[Question #5072] Positive for HSV1- Oral or Genital?

25 months ago

Hello Doctors,

I'm a 3o year old heterosexual male. About a month ago, I noticed a small fleshy bump on my scrotum. I've never had anything like this appear before so I began to monitor it closely and do some research. At first, I thought it most closely resembled a wart. However, after a few days passed, I could see what appeared to be a white head forming. I did have sex (not oral) a couple days before  I noticed the bump, so the timing was a little curious. I understand that it's difficult to visually diagnose these things but I thought it looked like some photos I've seen of a herpe and  I ordered a blood test via an STD check site. I had a blood draw approx 5 days after I noticed the bump and the IgG test came back positive (equivocal) 0.98 for HSV1 and negative for HSV2. At this point I was fairly certain that I had picked up HSV1 genitally. BUT Roughly another 5 days after the test there was a pronounced white head. I gave it a little squeeze and a soft white substance sort of rolled right out leaving a clean crater that soon disappeared. I never had any symptoms that are listed for Genital herpes; the bump never caused me any discomfort at all. It's possible that I simply picked up oral HSV1 at some point and this is all a big coincidence...  but I really don't know how to be sure. I want to be responsible about it and my sex life is certainly on hold until I can confidently sort this out. I don't have any genital lesions right now but there is some activity on the bridge of my nose that actually seems more consistent with a herpe legion. It started last week and it's clearing some now but it more resembles a break in the skin than a pimple. 

Questions:

1. what can be done to verify if I have oral or genital (or both) HSV1? 

2. Is it likely to have both or would the presence of oral herpes be enough to rule out genital? 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
The bump that you describe sounds nothing at all like a herpes lesion.  Not at all. 
If you went to a traditional lab, .98 is not positive but rather equivocal.  Can you clarify?  Let's assume for a moment that you are positive for HSV 1 (as it about half the population of the US).  Usually facial herpes lesions occur on the edge of the lip or in the nares but it can show up on the chin or even the eye.  Or it could be genital.  There is not way to know the location of your infection (if you actually are infected) without a lesions to swab test.  Again, this may not represent a true positive. The herpes western blot would be the test to clarify this for you from the University of Washington.  Please let me know what other questions you might have.

Terri
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25 months ago
Hi Terri,

Thanks for the response and for the work that you do. I've read several threads and I'm sure that it must be tiring responding to the same types of questions  but this work is important because it's hard to find a doctor that is both knowledgable and comfortable to speak with about sexual health. 

In response: I used a site called STDCheck.com and the results came from labcorp saying "Your test results indicate that you have tested positive for either one or both strains of the herpes virus, please review your test results for verification on which strain of HSV is (or which strains are) being indicated as positive." They recommend speaking with a doctor and/or getting retested in 2-4 weeks. 
When I look at the actual results, they are equivocal for HSV1 (0.98) 

I'm wondering what you would suggest in this case. Is it worth retesting?  My only real concern is that I have HSV1 Genitally and that it  is asymptomatic. As far as I know, I've never had a cold sore either... so even with a western blot, I wouldn't know if it were genital or oral correct? I'm just looking for some peace of mind; I don't want to end up hurting anyone I love. 

Thank you. 


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
The western blot would not tell you a location, correct, but it would tell you if you actually have HSV 1 or not which now, you do not know.  You could try retesting in a few months and see if the number goes considerably higher.   Do you think you could recently have been infected?  If yes, then this number could reflect a new infection, with the number climbing from negative to equivocal to a higher positive.  Or it could reflect another blood protein that has nothing to do with herpes at all.  Right now, you just don't know what is going on.

Terri
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