[Question #6475] What can this be?

16 months ago
I received unprotexted oral sex.  It was very brief (a matter of seconds) before I stopped it on 10/4/19.  Exactly two weeks later (10/18)I had some tingling in my penis. Next day I had what I thought was a pimple.  It only last 4-5 days, was painful but did not pop, blister or anything like that.  It was painful but short lived.  I also felt very flu like and did have what I  believe to be swollen groin lymph nodes. 
I decided to get tested for everything on 10/21. Everything came back negative except HSV1 (this was 17 days past exposure).   
IGG level was 3.24
I then was tested again on 10/29 and the IGG level went down to 2.64
and then one more time on 11/18 and was was even lower at 2.21

I am now 13 weeks past exposure.  I am still having a lot of pain in my hip (maybe top of my groin and  lower abdomen.   Is it safe to say it is genital HSV1?  Couple specifics questions on why I'm wondering. 
1)  I'm concerned that I am still having issues this long after.  Is it possibly something else?  Another STI or something different entirely? 
2) If this is a primary infection (I had never been tested before or had any symptoms-- Oral or genital) isn't 14 days long before first symptom? 

Thanks. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
16 months ago
It is definitely not safe to say that you have genital HSV 1 infection, no!  You have jumped to conclusions on this one.  So let's step back.  I think it is likely that you have HSV 1 infection, though your value is in the low positive range that we primarily assign to HSV 2, but I have seen false positives for HSV 1 in the low positive range as well.  Low positive is defined at 1.1 to 3.5 and we see some false positives in this range.  Have you ever in your lifetime had a cold sore on your lip or in you nose? 
Your description of the lesion you noted on your penis is somewhat confusing to me.  It was painful but didn't pop or blister.  What did it do and what did it look like more specifically?  Are you able to be in touch with the person who gave you oral sex to ask about any history of cold sores?  I think the chances of you acquiring HSV 1 from receiving a few second of oral sex is just incredibly low indeed! 
And yes, 14 days is a very long time after new infection to get sores.  Again, I think this is so unlikely.  Have you received oral sex in the past, unprotected intercourse?

Terri
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16 months ago
The lesion was very similar to a pimple  in all ways (appeared to have pus).  I didn't realize at first so I tried to squeeze it but nothing really came out and it went away in about 5 days.  It definitely did not look like the pictures you see online though.  I do not recall any cold sores on my lip or nose.
Yes I have had oral and unprotected sex in the past but not with many partners at all.  The reason I thought this was possibly a new infection is because of the flu feeling and swollen groin lymph nodes. I was confused when the Igg levels went down as time went on as I expected the opposite (them to be increasing). 
What about still having pain. Is there a chance if it is a new HSV1 infection that I would still be having pain 11 weeks after the first symptoms (the tingling and then the pimple, lymph node pain)
The pain  was in the groin and now it moves from the groin (very high... basically in my hip) to my abdomen and lower back/butt cheek.  I tested for HSV2 as well to be sure (which i researched was unlikely from oral sex) and tested negative all 3 times (up to 6 weeks after potential exposure). 
Super anxious and want to figure out if this could be something else. I was pretty confident it was HSV1 genital based off of the initial but now I'm unsure. Seems unlikely from exposure and now that it has lingered so long. 
 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
16 months ago
Herpes lesions do not normally contain pus - they are more like water blisters than pus filled lesions.  Herpes lesion pain would not last 11 weeks.  If indeed you are infected with HSV 1, you cannot know where it is unless you have a lesion to swab test, either oral or genital.  I wish there was a simpler way to know what is happening with your HSV 1 infection but there simply is not.  I don't think the flu symptoms and groin nodes are enough to assume that you have genital HSV 1 infection. 

Terri
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16 months ago
So just to clarify a couple of things
1) The pain is not where the lesion was.  The lesion came and left pretty quickly.  The pain that is still going on ( I assumed it was groin lymph nodes) is very high as I mentioned, almost where my groin and hip connect.   It sometimes makes my lower back hurt and at times my abdomen.   So if it was HSV1 genital and it was primary you would not expect that the lymph nodes would stay swollen or hurt for this long.  Is that safe to say? 
2) Possibly a lot of anxiety because I was pretty convinced. Any idea what else this could be? I assumed STI (and specifically HSV1) because of the timeline chain. Two weeks after this happened I had tingling in my penis, then the next day the "pimple like lesion" then swollen lymph nodes (within a matter of a couple of days from the tingling) and that has continued but changed for sure as far as location.  The biggest thing that threw me off was the 14 days before anything started.   Is there anything else it could be? 

Let me know if the timeline and symptoms make sense please... Thanks again. 
16 months ago
Also, if I did another HSV test and the Igg levels has risen woudl that change your opinion about it being a new infection? 
My lower levels (I thought) were also indicative of this being a new infection but I now suspect I may be wrong. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
15 months ago
1) The pain is not where the lesion was.  The lesion came and left pretty quickly.  The pain that is still going on ( I assumed it was groin lymph nodes) is very high as I mentioned, almost where my groin and hip connect.   It sometimes makes my lower back hurt and at times my abdomen.   So if it was HSV1 genital and it was primary you would not expect that the lymph nodes would stay swollen or hurt for this long.  Is that safe to say?

That is indeed safe to say, yes.

2) Possibly a lot of anxiety because I was pretty convinced. Any idea what else this could be? I assumed STI (and specifically HSV1) because of the timeline chain. Two weeks after this happened I had tingling in my penis, then the next day the "pimple like lesion" then swollen lymph nodes (within a matter of a couple of days from the tingling) and that has continued but changed for sure as far as location.  The biggest thing that threw me off was the 14 days before anything started.   Is there anything else it could be?

I'm puzzled about what it might be as well, but if anything like this comes up again, you should go right in and have it evaluated by a professional - it's very difficult over the internet to try to sort things out without an actual person to see. 

Your numbers are kind of all over the place.  From what I've seen so far there is no way to know for sure that this is HSV 1 or when you got it.  Your values are in the low positive range and I just had a person with a 3.3 index value for HSV 1 than turned out negative on the western blot.  At some point, you may wish to pursue the western blot for a clearer answer


Terri
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