[Question #4335] Follow up from last year. (HPV & HSV)

31 months ago

I posted back about 15 months ago regarding my HPV infection. Since then I’ve been 7+ months, wart free. I was also able to obtain the Gardasil 9 vaccine from my local Pharmacy. My current question revolves around the vaccine and recurrence’s. I found a few studies that claim the Vaccine prevents recurrence’s in woman. I believe it was regarding Cervical Cancer more than Genital Warts.  I was curious if any new research has come to forefront stating the same for men regarding cancers and warts?

 

Last time, I was also questioning the accuracy of the Herpeselect blood test. Over the last 8 months I’ve been battling a rather moderate Ringworm infection in my groin area along with Genital Dermatitis. I work out a lot and sweat a lot in that area. I’ve been working with my Dermatologist to correct the issue. Which brings me to my question. A few weeks back after spraying with anti-Fungal I noticed severe burning on the top of my shaft where it meets the head. Which didn’t seem unusual for me because I’ve had the same burning in the past on other areas of my Penis. The next day before re-applying I noticed a few very tiny scabs on the top of my shaft below the head where the intense burning was coming from. I’m sure they weren’t there the day before due to my constant treatment to the area with creams and sprays, I’m always examining the extent or improvement of the Fungal infection. Anyway, it didn’t really alarm me because I figured it was due to the fungal infection or my past Genital Dermatitis issues. Anyway, throughout the day out of habit I would pick at the scabs before using the bathroom. They were very small and very tight against the skin. I’m not sure what exactly happened, maybe due to irritation from scratching and picking at the scabs they became slightly lifted off my shaft with a water blister under it.  Not thinking I scratched it off, No pain. Later that evening I decided to head to the ER for examination. The Doctor was a little younger maybe 35ish. He seemed informed. He asked me if I had any new sexual partners and I responded that I have not been sexually active in over 20 months. I also mentioned that I had 2 negative HerpeSelect HSV2 blood test (One was 27 weeks post exposure and the 2nd was at 70 weeks post exposure, I ask for the test with my annual exams) I do have oral HSV1 and tested positive for HSV1, and probably have had it for 25 years.  I usually break out 2-3 times annually on my lips. I also mentioned to the Doctor that 2 weeks earlier that I had cold sore on the middle of my top lip. He said that was completely unrelated. He examined that area and his exact words were (I’ve seen a lot of herpes in my career and whatever you have going on it isn’t herpes, I Guarantee it), also you can’t scrape Herpes off he said. I asked for a swab regardless, and he said there wasn’t anything left to swab, and that he most likely wouldn’t do a swab anyway because of the multiple negative Herpeselect test. He told me to follow up with my Dermatologist and to rule out Herpes and then he sent me off with a diagnosis of Non-specific skin erosion and rash. The rash was at the base. 4 days later the wound looked the same, no cratering, or redness. I decided I needed a second opinion, so I headed to the local Ready Care. An older gentleman inspected it, I believe he was an P.A and stated he agreed with the 1st doctor, said Herpes would look much worse, timing for Herpes is off, and he never would of noticed the 2 tiny erosions unless I pointed it out because it was so small. Lastly, I finally made it in to see my Dermatologist 3 days later, now a full 7 days after seeing the ER Physician and 3 days after seeing the Ready Care P.A.. He examined the area but couldn’t make it out due to healing, the area filled in with new skin. He did notice the rash at the base and other skin textures that indicated Dermatitis and that was his diagnosis. So, my question have you ever seen a situation like this? should I seek additional testing like the Western Blot? Or do I have enough evidence with my Physician examinations, Lack of sexual activity, and multiple negative HSV2 test to forget about it and to believe the Dermatitis diagnosis? I’m aware that you the (Moderators) aren’t a big fan of repetitive users, but this situation seems unique to me as I wasn’t able to find anyone else with a similar experience online.


Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Welcome to the Forum.  I'll be glad to comment.  First, regarding HPV.  With no recurrence after 7 months, you can be confident that your warts have been taken care of and they will not recur.  Whether your HPV vaccine reduces the already negligible risk for wart recurrence is unclear.  While research clearly shows that the vaccine is almost completely effective for preventing new HPV infections, the question of whether the vaccine has any impact on risk for recurrence or the natural history of existing infections is not clear and if there is an effect, it is likely small.

Now on to your herpes question.  Several comments:
1.  The HerpeSelect is a VERY good test for detection of past HSV-2 infections detecting somewhere in the neighborhood of 95% of infections which would be detected by a Western blot test (it misses up to 25% of HSV-1 infections however).
2.  Your lesions have been repeated examined by trained physicians who feel that there is nothing to suggest HSV.  Other sorts of genital dermatoses are common.  Should the lesions recur, I suppose a PCR might be helpful but given the information you provide, I would anticipate it to be negative.
3.  The Western blot - will pick up a small additional proportion of persons who have had HSV-2 but not many in cases such as yours.

Putting all of this together, my bias is that you have worked hard to rule out HSV-2 and have done so.  Were I you, I would believe my test results and doctors and not worry further.  I am also not sure just how much things would change for you if you did have a positive Western blot. 

I hope this information and perspective is helpful.  EWH
---
31 months ago

Hi Dr. Hook,

Thank you for the strong responses regarding my questions. I have a few follow up questions for you, if you don’t mind answering. I’ve done a little research over the last few days on what we discussed. As doing my research, I'm positive they aren't anything that you haven't already answered before for people in the past, but these questions are  just a little more in depth...

 

1.       I’m happy to hear that you are sure that my wart problem has resolved itself. Am I still contagious at this point? Does viral shedding happen even after the warts are resolved? I haven’t been active in nearly 22 months, so I’m assuming I’m part of the 90% that has totally cleared the infection within the 2 year time frame.

 

2.       I grew up in a household where everyone including myself, siblings, and parents suffered from Oral HSV1. I would say that I most likely acquired it from my mother at a very young age. I would also say that I’ve probably been infected for 25+ years, since probably of the age 9 or so. Looking further into (multiple site infections) from the same virus I see most experts agree that having the same virus type in different locations is exceedingly rare once the infection has become established. Reading through the forum board, I even see Terri Warren claims that she has only seen it once happen in 33 years of practice and heard of maybe 2 other cases of this happening throughout the online forum discussions. I found similar responses from yourself and Dr. Handsfield and even supporting information on the John Hopkins medical site that states the same regarding multiple site infections once established it move to infect new locations. But of course, if you look hard enough you can find any atypical situations regarding nearly anything on the internet. In your opinion, just how common is this to happen?  and assuming most people do have HSV1 is that something that I should worry about in further relationships. Assuming someday that I find a girlfriend in the future that may already carry an HSV1 infection do I put her at risk by performing oral sex on her or her performing it on me if we are already infected? Is this a low enough risk not to worry?

 

3.       As well, I did a little research regarding the Western Blot and the accuracy of the Herpeselect testing. If the Herpeselect detects 95% of HSV2 and 75% of HSV1 compared to the Blot. Should that add even more certainty to my results? According to my research the biggest reason for the Herpeselect is missing infections is between testing to soon, taking anti/viral, taking longer then the standard time frame to convert and being IGG antibody deficient.  Now regarding the 2 Herpeselect test that I did have done, on both occasions, I received the exact same results. HSV1 positive and HSV2 negative with the last one being 70 weeks post exposure. I’m aware that there are 4 different subclasses of IgG antibodies and the IgG subclass 1 and 2 react to the two strains of HSV 1 and HSV 2. But since I’m making the HSV1 antibodies and they are getting picked up on the HSV1 test @75%  accuracy I assume that  my body would be making antibodies for HSV2 if I did have the virus being that test is even more accurate @ 95%....?

 

4.        Please don’t have me wrong, I’m very much thrilled with your response that you’re in agreeance with my Physicians and previous testing results and that this is just something that I should just forget about. But as you can tell... I like to dig a little deeper… I’m not worried about it honestly enough to go through with the Western Blot I believe. I feel with my test results and now having  4 experienced Physicians that include yourself, I can move on. I even found additional information regarding why scabs do turn into blisters after such additional irritations such as scratching and picking.  But, curiosity does get the best of me sometimes. In your opinion if I did test on the Western Blot in your experience would my results still be negative...? 

 

Thank you for your help..


Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
1.  No, you should not be contagious at this time. Your wart is gone, there is evidence of continuing infection.
2.  Ms. Warren has seen this on one occasion, neither Dr. Handsfield nor I have ever seen it in our combined nearly 70+ years of STI focused work.  It is not something to worry about.
3.  Given your test results and history, I agree that the accuracy of the HerpeSelect in your case is greater than 95% but there are no scientific data to determine just how different your results might be.  That said, given your history, I would not be worried.
4.  Yes, were you to have a Western blot at this time, it is far more likely than not that that too would be negative for HSV-2. 
EWH
---
31 months ago
Hi Dr. Hook,

Thank you for the help. Please take care.