[Question #4084] Dr Hunter Pls Help. Negative IgG but still struggling with Genital Issues

84 months ago

Dr Hunter, I had protected encounter with a CSW in Feb,after 4 days I started itching really bad in genitals. Saw dermatologist and urgent care doc and no one felt it is herpes as there were no sores. My 4, 7.5, 10.5 and 18.5 IgG are negative but my scrotum and anal and groin areas are badly itching and raw even after 6 months. I tired Lotrimine and other fungal creams and powders my genitals are never felt like normal like I was 6 months ago. I saw posts reading from Dr. Terri Warren that some people are never get picked up by IgG tests and they constantly show negative even they r positive no matter if u run the yet n number of times. This drives me crazy that we don’t have an accurate testing method. Only western blot will be the most ideal however to get it done there is a 3-4 week wait.
1. Can I be one of the person who did not show sores and constantly testing negative? How can I believe my IgG results?
2. I am constantly worried that herpes might strike me at some random time. I read posts saying people never knew they had hsv and found out in testing and about people having out breaks never tested positive. I am concerned I am testing negative and being asymptotic.. how likely is this case?
3. The doctors could not offer anything other than the steroid for my genital itching and tingling and irritation. It just seems to get back. I remember u saying this is not herpes and could be something else. I am not sure why am I not able to feel normal. I am deeply regretting for what I did. I don’t want to give this to my wife. 4. Can I have sex with my wife?
5. I got a bump on nose which I never got before can it be herpes? It is hard red and does not seem to contain any fluid. I heard herpes can manifest in many forms. This is more like a red bump hard and painful and did not ooze.
6. Should I be worried about oral hsv? I never kissed other ladies other than my wife.. I only had vaginal..

Edward W. Hook M.D.

84 months ago

Welcome to the Forum. Clients on this site are not permitted to request who responds to their questions. All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions. As it happened, today I happened to pick up your question. As an FYI, having worked closely for over 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary. I will be addressing this question.

Although a small proportion of persons with herpes are not detected, most are. Your combination of having been repeatedly examined by trained health care providers who see not evidence of genital herpes, your negative tests, and the duration of your symptoms make the chance that you have genital herpes from the low risk exposure you describe virtually non-existent. I would not worry about this. I will point out however that when patients start looking for genital symptoms it is not at all unusual to notice normal sensations that were there, unnoticed before. This sensations are most often itching and, unfortunately, in such cases scratching the itch tends to make them worse.

Now, one to your specific questions:

1. Can I be one of the person who did not show sores and constantly testing negative? How can I believe my IgG results?

Please see above. This is not herpes from the encounter you have described.

2. I am constantly worried that herpes might strike me at some random time. I read posts saying people never knew they had hsv and found out in testing and about people having out breaks never tested positive. I am concerned I am testing negative and being asymptotic.. how likely is this case?

See above. Most unlikely.

3. The doctors could not offer anything other than the steroid for my genital itching and tingling and irritation. It just seems to get back. I remember u saying this is not herpes and could be something else. I am not sure why am I not able to feel normal. I am deeply regretting for what I did. I don’t want to give this to my wife.

The two leading causes would be a fungal infection and the normal sensations I mentioned above.

4. Can I have sex with my wife?

Yes.

5. I got a bump on nose which I never got before can it be herpes? It is hard red and does not seem to contain any fluid. I heard herpes can manifest in many forms. This is more like a red bump hard and painful and did not ooze.

No.

6. Should I be worried about oral hsv? I never kissed other ladies other than my wife.. I only had vaginal..

No reason for concern.

I hope this information is helpful. Please do not worry about herpes. EWH

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83 months ago

Thank you DR. Hook.

For some reason I am not able to get the herpes scare out of my mind. Dr. Terri mentioned in her earlier posts that “there is always that chance that one could Ben infected and not stay asymptotic and not getting picked up in the IgG” so I am thinking to go for the Western blot and I constantly still itch and specially the itching returns when it gets sweaty there.

I have been experiencing painful bumps on nose on mustache areas could it be that I transferred the virus on to my face from my genitals? I did not have oral sex or gave it. What’s the possibility of herpes type 1 transferred from genitals to genitals? Any thoughts?

Can I expect my western blot to be negative as well for both the 1 and 2 types?

Edward W. Hook M.D.

83 months ago

I'm sorry to hear that you continue to worry about the possibility of HSV infection after the low risk encounter you describe. Your likelihood of having acquired infection from the encounter you described is tiny and your multiple medical evaluations by trained health care providers and negative blood tests virtually assure you that you were not infected. Answers to your follow-up questions:

The Western blot assay performed at the University of Washington is accepted as the most accurate blood test for HSV and, particularly for HSV-1 infection, is substantially more accurate than the more widely available HerpeSelect test which is most likely the test you have had. The HerpeSelect may miss up to 25% of HSV-1 infections but only missed a very HSV-2 infections. Thus if you get a Western blot test, my suspicion is that you may (but probably will not) find that you like over 60% of adults, may have HSV-1 that you did not know about but it is most unlikely that you will find that you have HSV-2. If you have a positive test for HSV-1, that does not mean that you acquired the infection during the encounter you described - most people acquire this infection in childhood and a positive antibody test tells you nothing about the location of your infection. Further, since the exposure you are concerned about, there is little risk that acquired HSV-1 as genital to genital transmission of HSV-1 is very, very rare.

The bumps in your mustache area are unlikely to be HSV of any sort -unlikely location, the description is not suggestive, and you were not exposed. If you feel you must be tested, I would suggest seeking a HSV PCR test, not a blood test.

If you get a HSV Western blot test from the University of Washington, the most likely result is that the test will be negative. EWH

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83 months ago

Hello sir, thanks for th suggestions.

None of my family members have cold sores or I since childhood. I am 100% sure of it.

I never kissed anyone other than my wife and the only encounter I had (other than wife) is with the CSw which probably would put me at risk for hsv1 and 2. The reason is our relationship got worst in the last two years and we abstained from sex which increased my sex cravings leading to this encounter.

I never had a cold sore and I can confidently say I never kissed anyone before which could lead me to herpes. The genital to genital contact is the only thing we had with the protection on.

Can you pls see the sore on my nose and comment? This is the same one I had on my left and right nostril and on my moustache. You don’t not make any diagnosis as I know it is not encouraged but just a look will be great. Do they seem to be of any herpes manifestation?

https://honeycomb.click/topic/76532-does-this-look-like-herpes-12/

Do you think there is anything to swab here?

Can I be sure that I will be negative on Western blot? For both the strains?

Thank you for your continued service. It is very helpful for many ignorant people like us who are trying to make diagnosis over the internet just by reading stuff.

Edward W. Hook M.D.

83 months ago

Thanks for the additional information. Given your history your risk for having HSV-1 is lower than average but there is still some, probably smaller than average, and difficult to calculate risk. Most persons with HSV-1 do not know that they have the infection or experience cold sores.

We typically do not look at pictures on our site and any interpretation of pictures is unreliable. I did look a the link you describe however and it does not suggest HSV of any sort. See my comment about the location above. I do not think this is HSV but if you wish to be sure you need a PCR test. You do not have to have an open lesion for a PCR test to provide accurate results.

Can I assure you that your Western Blot test will be negative- no I cannot but as I mentioned in my earlier posts it is quite unlikely.

Thanks for your thanks. As I suspect you know, as per Forum Guidelines, now that I have provided three responses this thread will be closed later today without further replies. I do not recommend that you open a new thread asking further questions as there is little more to say and we do not routinely respond to repetitive questions. Please try not to worry. Take care. EWH

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