[Question #5491] Possible Exposure, Testing, and Retesting Help!

22 months ago
On 04/21/2019, I had protected oral sex and protected vaginal sex with a woman of unknown status. Lets assume that she’s high risk since I’m not sure. I noticed no bumps, blisters or lesions on her face or vagina but I cannot be too sure.  At no point did my penis enter her mouth or vagina without being covered by a condom. I did take off the condom and masturbate to completion at the end but at that point she had no interaction with my penis.

3 weeks after the encounter, I started feeling soreness in my testicles and intermittent tingling on the tip of my penis. I also intermittently felt a crawling sensation in my pelvic and groin area. I saw my primary care physician and she did a Urinalysis and returned negative for common bacteria infections. Upon visual inspection she noticed no evidence of herpes or other STDs and prescribed clotrimazole cream in case it was balanitis. A week later I saw a urologist for the tingling and he suggested the irritation could be from masturbation or cleaning and told me not to worry. He also did a visual inspection and saw no signs of herpes or any other STDs.  At no point during this time did I present with any bumps, sores, blisters, lesions, etc.  I had some leg and thigh soreness but I attributed these to regular exercise with an elliptical machine.  I sometimes feel a burning feeling in my lower thighs behind the knees.

6 weeks after the encounter, I took HIV 4th gen test as well as testing for Chlamydia, Gonorrhea, Syphilis, HSV 1 + HSV 2 IgG, Hep A, Hep B, and Hep C. Results were negative. 

Now at almost 7 weeks, the soreness, intermittent tingling, and intermittent crawling sensations are back and I'm terrified I could have caught genital HSV1 or HSV2. I plan to retest at 8 weeks and 12 weeks.  I have been inspecting my penis multiple times a day and cant seem to find any lesions, bumps, sores, or blisters.


What is my likelihood of having Genital HSV-1 or HSV2 based on this encounter and testing?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
22 months ago
I think the chances of you having HSV 1 or 2 NEW infection from this encounter are just incredibly low. They aren't zero, but your symptoms don't fit well with a herpes infection - yes, some people can have the crawling sensations with a herpes infection but not testicular soreness.  And the most important thing is that you have had no sores, blisters or bumps.  Can people have herpes with no symptoms? Yes, it is possible but most people with herpes DO have symptoms, though they may miss them or confuse them with some other disease state, but you have been diligent (very) about inspecting your genital for symptoms.  The fact that your IgG test at 6 weeks out was negative is also a very good sign, though done a bit early.  It doesn't sound to me like you acquired herpes at this encounter.  You may wish to do a final test 12 weeks out as 6 weeks can be a bit early for some people, but really, with all the condom protection, I seriously doubt that you acquired herpes at this encounter.

Terri
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22 months ago
Hi Terri,

Thank you for your response. 

At 7 weeks I had negative IgG tests again.  I do have some areas I would love some clarity on. 

1. Does HSV1 genital infections present with symptoms more often than not?

2. Would the initial outbreak occur someplace that wasn’t protected by the condom?

3. Are herpes symptoms (crawling and tingling) intermittent or constant? My symptoms are intermittent.

4. Do you know what else can cause the crawling or tingling feeling?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
22 months ago
Yes, HSV 1 genitally is actually more likely to present with symptoms than some new HSV 2 because if someone already has HSV 1 and they acquire HSV 2, they are often without symptoms or very minimal symptom because the HSV 1 antibody really modulates the HSV 2 presentation.
The initial outbreak might occur where a condom didn't cover, correct.
The prodromal feelings of tingling and crawling are usually intermittent
It is unknown what else can cause these feelings BUT I've had probably hundreds of people who have done antibody testing for herpes because of these sensations (no sores) and the huge majority test negative for HSV 2.

Terri
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22 months ago
Thank you for this information Terri.
You have been very helpful. I just have a final few bits to inquire about.

1. Since you said these tinglings are prodromal, does that mean if the tingling subsides and there is no outbreak, it is unlikely to be Herpes?

2. My tingling and soreness has gone away for the past two days and I still haven't had any outbreak symptoms such as lesions, bumps, blisters, fever, fatigue, etc. If I test negative at 12 weeks for both HSV-1 and HSV-2, (given my encounter) would you recommend getting a Western Blot done with negative IgG tests and no outbreaks?
I'm trying to refrain from doing this as I believe it would further my anxiety. This was the only sexual encounter I've had in the past year so I'm not concerned of other exposures. If it is any encounter that I acquire or was exposed to HSV 1 or 2, this is the only possibility. 

Thank you!

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
22 months ago
1.  Yes, that is what I mean. 
2.  If you test at 12 weeks, the IgG test results will pick up 70% of HSV 1 and 92% of HSV 2, compared to the gold standard western blot.  You can decide how much accuracy you need to feel settled about this.

Terri
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