to be able to get the advice of an expert in this area.  I had one quick follow-up question I wanted to ask with respect to the number I received on the HSV1 IGg type which was 20.7 (when the test said anything above a 1.09 constituted a positive result for the antibodies) so it seemed on the high side.  From all that I've read, it seems as if the number reported (whether high or low within that positive range does not matter), just whether it was positive or not.  Can any additional information be gleaned from the value of that number, like how long someone has had the antibodies present in their system (i.e. a high level of antibodies like mine would suggest that its something that I've had for a long time, etc.)?  From all that I've been able to surmise, that number can ebb and flow over time, but that it does not offer any further insight into the antibodies, how long they've been in your system, etc.  That being said, I wanted to get an experts take on that question.  Thank you again for your response below, you provided me with a great deal of peace of mind.  If anything else pops up, I will make sure to have it looked at and potentially swabbed by a Doctor per your recommendation.  Let me know what you think about the above question regarding the IGg number that showed up on my test.  Thanks!!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
So at the level of 20.7, we can only know that you have a well established and robust immune response to HSV 1.  We know you didn't get it a week ago, or even two weeks ago, but we cannot know whether you've had it 30 years or 30 days.  The index value of the IgG test only matters when it is in the low positive range (1.1 to 3.5). In this range, about half of the positives are false positives and need confirmatory testing. 

Terri
---
43 months ago
Terri,

One more quick question. Based upon all that I have already ruled out with my testing, and the subsequent reading I've done; do you think a chancroid should be a concern ?  Based upon all of the reading I've done on this website and others, it seems like chancroids are extremely rare in the US, especially among heterosexual men(something like 500 cases per year I've read).  In a our opinion, is that likely not a concern in my case  ?  From what I've read, it seems like I would surely have more pain and more sores, but I wanted to ask your expert opinion.  Would I expect to have a lot more in the way of symptoms then that one painless bump on my pelvic area that resolved on its own.  I feel like at this point I am likely worrying about nothing, but would really appreciate your expert opinion. Thank you ! 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
I think the chances of you having chancroid is extremely low!  In 33 years of practice in Portland, Oregon, we never once saw chancroid.  Your symptoms would be quite different.  If you told me you frequently traveled out of the country and had sex with people outside the country, I would more slightly more concerned but your bump sounds nothing like chancroid but it does sound like you've been on the internet looking around, yes?  If you want to be more clear about the bump, if it is still there, you should have it biopsied off for greatest clarity.  I think that would give you the answers that you seek

Terri
---