HSV Second Opinion

[MR123456]

Dear Dr. Handsfield,

Back in 2011 I took an hsv 1 and 2 IGG blood test. Both of the results came back negative. I took another blood test mid January this year. My hsv 1 came back positive. In the time frame between my 2011 test and 2014 test, I slept with two women (received oral sex from both of them) and received oral sex from a third. The two women I slept with, I used a condom (each was a one time occurrence). So after my last encounter, which was new years eve 2013, I developed a single white bump around my hairline near the base of the penis. The bump appeared on January 31 (one month after). The bump had a red ring around it and was white in the center. From what I remember, it looked like one of those hair nodes around the base of the penis. Anyway, about 5 days later, I woke up for work and noticed the bump had turned completely purple/black. It was never sore to touch. Mid day at work, I went to go to the bathroom and noticed it had opened, the stuff that came out was yellowish/mixed with blood. Within 8 or so hours, the sore was closed. I couldn't get to the Dr. the next day due to a snowstorm, so I got into his office about 3 days after the sore opened/closed. All that was left was a pink patch with a small dot scab in the center. He examined the scab and said it looked like it was on the hairline, I wouldn't worry about it being herpes. He also understood my panic with my recent diagnosis of HSV-1 and never having any symptoms prior. His advice was to put some Neosporin on it and said hsv-1 wouldn't be that low on the penis anyway. So, with all that said, I wanted to get a second opinion. Should I be abstaining from sex, I'm very worried. He was never able to culture it and at this point (about 2 weeks after the initial bump), all I have is a slight pink patch of skin. Should I hold off and wait for it to reappear? I also need to note that now that the bump has healed, there is no hair node there anymore, at least to my undertrained eye.

[Edward W Hook, MD]

I'm pleased I couild help.  EWH

[MR123456]

Thank you.

[Edward W Hook, MD]

I see no reason to mention that yo might have HSV-1.  I am skeptical that you do.  Further, please remember that, know it or not, most of your future partners will have HSV-1, whether or not they know it (Over 60% of Americans have HSV-1, most persons do not know they are infected).  EWH

[MR123456]

Thanks for the quick response Dr. Hook. So would it be safe to assume I can engage in protected sex with a future partner? Am I obligated to state I have HSV-1 despite the possibility of a false positive?

[Edward W Hook, MD]

Welcome to the Forum. Dr. Handsfield and I share the forum and answer questions based on our availability.  As it happens, I will be answering your question.  For better or worse, clients are not able to request a response from one or the other of us and once someone receives a response from one of us, the other will not chime in.  This approach allows us to assist more MedHelp clients.  FYI, part of the basis for our partnership is that while our verbal styles may differ, Dr. Handsfield and I have worked together for more than 30 years and have never come to different conclusions in our advice to MedHelp clients.  

Before I address your question, I need to tell you that I find myself wondering why you are having repeated blood tests for HSV.  I worry that your experience may be a good example of why we (as well as the CDC and most other experts) recommend against routine use of HSV blood tests as part of "routine STD checks".  The tests are not good enough for this purpose, yielding relatively common false positives, sometimes taking a while (up to six months) to become positive, and all too often leaving clients with more questions than answers.  

As for your situation, let me first comment about the lesion that you describe and then follow with a comment on your blood test.  The lesion you describe is a great description of folliculitis, sometimes called "hair bumps" which are local infections occurring in pores or the base of hairs.  The occur in about the location you describe, often contain the white or bloody material that you describe, and can leave to sorts of minor scarring that you may have at this time.  The lesion you describe,, on the other hand, really does not sound like HSV.

As for your blood test, there are problems with false positive tests with the most commonly used blood tests for HSV and in the absence of other evidence of infection, this may be what is going on with you.

My advice would be to more forward and not worry unless the lesion you have described recurs.  Should it recur, I recommend a PCR or culture test be taken from the lesion as soon as possible after it appears.  I do not recommend further blood test.

I hope this comment is helpful to you. EWH