[Question #871] unprotected oral sex with a “bar girl” in South America

53 months ago
4 months and 6 days ago I received unprotected oral sex from a "bar girl."

2 days later  I had pain in my lymph node in my right inner thigh (only when I touch).  The pain went away after a few days, but the lymph node is still swollen to this day; about the size of a regular m&m.   I went to a surgeon about a month ago and he told me to come back in a few months if the swelling hasn’t gone down, but I wasn’t given any type of diagnosis.

While still in South America, 19 days after the incident I decided to get a IGG test for HSV 1 and 2.   I got a 39.7 U/ml for HSV1 and a 15.6 U/ml for HSV 2.    Apparently in their scale anything over 30 is positive and less than 20 is negative.  The test was a enzyme immunoassay, ELISA.

Back in US at LabCorp, 2 months and 23 days after the incident I got a negative result for all STDs INCLUDING HSV1.

3 months and 7 days after the incident I got a negative result for all STDs except I got an equivocal result of 1.04 for HSV1.

4 months and 5 days after the incident I got a another equivocal result of .93 for HSV1.

Could the results that I got in South America have been invalid since I tested negative for HSV1 later?

What could the downward trend in the result value mean?  I would have expected the equivocal number to have gone up if I was; in fact, positive.

I haven’t had anything that appears to be lesion-like.  My only STD-like symptom has been tingling around my penis head and urethra, but this could be my nerves.  I am not sure.  My doctor told me it was “probably just some irritation.” 

What do you recommend that I do?   I really want to understand my herpes situation since my wife and i have a two year old another baby due in a few months.  We haven't been sexually active in quite some time because of this incident.  We are making strides in that direction and I wanted to be cautious with the health of her and our children.

Thanks,
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
The test used in the US for HSV 1 misses about 30% of HSV 1 infections, so I'm honestly not sure what to make of your  testing here - you could be infected with HSV 1 or not.   The way to find out would be to get a herpes western blot, and you could do that by contacting the University of Washington (google HSV western blot and UW).  Now the question is if you are positive, did you get HSV 1 from receiving oral sex at this encounter or not?  Though you had a groin lymph node enlarge, that doesn't mean you got HSV 1 genitally.  Have you ever in your life had a cold sore on your lip?  If yes, then the HSV 1 could be coming from that, or you could have been infected orally or genitally years before and didn't know it. Does your wife get cold sores?

Terri
---
53 months ago
Thank you Terri,

Neither my wife or I have ever gotten cold sores.

I'm glad you are confused by my test results because they don't make sense to me either.  

I guess to me the issue isn't so much if I have HSV1 (if I had it before), it's if I contracted it during this incident and could I transmit it to my wife.   And it sounds like all of this is a big question mark. :-/   I don't think getting the WB will help with this at all; it will probably just add more questions.

If I had HSV1 for a long time, would you expect the result number to go down?

If I "recently" acquired HSV1 would it be expected for the equivocal result to go down over a month after getting an equivocal result?

The swollen lymph node also has me very confused as well.  I was told that a swollen lymph node is unusual without an outbreak, but I found several cases online of people saying that they had constant lymph node swelling after being diagnosed.

Have you you, Dr. Handsfield or Dr. Hook seen anything like my situation before?

I only wish I had identified my sex/porn addition before this incident.  That has been the only bright side out of this disaster, because that is something concrete that I have been able to work on.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
Unfortunately, there is not going to be a way to know, if you do have HSV 1, when you contracted it or how you contracted it. Your first positive HSV 1 test was 19 days after the encounter, during which time you could have already made antibody.   I would expect that possibly if you just contracted it, that your HSV 1 index value would climb, which is isn't apparently doing, but again, the US test can miss it altogether so that is no definitive.  In my experience, lymph nodes can come up with outbreaks, but then go away after outbreaks are over.  They are responding to active virus. 

I'm not clear that you are going to get what you need now, which is to know if you had HSV 1 before the encounter and do you have it now.  The only thing that I can see as possibly helpful to you in this quest is to know if you have it now.  If you don't have it now, then all of this doesn't matter, correct?  That's where the western blot could be helpful for you; I don't think that it is going to make anything really worse if it is positive, right? 

Terri
---
53 months ago
Terri,

I think you are right and I agree.  I think the WB is the next logical step.  Although my wife has told me that she is willing to have protected sex with me until our child is born and then "roll the dice" after that.   So she is ok with me not pursuing additional testing.

Also, one last question before you cut me off.   

I noticed that the tingling in urethra is intensified after I ejaculate (not during).   I wouldn't describe anything that I feel as pain, but there is general feeling of discomfort that I feel throughout the day.   I don't notice any increased sensation during urination.    I am going to go back to my PCP, but if you could give me things to tell him in terms of what he should check for that would be extremely helpful.   I am hoping that this is a UTI, but my symptoms don't really seem to line up with that either.    Would there be any particular specialist that you would recommend besides PCP?  I'm guessing a urologist.

From what I have read about HSV,  I wouldn't expect to have these tingling sensations for months.  I also read that urethritis associated with HSV is usually accompanied by "extreme" pain.

Thank you for your time and all that you do for your real and virtual patients.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
No, I agree that tingling for months with herpes does not make sense.
My suggestion would be to consider prostate issues - sometimes those result in urethral sensation changes. 
And it is correct that in my experience anyway, urethral herpes is quite painful as you have acidic urine passing over open sores - OUCH!  What you describe really sounds nothing like that, in my opinion.

Terri
---