[Question #1983] Hsv misdiagnosed

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85 months ago
Hi Doctors,

Around 10 years ago I was diagnosed with balanitis. I received oral sex from a female on a Friday night & again, from a different female on the Saturday night/Sunday morning. 
On the way home, in the early hours of Sunday morning I was attacked, receiving a few punches to my head, and had money stolen which stressed me out.

On the Sunday I noticed a small red painful dot on the head of my penis. 
Over the next fee days a small lesion appeared and it became what I can only describe as very nasty looking and raw. 

I must point out, I never had a cold sore in my life.

When I finally got to the doctor, about a week later he told me it was balanitis and gave me a powder to put on it.
About 2 months later I noticed a tingle in the same area on the head of my penis and the same symptoms again. I had a few out breaks in the next couple of years, one following after I had the mumps and then no outbreaks for around 6/7 years. 

I got on with life, getting married and having a child with my wife. 

We've always used condoms apart from we we're trying to get pregnant. 13 days ago we decided to try for another baby. We had unprotected sex twice, a couple of days later I noticed burning in the head of my penis and red patches.
 This time I went to an sti specialist who said i should have been swabbed and blood tested all those years ago. He did a blood test but said it wouldn't be very accurate, especially after all these years. so I'm assuring it's an igm test. (I live in Ireland) awaiting test results. My wife has no symptoms since the unprotected sex.

Q. Is it likely I got herpes from the oral sex 2 days before symptoms appeared? or could it have been the stress from being beaten up the day before the symptoms appeared that triggered a dormant infection?

Q. or could it be the unprotected sex has caused balanitis?

Q. it's almost 14 days and my wife had no symptoms, is this a good sign? 

Thank you so much for your time.

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Terri Warren, RN, Nurse Practitioner
85 months ago
Your description of a painful, raw looking lesion that has come back is certainly worrisome for herpes to me.  And yes, you could have contracted HSV 1 from receiving oral sex.  Did the doctor do a blood test?  What would be useful is an HSV type specific IgG antibody test.  No IgM.  But even if you do that, it could be falsely negative as the test misses a substantial amount of infections, about 30%.  If you've never had a cold sore in your lifetime, your HSV 1 IgG is positive and your HSV 2 is negative and you have recurrent lesions, I think it would be reasonable to assume that you have genital HSV 1 infection.  However, if your HSV 2 IgG is positive, that would be the cause of the recurrent lesions.  The HSV 2 IgG test is quite good, in comparison.

The red patches you noticed on your penis after unprotected sex:  were they red and raw and painful also or just red spots? 

To answer your question, you could either have HSV 1 from the oral sex (or previous oral sex) or HSV 2, triggered by the traumatic event - the antibody tests will help you with that.
So balanitis is just an inflammation of the head of the penis - normally that is caused by a fungal infection not a herpes infection and you could google it to see if this is what yours looks like.  In my experience, candida balanitis (fungal) presents as scattered red dots on the head of the penis, not a raw painful lesion.

Has your wife ever had a cold sore in your lifetime?  If yes, and you happen to have HSV 1, she will likely never get this genitally.  However, if you have HSV 2 it would probably be a good idea to discuss this with her when you get your results. 

As you can see, the IgG test is going to be useful (hopefully) in sorting out this issue.  If your IgG is negative for both, then I would strongly suggest that the next time you get one of these you have it swab tested immediately and typed (HSV 1 or 2)

Terri
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85 months ago
Thank you Terri.

I showed the latest red patch to the sti doctor who said he though t it was balanitis. It seemed to improve after powder treatment but still a little tender, shiny and red.

He did a blood test on Wednesday and will have results next week. But I think he said it was a non specific test. I think they only do igm in my country.  He also said 'herpes is herpes, it doesn't matter what kind you have' which wasn't very reassuring.

I'm now very worried that it's herpes I've had all along, it's more the thought of passing it to my wife.  I don't want to worry her until I get results.

Would she have shown symptoms by now, 12 days after sex? 

Thank you



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85 months ago
Sorry, I forgot to add that she's never had a cold sore. 
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Terri Warren, RN, Nurse Practitioner
85 months ago
Yes I think if she was uninfected before, I think it would be too late now for symptoms to show up in her if she became infected at this encounter.
If they did a non-type specific test, that isn't going to be too useful unless it is completely negative.  and IgM is useless, even if positive, so it sounds like you may have difficulty using the blood test as a way to find out if your symptoms are herpes or not.  So that leaves a swab test if it comes back.  And if you saw a doctor for the most recent red spot and they thought it was fungal, then I would guess there is a good chance it isn't herpes.  It's so difficult to guess over the internet - your decision to be seen is the best one and if it comes back I hope you will do that right at the start of the presentation of symptoms

Terri
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