[Question #7657] Do I have Genital Herpes?

1 months ago

Hello Doctor,14 weeks ago, I had a protected oral and vaginal sex with a female sex worker. The encounter is fast, I just inserted several times and I didn't have ejaculation. It was my first sex intercourse. When I took off the condom, my penis got minimum, I worried some liquid fell on my penis.

And I got Capita test in 3, 4, 5 week, igm and igg for HSV I and II were all negative. In the 6 week, I got Roche test, all negative, the value for HSV II igg was 0.06.

However, I returned to a small Asian village. In the 12 week, I got test there, HSV II igg turned positive, and the value is 1.4. 2 days later, I took the same test again, it was still positive, and the value was 1.2. The lab said the test was made by a company called dia.pro in Italy. I couldn't return to the city for the moment.

I don’t have sores for 14 weeks. 2 days ago, I found a sore. It was at the base of my penis, and on the back of my penis.  Feb 17 I climbed mountain. I casually checked my genital part at 9 p.m. before sleeping, it was ok. At 3 a.m. on Feb 18. I felt itch, and I found the sore. It was filled with clear water. When I pulled the skin, it was round. When not, it looks like a cut. I cleaned the water, and continued sleeping. And when I woke up at 7 a.m., it had developed scab. I talked to my doctor online, he said it doesn't look like herpes, because it was single. He told me it was because of friction when climbing mountains. But I had had severe sports in the 14 weeks, such sore never showed up.

1. Do you think I have genital herpes?

2. Assuming I had herpes, will I receive regular severe outbreaks at some points in the future?

3. Some people don’t realize they have herpes because it was mild. When they realize because of a classical outbreak, will the outbreaks in the future still be mild?

4. Some websites said for some people first outbreak take place years after the infection. If the first outbreak happens, will those people start receiving regular outbreaks?

1 months ago
Dr. Hook/Dr.Handsfield I have read your answers on Medhelp.  And I don't have any sores in the first 14 days.  What worried me most was that I am afraid that some days there will be a severe primary outbreak all of sudden and change my life forever.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
Good morning,
I answer the herpes questions on this forum so I will be helping you today. 
I think it is quite unlikely that you have HSV 2.  Your positive index values in low, though I don't know what the references ranges are for the specific brand of test that you describe.  Do you know?  They should be listed on your results page.
The concerning part of your post is when you describe what sounds to me like a water blister at the base of your penis.  How long did the whole sore process take to heal, from the time you first noticed it until the scab was gone.  Could you have scratched yourself in your sleep to have cause this or was it an actual water blister when you first noticed it?
Let me answer your questions and then I hope you will answer mine

1. Do you think I have genital herpes?

Not really, but I am a little concerned about the sore you describe

2. Assuming I had herpes, will I receive regular severe outbreaks at some points in the future?

IF you have herpes, and that's a big IF, and this is a first outbreak, then it is very unlikely that anything more dramatic will happen in the future in terms of outbreaks

3. Some people don’t realize they have herpes because it was mild. When they realize because of a classical outbreak, will the outbreaks in the future still be mild?

IF you have herpes then yes, likely mild in the future

4. Some websites said for some people first outbreak take place years after the infection. If the first outbreak happens, will those people start receiving regular outbreaks?

Some do, some don't.

So here's the deal - this was your first intercourse, the penetration sounds minimal to me AND you used a condom which was a very good decision.  If you had not reported a sore, I would say you have nothing at all to worry about.  Which is why I am asking you a bit more about the sore.  And I am also curious about why you tested so often for herpes in the weeks following the encounter.  Can you tell me about that?


Terri

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1 months ago
Terri, thank you so much for your help. The lab said any index under 1.0 was negative, and higher than 1.0 was positive. 
I found the sore at 3 a.m. in the morning, and when I woke up at 7 a.m., it had developed scab. I did check my genital part that night before going to bed though, not very carefully, can't be sure whether it was there. And it takes 2 days from when I found the sore to when the scab disappear: I found it at 3:00 a.m. Feb 18, and now it's 23:00 Feb 19, the scab has gone, and it becomes normal except being more red than the skin nearby. I was planning to do a PCR test in the morning, and it healed before I went to the hospital.
And it wasn't a blister when I first noticed it. It was a single ulcer or a single sore filled with some water. When not pulling the skin, it looks like a single cut. And I have measured it, it is 0.5 cm long. And I can't be sure whether it was because of the scratch or something else, and it never happened before. I checked my genital part quite often, I never saw any red rash or pimple days before the sore came out.
And, Terri, the reason I tested so many times was I was so scared. The local doctor told me six week's test is a conclusion, so I tested every week. Before this encounter, my girlfriend whom I have fallen in love with for 6 years broke up with me. I felt lost, I don't know why I reached a sex worker. After that, I think I have failed everybody I love. Since Herpes is a permanent infection, that's what I fear most. So I take test every week. And thank you again, so grateful for your help.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
You know, from your description this time, I think herpes is even more unlikely.  It healed so quickly and the fact that you don't think it was a water blister makes a big difference in my mind.  I can't tell you it isn't herpes with 100% certainty because of the very low positive test, but I can tell you that 1) your experience sounds very low risk and 2) your symptoms healed so quickly it just isn't really consistent with herpes.
Where you are?  Can you ship a confirmatory blood sample to the US if you want more certainty?

Terri
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1 months ago
Terri, I live in a remote village in Asia. I don't think there are any lab who are willing to do that, since every lab was affiliated to a hospital.
I still have some confusions:
1. In your opinion, is there a possibility that some day a lot of blisters suddenly appear in my penis?
2. I was very worried that I was in the process of seroconversion. My six week test value was 0.06(under 1.0 was negative), can that say the low positive result was incorrect?
3. I read about an answer. It said "there is a miniscule chance a blood test would later pick up an otherwise unknown infection" . I don't have sores in the first 14 days. Terri, based on your extraordinary experience, among all your patients, is there someone that doesn't have a primary outbreak and then picks up an infection by blood test?
This is the Medhelp answer:https://www.medhelp.org/posts/STDs/Possible-HSV-2-Exposure/show/1616016
Terri, thank you again for your help. So grateful for it.

1 months ago
4. I talked to the local doctor. He said Herpes always perform like multiple small sores in one small area. Is there a chance that one single cut-like sore (about 0.5cm long) is a Herpes outbreak?
I was very scared, so I know I might be a little annoyed. Thank you for your patience, Terri. Very grateful for your help.
1 months ago
Terri, there are something that I express wrongly yesterday. Today is Feb 20, and the sore still have a little scab on it. I said it didn't have scab on it yesterday, it might be that I scratched it out. But one thing is clear, it did develop scab 5 hours after I found it.
1 months ago
Hey, Terri. I read one of your slide in slideshare.net today. You said an excoriation can be the atypical subtle presentation of herpes. And I must said, the picture in the slide(Photo courtesy of Jeffrey Gilbert, MD) and my sore are alike, though the lesion in the picture is multiple and mine is single. 
Here is the slide: https://www.slideshare.net/terriwarren/genital-herpes-update
Is my sore atypical herpes?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
1 months ago
1. In your opinion, is there a possibility that some day a lot of blisters suddenly appear in my penis?
I doubt it, IF this is herpes.

2. I was very worried that I was in the process of seroconversion. My six week test value was 0.06(under 1.0 was negative), can that say the low positive result was incorrect?
No, but it makes it more likely.  By 6 weeks out, 70% of those who are going to be antibody positive, will be so. 

3. I read about an answer. It said "there is a miniscule chance a blood test would later pick up an otherwise unknown infection" . I don't have sores in the first 14 days. Terri, based on your extraordinary experience, among all your patients, is there someone that doesn't have a primary outbreak and then picks up an infection by blood test?

Oh yes, definitely.  Some people appear to have a protein in their blood that trips the IgG test artifically.  It happens quite often, in fact.
This is the Medhelp answer:https://www.medhelp.org/posts/STDs/Possible-HSV-2-Exposure/show/1616016
Terri, thank you again for your help. So grateful

4. I talked to the local doctor. He said Herpes always perform like multiple small sores in one small area. Is there a chance that one single cut-like sore (about 0.5cm long) is a Herpes outbreak?
I was very scared, so I know I might be a little annoyed. Thank you for your patience, Terri. Very grateful for your help.

Is it possible?  Yes,it is likely?  No It is incorrect that everyone with herpes presents with multiple genital lesions.

Terri, there are something that I express wrongly yesterday. Today is Feb 20, and the sore still have a little scab on it. I said it didn't have scab on it yesterday, it might be that I scratched it out. But one thing is clear, it did develop scab 5 hours after I found it.

I"m so sorry that you didn't have the sore swab tested right away - that would have been helpful, but I think now, it is likely too late for an accurate swab test, even though there is still a swab present.

Your sore could be atypical herpes, I just can't say with any certainty.

I know you live in a small town but I still think that you should try really really hard to see if someone could draw and spin one serum separator tube of blood and you should ship it to the US to the University of Washington
Your situation is complicated - complicated with the sore.  I still think given a single episode of intercourse, with a condom, that this is truly herpes.  And if you can't get a blood draw and ship it to UW
then if you get another sore, have it swab tested immediately, at a minimum.  I sure wish I could give you a more definitive answer.

Terri



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