[Question #6737] HSV-2 Potential
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65 months ago
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I'll make this quick... 29 year old male. Contracted gonorrhea/Chlamydia in May of 2019. Was treated with rocephin and amoxicillin. They also believed I had a minor UTI. Started UTI treatment 3 days later with Bactrim as symptoms were not improving. About 2 days after, noticed some pimple like spots on the underside of the shaft and two on the head. Went in, they did a culture, came back positive for HSV-2. Doc originally thought it could be a yeast infection due to antibiotics. Had an IgG test done in late July, and again in February of this year. Both have come back negative for both HSV types. I now have pimple like spots currently on the shaft but this time all on the top and none on the underside or head. Could it have been a false positive culture? Should I rely on the blood tests over the culture? Thanks!
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Terri Warren, RN, Nurse Practitioner
65 months ago
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Interesting situation. Yes, I would believe the culture over the IgG blood test. The IgG antibody test misses 8% of HSV 2 and 30% of HSV 1, compared to the gold standard herpes western blot from the University of Washington. However, if you were my patient with this discordant result between culture and antibody test, this far out from possible infection, I would suggest that you have these new 'pimples' swab tested again if they are new and fresh. While there is such a thing as a false positive culture, statistically, there is a far greater chance of the IgG test missing an HSV 2 infection than a false positive culture, especially since the culture was taken from an obvious lesion (vs. a blind swab) AND it was typeable. for greatest clarity, you could obtain the herpes western blot yourself.
Terri
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65 months ago
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That was a fast response and I appreciate it! I already have an appointment with planned Parenthood tomorrow. I wanted to provide some follow up details I left out.
These lesions/pimples don't burst, are quite small, and have white heads much like a pimple. I have no associated pain whatsoever in any capacity. They don't itch or bleed. I also have a fiancee (been together 6 months and this is the first "outbreak" with him) and he has shown no signs or symptoms of an infection.
Another odd part about this particular set is that they are in a different spot and they didn't all appear at once. It started with 3 and now there's about 8. The skin isn't overly red or inflamed and the spots feel firm when touched.
Maybe I don't know much about herpes, but I was under the impression that recurrent outbreaks occur in the same spot? I was also prescribed valcyclovir during the first outbreak which didn't seem to help at all. They eventually disappeared about 2 weeks after showing up.
Thanks for the info! It's quite helpful.
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Terri Warren, RN, Nurse Practitioner
65 months ago
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Outbreaks of genital herpes can show up anywhere in the boxer shorts area - very often not in the same location. They can be on the penis or buttocks or thigh or even lower belly.
So you are going to Planned Parenthood for what? Another antibody test? Another swab test? Let me know how that comes out OK?
Terri
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65 months ago
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I went to Planned Parenthood for another swab test, to hopefully resolve this confusion. After looking at the lesions, provider was pretty convinced it was herpes, despite the lack of typical symptoms. She said I'm probably one of the lucky ones that presents atypically, which I'm pretty grateful for. She did do another swab as she did understand my frustration with differences in test results, despite how accurate.
In the meantime, she prescribed me acyclovir for my current outbreak while we wait for what she believed would be a positive swab test.
My partner and I have talked about it and we've agreed that if I have another one relatively soon, I'll push for daily medication.
As frustrating as this whole process has been, I'm thankful to have a (relatively) final answer. Provider did say based on lack of symptoms, it's likely I've had it for years and it only presented last May because of the conglomeration of infections I had all at once.
Thank you for the input and help! It's much appreciated.
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Terri Warren, RN, Nurse Practitioner
65 months ago
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You're welcome. I'll leave this open until I hear back from you about the test results. Has your partner been tested?
Terri
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65 months ago
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The partner has not been tested. He is quite ok with the diagnosis. He actually thinks he may already have it as well, given the high risk sexual history he has. More than likely, he's like me and has just never had an outbreak. I'll post here once I have test results in a week or so.
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Terri Warren, RN, Nurse Practitioner
65 months ago
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OK, I'll wait.
Terri
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65 months ago
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As you and I suspected, the viral swab came back positive today. Partner and I have talked about it and are both really ok with the diagnosis, mainly because it's such a manageable disease. We've both agreed that the best course is for me to do daily suppressive therapy, which the provider has given me enough medication to do so for a year. Or, she said, if I don't want to do that course, to have a bottle on hand and take them three times a day for about 10 days when an outbreak starts.
The initial sores are pretty much gone thanks to the current round of meds I'm on. I want to thank you for the input and the helpful information!
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Terri Warren, RN, Nurse Practitioner
65 months ago
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As we suspected.
So treating as outbreaks come up with do nothing to reduce transmission to partners - just so you know. condoms reduce transmission by 96% so if you aren't taking antivirals daily, then you should always use condoms with every intercourse. It is also certainly possible that one or both of your partners already have HSV 2 - they may want to get tested to see what's up.
Terri
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