[Question #6219] Symptom appeared after negative asymptomatic testing (HSV)

16 months ago
Hello.

Approx. 95 days ago I had a risky encounter. I (male) had one-time unprotected vaginal sex with a stranger (who did not seem to be all that high risk). I did develop flu symptoms shortly after but was diagnosed with mono from my doc, with which my symptoms and testing was consistent with. At exactly 12 weeks post exposure I went ahead and did a 10 panel STD test to be safe (gon/ch/hiv/syph/etc.) and was negative on all counts, including HSV 1/2. 

However, this past Monday (93 days post-potential exposure) I noticed a moderately sized reddish bump on the shaft of my penis near the base. It is a singular bump/blister/pimple and completely painless unless I squeeze it (which I won't do anymore). Hair does grow where the bump is so maybe it is ingrown? How would one differentiate? No other symptoms are present except maybe slight itchiness, but I cannot tell if that is due to the bump or if it's just a general thing/psychosomatic as the occasional itch down there isn't all that uncommon with me.

So I guess my question are, how typical is 
1) a painless first outbreak of herpes 
2) a negative IGg HSV blood test missing HSV 1/2 at 12 weeks post-exposure 
3) developing a singular bump/blister as opposed to a cluster in the initial outbreak
4) developing the initial outbreak more than 3 months after exposure

And 5) should I get tested again?

Thank you so much for the help!!!

16 months ago
Well my anxiety/curiosity got the best of me, I decided to pop the bump in a sanitary fashion. A small amount of yellow-ish pus came out.  Very  much appeared consistent with the pus from a pimple. My other questions still stand however. I am not sure if this is all that telling but thought I’d add as much info as I can.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
16 months ago
1) a painless first outbreak of herpes

Not common but possible

2) a negative IGg HSV blood test missing HSV 1/2 at 12 weeks post-exposure

The IgG test for HSV 2 misses 8% of HSV 2 infections at 12 compared to the gold standard herpes western blot

3) developing a singular bump/blister as opposed to a cluster in the initial outbreak

This would not be an initial outbreak but rather a recurrence or a first recognized outbreak but I seriously doubt that is what is going on here.

4) developing the initial outbreak more than 3 months after exposure

See #3.  The primary outbreak could go unnoticed or not happen at all

And 5) should I get tested again?

I don't think so - it won't gain you anything really.
Something with pus in it does not sound like a herpes outbreak to me - it sounds like a pimple, as you described it or an ingrown hair or folliculitis.  Honestly, this does not sound like herpes to me.

Terri

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16 months ago
Thank you!!

So I should still feel pretty good about my blood test I guess although it’s not the gold standard..

A more general question:
If you were a male, what symptoms would concern you or be red flags for a herpes lesion/outbreak? What about an unknown sore in the “boxer region” would tip you off specifically towards herpes? Conversely, what about a lesion of some sort would NOT concern you from a herpes standpoint? Are there any tell tale signs that a lesion is due to herpes or not due to herpes, or are symptoms too variable among individuals? Just wondering what I should possibly be on the lookout for... don’t want to be concerned over every ingrown hair/pimple I get down there so it would help to know any big differences!

Overall, if this singular sore relieves itself,  given no other additional symptoms, should I move on without worry?



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
15 months ago
skin lesions that start as blisters, ulcerate and scab over. 
Lesions on other parts of the body would usually be grouped and on a red base. 
If a hair is coming out of the lesions, we would expect folliculitis rather than herpes. 

Terri
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15 months ago
Thanks,

I did not notice any ulceration and not really a scab either, but  the tissue is still a little pink where the pimple was. Considering pus came out and a hair is growing out of it, I think I’m safe to assume that the bump wasn’t herpes right? I know your advice is limited by the lack of sight, but from what you’ve said and what I’ve read this doesn’t sound like it.

So considering my “symptoms” for HSV and my negative test for pretty much all  major STIs (HIV, G, Ch, HSV1/2, hepABC,  Syph) at 3 months past potential exposure , can I safely and confidently move on from this encounter without worry of infections? Could I have unprotected sex with a future partner? She said she recently tested  negative for “everything” too but not sure what that included.

Also side question, feel free to not answer since you’re very busy, but how did you get into the field of virology? Field seems fascinating.

Thank you again.
15 months ago
Oh also another side question! When do you think there will be a Herpes vaccine, if ever? T
15 months ago
Alright you really don’t have to answer those last questions lol just my curiosity! All I would really like to know is, with my tests and lack of any real concerning symptoms, if I am good to go (as far as the STIs I tested for) and can have unprotected sex with a future partner without any real reason to worry about spreading something from this encounter (won’t be with a stranger again I can promise you that...) sorry for the bombardment of questions!!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
15 months ago
I do agree with you that this seems far more likely to be an ingrown hair than a herpes outbreak, yes. 
As you may know, the IgG test for herpes is good though not perfect.  it misses 30% of HSV 1 and 8% of HSV 2, compared to the gold standard herpes western blot.  So it's pretty darn good for HSV 2 but again, not perfect. Most people would rely upon those results that you have for herpes while others would seek out the better test.

There is a lot of promising work being done on vaccines right now - I am very hopeful!

Terri
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