[Question #4743] hiv and hsv or other

27 months ago
Doctor: some follow up questions to a prior post. Had brief unprotected vaginal intercourse with a csw after condom broke, maybe 5 or 10 seconds. After 27 days, I noticed a flaky scab around my coronal sulcus under my glans. It healed a couple days later. Surprisingly, I never noticed the original sore, but perhaps it started on day 21 or 22. I had several iterations of std tests, all negative except hsv1 was always positive. (Most recent panel taken at 12 weeks post).

Have had genital itching, discomfort and frequent urination ever since noticing the scab. Trying to figure out the cause of frequent urination. It is very uncomfortable. Also trying to figure out the scab.

The scab suggests hsv, but I have never had any symptoms in my life until the scab. (And it seems like it showed up a bit late post exposure?) The 12 week test was negative for hsv2.

Further, my girlfriend started having recurring yeast infections and bacterial vaginitis the past 2 months. After it subsides from antibiotics, it seems to flare up again when we have sex.

1) Can I be giving her some kind of bacteria?

2) Does a recently contracted hsv1 or hsv2 infection cause vaginal yeast infections or bv?

3) Can yeast infections or bv cause vaginal bleeding?

4) Other than hsv, is there another possible cause of the penile sore I described in my initial question? Hiv?

5) Is 12 weeks or 16 weeks conclusive for hsv testing?

6) When frequent urination is caused by psychological or emotional mechanisms, how long does it generally take for those affected individuals to recover from frequent urination symptoms?

7) Can emotionally derived frequent urination symptoms affect you while you are sleeping, or would those such symptoms only occur during awake hours?

8) During the day, need to urinate with 6 to 8 ounces of urine in the bladder. Really need to urinate with 16 ounces in the bladder. Is that normal?

9) You mention you have never had a forum member with a negative hiv duo or rna result at 6 weeks turn positive for hiv with subsequent testing. Could that be because your forum members were never infected with hiv in the first place, or is that based on actual test data?

10) Is it possible to have hsv1 or hsv2 without ever having symptoms?

11) You mentioned the hiv duo tests are 100% conclusive any time 6 or more weeks after onset of infection, and then remain positive for life. I assume you mean that the tests are 100% conclusive any time 6 or more weeks after potential exposure and remain 100% conclusive anytime thereafter?

12) Is there any bacteria or other obscure sti that I should be concerned about based on my symptoms?

13) Given the circumstances, is it a good precaution to take a general antibiotic even if urinalysis shows no infection?

14) Does hsv1 or hsv2 ever cause neurologic damage that could interfere with bladder function/urgency to urinate/other sexual function? Any other std?

15) If oxybutynin does not improve frequent urination feelings, is that an indication they are psychologically derived?

Thanks in advance doctor for your service and guidance.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Welcome to our Forum.  Today I happened to pick up your question and will be answering it.  Before I do, let me point out that many of the questions that you have asked below were already answered in your earlier interaction with Dr. Handsfield.  Further, Dr. Handsfield. Ms. Warren and I have all both reviewed your prior post and discussed this set of questions which we find to be excessive and beyond the number of questions any of us have ever received in this or other forums despite having worked on them collectively for many years.  Due to the excessive nature of this follow-up and, in some instances, repetitive series of questions, I will provide answers to your questions and a single follow-up opportunity for clarification.  Also as an FYI, in preparing to respond to these questions, I have reviewed your earlier interaction with Dr. Handsfield and agree with his statements.  

In addition, it is my opinion that the "scab" you noticed nearly a month after your condom mishap with the CSW was probably unrelated to that event.  Your original post indicated that you had had sex repeatedly with your GF in the days prior to noting the scab and I suspect the lesion you noted may have been related to the irritation that followed repeated sex rather than other causes.  Now, on to your questions:

1) Can I be giving her some kind of bacteria?
No.  through sex you do share each others genital bacteria but you have negative tests.  BV is, unfortunately, commonly a recurring problem and it is not unusual for treatment of BV to predispose women to yeast infections.  This is something she should work on with her own gynecologist.  You have not caused her problem.

2) Does a recently contracted hsv1 or hsv2 infection cause vaginal yeast infections or bv?
No.

3) Can yeast infections or bv cause vaginal bleeding?
Yeast in particular can be irritating and make infected surfaces more likely to bleed.

4) Other than hsv, is there another possible cause of the penile sore I described in my initial question? Hiv?
You do NOT have HIV.  As Dr. Handsfield told you, you proved this on multiple occasions.  I explained a possible source of the sore above.  If you had penile yeast infection it also might predispose you to irritation.

5) Is 12 weeks or 16 weeks conclusive for hsv testing?
It can take up to 6 months for HSV blood tests to be completely conclusive but nearly all persons who acquire HSV develop positive blood tests by week 12.  After that a very small percentage (2-3%) become positive over the next few months,

6) When frequent urination is caused by psychological or emotional mechanisms, how long does it generally take for those affected individuals to recover from frequent urination symptoms?
Until their genitally focused anxiety resolves.

7) Can emotionally derived frequent urination symptoms affect you while you are sleeping, or would those such symptoms only occur during awake hours?
Anxiety can disrupt sleep.  Many men get up in the evening to urinate.  

8) During the day, need to urinate with 6 to 8 ounces of urine in the bladder. Really need to urinate with 16 ounces in the bladder. Is that normal?
Yes

9) You mention you have never had a forum member with a negative hiv duo or rna result at 6 weeks turn positive for hiv with subsequent testing. Could that be because your forum members were never infected with hiv in the first place, or is that based on actual test data?
Sigh, you can't give this up can you.  this statement is based on careful scientific study of literally hundreds of thousands of persons with and at risk for HIV.

10) Is it possible to have hsv1 or hsv2 without ever having symptoms?
Yes but those people have positive tests.

11) You mentioned the hiv duo tests are 100% conclusive any time 6 or more weeks after onset of infection, and then remain positive for life. I assume you mean that the tests are 100% conclusive any time 6 or more weeks after potential exposure and remain 100% conclusive anytime thereafter?
Correct

12) Is there any bacteria or other obscure sti that I should be concerned about based on my symptoms?
No

13) Given the circumstances, is it a good precaution to take a general antibiotic even if urinalysis shows no infection?
No, this is a BAD idea which will only confuse things. Antibiotics should be taken for defined reasons.

14) Does hsv1 or hsv2 ever cause neurologic damage that could interfere with bladder function/urgency to urinate/other sexual function? Any other std?
No.

15) If oxybutynin does not improve frequent urination feelings, is that an indication they are psychologically derived?
This question is more appropriate for a urologist than an infectious diseases expert however it would seem that that might be the case.

This completes this thread.  I hope my answers have been helpful.  You have one follow-up for purposes of clarification.  EWH

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27 months ago
Doctor: Thanks for your expertise and feedback. This forum is a great service. Sorry for my long initial question, and thanks for your willingness to provide feedback. I am just trying to get to the bottom of these issues.

1) No follow up.
2) No follow up.
3) No follow up.
4) From your experience, how common is a tear at the coronal sulcus near where the glans connects to shaft from masturbation or sex, as you surmise? Could hsv1 cause that kind of sore?
5) Any way to know if hsv1 was contracted years ago or recently?
6) Can anxiety literally reprogram the mind for urininary frequency?
7) Is that why urinary frequency could still occur at night? It just seems like my bladder shrunk. And it seems strange it happened so abruplty.
8) No follow up.
9) No follow up.
10) How likely is it to have contracted hsv1 years ago and never had a symptom?
11) No follow up.
12) So if you test negative for 10 panel std tests at 12 weeks, you are certain to have no health consequences from unprotected sex?
13) Forgot to mention that my urine seems to have a stronger odor than it used to. Does anxiety cause urine to smell or other non uti related reason?
14) I have occasional itching, discomfort and sometimes shooting pain in genitals. Can that be anxiety driven? Otherwise I feel totally fine.
15) No follow up.

Thanks in advance. Your service has been a huge help.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Straight to your follow-up questions:
4.  This is repetitive.  Lesions of this sore are not uncommon after masturbation..  OTOH, lesions such as you describe would be uncommon for HSV of any sort and the timing is wrong.
5. When  person is found to have a positive blood test for HSV with out prior tests there is no way to tell how long the infection has been present.  If it goes from negative to positive, it is reasonable to presume the infection was acquired relatively recently, most often in the past 12 weeks.
6.  Absolutely
7.  Nothing more to add
10.  In North America most HSV-1 is acquired during childhood as oral HSV.  The duration of your infection is unknown.  it is statistically more likely that your HSV-1 ir oral than genital.
12.  Correct
13.  No but your anxiety-heightened awareness may make you more aware of odors as well as sensations which you would have otherwise overlooked.
14.  These symptoms, particularly the itching, is classical for anxiety-related heightened awareness.

I'm pleased my comments (as well as Dr. Handsfield' s before me) were helpful.  this thread will be closed later today without further answers.  Take care.  Please don't worry.  EWH
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