[Question #6474] Is there cause for concern?

14 months ago

I had one sexual partner for five years. I broke it off in May of 2019. Throughout 2017 I experienced severe vaginal bleeding, pain, and severe abdominal swelling.  My primary care physician performed a full STD panel, including HERPES I & II in October 2017. She said she saw no visible sores that would resemble an outbreak, yet my cervix was swollen along with my uterus. She also performed a pap smear/HPV test. My vaccination records showed I had Gardasil (HPV vaccine). The pap smear revealed nothing. Also, the entire STD panel was negative.

Three months later January 2018, three large fibroids were found.  We did not have sex much throughout the remainder of 2018. I had a UFE performed in October 2018. He and I resumed regular sexual intercourse, twice to three times a week between November 2018-May 2019. (Condom protected/unprotected oral).

I have a wellness exam this January.  While my ex got tested, his doctor did not screen for HSV I or II.  Sometimes oral would irritate my vaginal region, yet the irritation would go away in a couple of days. He is overweight and did have skin tags on different areas of his private parts. I never saw any clusters or blisters. I was visually thorough during oral. I think he had one small hardened piece of skin on his penis. It was lighter than his penis and no larger than the head of a pin. It never went away therefore I do not think it was herpes related. Yet, I am not a doctor and I very well could have overlooked something.  Should I get a full STD Panel?  We are both African American. STD sites make it sound like all Black women have HSV I or II and all black men have HIV. 

Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Welcome to our Forum and thanks for your question and all of the background information you have provided.  I'll do my best to help.  In doing so I may be "reading between the lines" a bit so if I go off course, please use your follow-up questions to guide me in providing the answers you seek.

1.  I presume that your wellness examination in January included testing for the common STIs, gonorrhea, chlamydia and HIV.  If so unless you have had other exposures in the interval, your results are reliable and need not be repeated at this time (BTW, congratulations on your commitment to regular, periodic sexual health examinations- this is a great way to stay healthy).

2.  The vaginal irrigation that you experienced from time to time following receipt of oral does not sound at all like HSV.  HSV recurrences do not necessarily correlate with sexual exposure and if you had acquired herpes during sex, the resulting irritation would likely occur 4-10 days after exposure, not sooner.

3. You are right about the way things sound on the internet. The fact is that rates of HIV and HSV (both HSV-1 and HSV-2) are disproportionately high among African Americans but by no means does this mean that all African American men or women have the infection.  OTOH, as an African American woman, the fact is statistically the chance that a new African American sex partner has an STI is higher than if your new partner were white.  Thus moving forward, condoms are your friend and as relationships mature, sometimes a great way to feel safe if for both members of a couple to go and get checked, as apparently you and your prior partner did.

4.  Herpes.  In general we do not recommend blood tests for HSV.  Now that you have had them and they are negative, you can be reasonably confident that you do not have HSV-1 or HSV-2 (although the blood test does miss up to a quarter of HSV-1 infections) but going forward, I would not recommend further testing. These tests, unlike the tests for other STIs have a relatively high false positive rate and can be misleading. 

5.  I do not know what the piece of hard skin on his penis might be.  There are many dermatological conditions which can appear on the genitals.   What you describe does not suggest any other STI other than, possibly a genital wart.    If it was a wart you should be OK. the Gardasil vaccine is highly effective and should prevent HPV infection with the vaccine HPV types, including the two types of HPV that cause nearly all visible warts. 

I hope that his information addresses your questions. If I may provide more information, please let me know- you have up to 2 follow-up questions.  EWH

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13 months ago
Thank you so much for your kind reply. It alleviated some of the anxiety. I had my appointment on January 20th. My doctor did not want to screen for HSV I or II without symptoms. She explained that the test can show antibodies, however, that does not denote infection, it shows exposure. It sent my head into a tailspin. Is this correct information? My test was still ordered though.  HIV, Chlamydia, and Gonorrhea were negative. I received the results for 24 hours.  Yet, the syphilis test was weird. I had an RPR titer of 1.2 and I had followup blood draw to complete an FTA-ABS test.  Is this standard?  I have not received the HSV I or II IgG back yet, the doctor said it could take a week, is this normal time span or should I be worried?  Even without symptoms, I'm not sure what to think. The shocker is syphilis and if the RPR test has a high probability of false positives.  

Lastly, I could not get a pap smear because I am not due until next year. My doctor and I went back and forth. She said my age range placed me in a low-level risk for cervical cancer, I'm 37. My HPV vaccine from my early 20s also lowers my risk significantly. She also explained the difference between a pap smear (cervix) v a pelvic exam. She explained if I want my uterus/ovaries checked, I would need to see an OB/GYN. I never knew the difference, ever.  I always assumed both were completed. Anyhow, I am now only required to get a pap smear every 5 years. This change is new to my ears. I always assumed a woman is supposed to get a smear every year. I just wanted to check to see if you knew about these new requirements and if this is the consensus among doctors? To be on the safe side, I did contact an ob/GYN in my network because I want to make sure I am not playing with fire with my life.

I realize my line of questioning sounds annoying, yet, I do not remember having a long turn-around for HSV in the past, nor any positive result for syphilis. Nor did I know that a woman does not need a pap each year. This a wow moment. 

Kind Regards. 



Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Your questions are by no means annoying.  I'm delighted to help and celebrate your commitment to sexual health. Several comments.

We would agree with not recommending routine tests for HSV-2.  The tests for HSV-2 have real problems with false positives and the blood test for HSV-1 has problems both with low sensitivity and false positives.  The tests are useful in certain situations such as when a person has proven herpes but does not know which type of infection they have (which type makes a difference in terms of recurrence rates, location of infection, etc.) or if one has a partner with known HSV-2 but are not recommended (by us or the CDC) for routine screening.  Unfortunately however, your doctor is incorrect regarding the meaning of having antibodies to HSV-2.  The presence of antibodies does NOT mean only that a person has been exposed and DOES mean that infection is present in that person (with all of the qualifications regarding false positive tests, etc.).

Your syphilis result is a bit of a surprise and indeed may be a falsely positive result.  If the 2nd test is positive however, the diagnosis is confirmed and you should be treated.  Let me know when you have your result and I'll be happy to comment.

Finally, regarding HPV, the distinction between a pelvic examination where many sorts of tests can be done and a PAP test is often not clear to many people.  Your doctor is correct on this.  In recent years however the recommended frequency of PAP smears has been reconsidered, incorporating more recent information regarding HPV.  At an age of the mid-30s, if you have had a recent negative PAP smear, you do not need another one for 3-5 years.  Your HPV vaccination adds to your lower risk as well.

I hope that this information is helpful.  As you know we provide up to two follow-ups to questions so you have one remaining.  Up to you but you may wish to wait until both your 2nd syphilis result and HSV IgG results are available.  EWH

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13 months ago
Final Update:  Below are my current test results.  Because I have not had sex in well over 16 weeks, I should be ok. The FTA-ABS was non-reactive.  That scared the crap out of me. Thank you for giving me sound feedback about my actual risks based on my behavior. I will let my ex know my results. Thank you. 
ComponentYour valueStandard range
HSV 1 IGG, EIA<0.90 Index<0.90 Index
HSV 2 IGG, EIA<0.90 Index<0.90 Index
Hsv 1 IgMNegativeNegative
HSV 2 IGM, QUALNegativeNegative
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
Thanks for sharing your results.  The PROVE that your reactive RPR was a falsely positive test for Syphilis and that you do not have the infection.  Similarly, your negative tests for HSV-1 and -2 are strong evidence that you do not have herpes as well.  This is, I think, good news and I hope that it will help you to move forward.  

Thanks again for the follow-up.  As per forum guideline this thread will be closed shortly without further responses.  Take care.  EWH
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