[Question #2190] First time test

47 months ago
Hi.  Late 30s male with no prior STD symptoms or STD testing until 2 weeks ago.  I've never had unprotected sexual intercourse except with my spouse (2 total).  Since my early 20s I have had a few unprotected oral sexual encounters.

A few weeks ago, I had protected sexual intercourse and unprotected oral sex with a CSW.  Approx 13 days after that, I noticed a slight agitation and pin sized sore just outside my urethra opening.  I went to my doctor who had "low suspicion" it was an STI.  He performed blood test for HSV 1&2, gonhorrea, and chlamydia.  Over the next few days, it hurt pretty bad to urinate. When the results came back it was positive for HSV1 (IGG 31) and negative for everything else (HSV2 IGG was <.91).  He also noticed a second sore forming next to the first one.  He prescribed Valtrx (1 gram 2x per day) and the sores and painful urination are gone after about one week.  As an aside, A few days prior to noticing this pin sized sore I was treated for bacerial conjunctivitis with 100 mg doxycycline for 14 days.   My questions:
1.  Does this sound like genital HSV1?  Is there any chance of this being HSV2 even though I was "symptomatic" but no HSV2 IGG present?
2.  I saw on a post from Terri from a couple years back that she has only seen a handful of confirmed HSV1 transmission from genital to genital contact.  Is this still true?
3.  Would the doxycycline ensure that if this was a bacterial infection it is now gone?

Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
I would say that it is possible that your symptoms are due herpes, yes.  The big concern for me was the development of a second sore next to the first one and pain with urination. Was a swab test done?  It should have been, most certainly.  Do you have that result? 
It is possible that you have new HSV 2 and the test was done too soon after the encounter for an accurate result.  I actually doubt that you have new HSV 1 since the value is so high - it is unlikely that you developed that level of immune response in 2 weeks.  It is true that HSV 1 is infrequently passed through intercourse. 
The doxy would take care of chlamydia but perhaps not gonorrhea.  Were you tested for these infections? 

Terri
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47 months ago
Yes- those blood tests came back negative.
Now I'm really concerned about the HSV2.   I don't even think the sore was big enough to swab, the doctor had to use a micro light just to see it.  Is there anyway possible to find out now if this is HSV2? I haven't had any further symptoms.
47 months ago
I also wanted to add that the 2 sores weren't painful to touch at all.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
Hmmmm.  Well, given all of your additional comments, it may well not be herpes but rather a friction rub of some kind.  But it still concerns me.  The two ways to find out  if you have HSV 2 is a swab test of a lesion or an IgG blood antibody test - no other ways to know.  Have you ever had a cold sore in your lifetime?
Perhaps you could have long standing HSV 1 genital infection?  Let me know about the cold sores please.

Terri
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47 months ago
Terri- I know this sounds bad, but I'm not sure about cold sores...maybe?  I know I've had sores in my mouth and around my lips but not sure if they were HSV1.  I just assumed it was herpes because of the painful urination.   Could it be I acquired genital HSV1 a while back but never noticed symptoms?  I'm at a loss and so concerned this is HSV2.  When should I be tested again?
47 months ago
Also, how likely is it to have HSV1 and HSV2? I'm 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
Given that I've not seen you and everyone describes symptoms differently, it just isn't possible for me to know what is going on here. 
Cold sores would present as blistery sores usually on the edge of the lip or in the nares. 
I wouldn't think you should assume that it is herpes - certainly other things can cause pain with urination but the sores do concern me.  I would suggest that you repeat the IgG test only in about 6 weeks and see what it looks like.  If you take antiviral medicine between now and then it can skew the test. 
Many people have both HSV 1 and HSV 2, yes 
And yes, you could have acquired genital HSV 1 a long time ago and you are just recognizing it now.  That's just one possibility here.

Terri
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