[Question #4862] Could it be HSV 2?

25 months ago
Hi Dr. So I am a 26 yr old straight male. 2 years ago I had unprotected sex with someone twice before losing contact with her. I caught chlymidia and got that cured. A year later I'm in a monogamous relationship, after my soccer game, I got flu like symptoms (fatigue, hot flashes) then a rash appeared on my penis. Went to a doctor after a week of this and asked if it's herpes and he determined the rash was contact dermatitis and i suffered from heat exhaustion and it was not herpes. I went to planned parenthood for a second opinion and told her my visit with the first dr. and she said while the rash looks concerning, I should wait to see if it goes away which it did after 2 days of this visit. This rash never caused any pain or discomfort and from my knowledge it did not turn into blisters or open sores. I have not had any symptoms since then, it's been a year. Could this have been a mild outbreak? Should I get tested even though I havent had any symptoms since the rash went away? I'm single again and I'm concerned that i might infect new partners. thank you
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
Not having seen the outbreak, I cannot give an opinion about that.  But it sounds like two clinicians did not think it was herpes.  If you want to be more certain about this, you could get an IgG test for HSV 1 and 2 - never an IgM.  I think given your rash on your penis and your worries, testing would be appropriate.  What do you think about that?

Terri
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25 months ago
Hi Terry, I actually talked to one more health clinician and she said that I'm just freaking out and if it were a herpes outbreak, I would definitely know since its painful. She told me to not worry and that they only test if there is an actibve outbreak with blisters or lesions. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
Well, I don't necessarily agree with that.  Not all herpes lesions are painful and there is definitely an antibody test that can be done to determine if you are infected or not, so they may not use that test, but it is certainly available.  The best of these tests is the western blot which is done only at the University of Washington, but people not living in Seattle can definitely get that done.  Or you can start with the IgG test locally where you are. But the rash that you describe that went away so quickly is unlikely to be herpes.

Terri
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25 months ago
Thank you for your responses Terri! I'll probably go the Igg test locally for now. So one last question just to be clear, the rash taking a week and a half to go away is too fast of a timeline for a  first herpes outbreak?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
I'm sorry, I read the rash went away in 2 days but that's how long it took to go away AFTER your visit, not totally.  My error, sorry about that. 
10 days does fit with the timing of a first infection, yes.  Certainly, if you get any recurrence of these symptoms, you should obtain a swab of the rash. 
Good to get the IgG test.  If the result is positive AND it is below 3.5 on the index value, you should obtain a confirmatory test.  Hopefully, it won't go that direction for you.

Terri
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25 months ago
Hey Terri, well I took an Igg test. They said they use the ELISA test which is FDA approved and is 98% accurate. The test came out <0.90 which meant negative. Is it safe to assume that I am not infected with genital herpes?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
24 months ago
I think you can say with 92% certainty that you don't have HSV 2.  The 98% figure comes from comparing the results of the antibody test to results of swab tests of people know to have HSV 2.  Your populations is people who either have symptoms that concern them or people screening for STI's.  These are very different populations than people who have known HSV 2 by positive swab test. 

Terri
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