[Question #2459] HSV seroconversion

45 months ago
  Approximately 3 to 4 weeks ago a woman performed oral sex on me and then we had protected sex.  A few days later, I developed some Vesicular appearing lesions on the scrotum at the left base of the penis and what looked like 3-4 molluscum spots on the Supra public region.  I took four days of Bactrim and Keflex with no improvement.   At roughly the two-week point, I took 4 days of Valtrex without any improvement,  and then had negative titers of IgG and I GM for HSV one and two.  I stopped the Valtrex five days ago,  and have had no change in the quality or quantity.  With active lesions, would I have expected any of the titers to come back positive (or even equivocal)?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
If this was new infection, it might take longer for the IgG test to come back positive - longer than 3-4 weeks, that is, especially with the involvement of antiviral therapy in the mix.  When you say that these are vesicular lesions, can you describe that a bit more fully?  Were they actually water filled blisters?  And what happened with the molluscum spots?  I'm a little unclear about why you were treated with Bactrim and Keflex - they are not effective against either of these two infections?  Was something else going on that these medicines were prescribed for you?
I'm also a little confused about the timing - you said at the two week point you took Valtrex but the encounter was 3-4 weeks ago?  Did you take the Valtrex 2 weeks out from the encounter?  Thanks for your help in understanding the timing a bit better.

Terri

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45 months ago
Hi Terri,
So with the rash developing and my partnering advising she had previously (and since) tested negative, I thought it was some kind of folliculitis, and so I had a friend put me on Keflex Bactrim, without improvement. 
At around the two week point (since contact), I saw a physician friend of mine who texted pictures of the pustule/vesicles to an ID friend who advised likely HSV-2. So I started taking Valacyclovir but two days later had the 1&2 IGG and IGM titers drawn - both were negative. So, I stopped the Valacyclovir, thinking I was in the clear. 
There are two sets of lesions. Suprapubic 4mm molluscum type lesion that is painless with some associated painless pinpoint lesions, and then a small cluster of 6 scrotal lesions 2-4 mm each which are painful and have a pretty terrible odor. Possibly a little clear fluid in each.
No spread of those lesions elsewhere.
I guess my biggest question is whether I should have a positive IGM at this point (or even "borderline").
I've now been back on the Valacyclovir for three days (restarted on my own) empirically. 
45 months ago
For clarity, timewise
Started Bactrim Keflex and took for a total of four days without change. 
Started Valacyclovir at the tail end of the antibiotics for four days with no change, and stopped when original IgG and IGM came back negative.
Five days without change.
Now back on Valacyclovir for three days
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
I've honestly not heard or seen herpes lesions having a bad odor.
The IgM test is useless - lots of false positives (thankfully you didn't get that).  The CDC says never to use IgM to try to diagnose herpes in adults also.  They are actually terrible tests and some larger labs have withdrawn them from their test menu = I wish all would. 
The group of scrotal lesions is worrisome 1) because they are in a group 2) because someone experienced looked at a photo and thought it might be herpes and 3) because they were painful.  Now they could be something like a staph infection as well but it would have been best if they could have been swab tested right away.  The IgG test can take up to 12 weeks to become positive and the more Valtrex you take, the more the test can be confused. 
Are the lesions still there?  Could you get them swab tested now?
I understand now about the Keflex and Bactrim

Terri
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45 months ago
I will try to get them swab tested tomorrow. I guess I cannot say for sure that's what smells, but I'm generally a pretty clean person so to have this recurrent new odor is somewhat surprising. 
Thank you. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Please let me know about your swab test and your visit to see what might be going on . I'm going to leave this post open for one more response.
I think a syphilis test would also be good to do.

Terri
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