[Question #7259] Exposed to Herpes, Need Advice

7 months ago
Late July - Aug. 17: Unprotected sex on 3-5 occasions. Partner later tested postive for HSV-II, twice.

Sep. 2: I was tested for HSV I and II (HerpeSelect), gonorrhea, and chlamydia (urinalysis). All came back negative.

Sep. 5: I began to notice a bit of pain and discomfort at tip of penis when manipulated or after urination. Then noticed swelling and redness of meatus. This became pain and pinching discomfort throughout head of penis, and I noticed a strange wrinkled texture from where my foreskin would have been all over the head of m penis. Tiny dots and subcutaneous lumps were also present. No discharge from anywhere, no burning during urination, some retention of urine.

Sep. 10: Urgent care PA ran urinalysis, ruled out UTI, and based on visual inspection said that she'd be "shocked" if herpes. Diagnosed me with balanitis and prescribed clotrimazole and betamethasone cream. Pain and discomfort have improved, but visual symptoms remain. I have also noticed tender, swollen inguinal lymph node on one side, as well as an occasional ache in my testicles. I am having trouble telling whether certain areas on my penis are just distorted from the infection or if I have sores, though I haven't seen anything that looks like a definite open sore or cyst. 

Was my IgG test useless, and when should I be retested? I have read that herpes can sometimes present as or cause balanitis, so I am deeply concerned.

I really apologize for going over the word-limit on my first post. I am extremely anxious and did not read the rules thoroughly.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
7 months ago
Balanitis is rarely caused by herpes, in my experience. 
so your first test, done about 3 weeks after the last encounter, isn't useless but it certainly is not definitive.  By three weeks from infection, about half the population that is going to test positive will do so.  The symptoms that you experienced do not sound like herpes  to me.  A man can have sex with a woman 104 times and there is only a 4% chance that he will acquire HSV 2.  So the odds are definitely in your favor.  Also, it might be worth checking with the woman to be sure her IgG test has an index value of greater than 3.5 to eliminate the possibiity of a false positive. 
If do you do want to retest, you might try again at 6 weeks - by then, 70% of those who are going to be positive WILL be positive.  A test done at 12 weeks is as good as it is going to get.

Terri
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7 months ago
Is the risk so low that you find it unnecessary to retest? I would certainly want to have a blood test before having unprotected sex again, I think. My understanding from the woman is that she was so high on the scale that the doctor opined that she’d had herpes for “at least four months.” 

When you’ve seen herpetic balanitis, has it been only balanitis or accompanied by typical herpetic lesions? 

Also, thank you so much for offering this service. There’s so much conflicting information on the Internet, and even from doctors, and it’s so nice to have a bit of certainty from someone so qualified. I’ve been reading a lot of your work.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
7 months ago
Good question.  I think that depends upon your level of worry, honestly.  If it helps you to move on, do it.  If you are one of the 6% who gets a low positive result, you can confirm with a western blot. 
When I have seen herpes lesions on the head of the penis, yes, they were almost always accompanied by lesions on the shaft of the penis.
Thank you for those kind words, much appreciated!

Terri
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7 months ago
I should clarify. When herpes causes balanitis, is balanitis ever the only symptom? Or could you have balanitis characteristic of a fungal or bacterial infection, without typical herpes lesions, but caused by herpes?

From the sounds of it, if I get tested now and am negative, I suppose my odds of having it would be really really low. I am growing more comfortable with my odds, but I would never forgive myself if I infected someone else through my own failure to take the right precautions.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
7 months ago
Again, I have almost never seen typical balanitis (inflammation of the head of the penis) caused by herpes.  When it is caused by herpes, there are herpes sores present, causing the inflammation and they look like sores or ulcerations in the skin.
If you are concerned about transmitting herpes to a partner, getting tested would be a good idea.  The herpes western blot is the most reliable test.  The IgG test picks up 92% of HSV 2 infections, compared to the western blot and there are some false positives on that test which we could subsequently resolve with the blot.

Terri
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