Persistent Burning & Redness: HSV, or something else?

Hello; I had protected vaginal and anal and unprotected oral sex with an individual of unknown HSV-status on March 26th and March 27th. Prior to intercourse, my unprotected penis rubbed against her outer labia several times. She presented no obvious sores, redness, or other signs of an STD, in either her mouth or genitals.

My symptoms, which I have been experiencing for a month:

1. Redness around the urethral opening. Initially, this redness -- and the mild burning that accompanies it -- encompassed more of my glans (glands), but after the first week it lessened to merely my urethra.

2. Small, soft, red-pink mass roughly .5 centimeters inside my urethra; it is the size of a small ladybug. It is lumpy, though not exaggeratedly so. It is not painful or burning. It appears to be part of the flesh that makes up the urethral opening *above* the urethral canal exit. My doctor has stated it is 'viral'. This has been present for three weeks to my knowledge.

3. Mild burning in urethral opening, an inch into my urethra. This is almost non-existant while walking or standing, but I am quite aware of it (as discomfort) when sitting.

4. An infection of my prostate, identified through an abdominal ultrasound which revealed a 'ring of white'.

Urine exam, growth, and swab revealed nothing.

I've had HPV warts on the skin of my penis, around the lower shaft. Last wart was 9/2010.

IgM blood test 2 weeks in: 1.7. The doctor I was seeing at the time proscribed Famvir, 3x a day, which I took for one week. This did not resolve my symptoms.

I was on 500 mg/day levofloxacin for two weeks. Placed on two more weeks of antibiotic and 1g/day of Valtex; according to my doctor, the mass is likely 'viral' due to the levofloxacin's lack of success with it.

I urinate/ejaculate fine (though I feel some slight burning afterwards). Typically, the burning/redness is considerably less in the morning (after I've been laying down for a long time...) and worsens throughout the day. Could this be HSV?

[Terri Warren, RN, Adult Nurse Practitioner]

It could be a wart in the urethra, I suppose, or it could be your normal anatomy.  Does he mean wart when he says viral, do you think?  I would seek clarification about that.  

So the IgM is very often wrong, but not every time wrong.  However, I would avoid doing it again and stick only with IgG testing in the future.  Having said that, your symptoms do not sound herpetic to me.  They are going on too long, no sores have appeared, and your IgG is negative so far (not definitive yet).  

Two weeks of antibiotics is often not enough to treat a prostate infection.  I'm not sure about those details, but you might want to follow up on that.  I'm assuming a chlamydia and gonorrhea tests were negative?

Terri

Has anyone suggested urethroscopy to look at the lesion?  In my opinion, the mass may be a red herring.  Could have been there forever but is just noticed now.  

[lostlatenight]

I'm sorry, some corrections:

1. The red spot inside my urethra is more like 1 - 2 centimeters inside; it requires some, ah, peeling to see it.

2. While my IgM was 1.7, my IgG was 0.2. This was only for HSV2 apparently. I now know, of course, that it was much too early to have anything reliable, and that the IgM is to be dismissed. As seems to often be the case with herpes, my healthcare providers were ill-informed; when I was proscribed Valtrex, it was suggested it might help clear up condyloma as well. :|

[lostlatenight]

Terri,

Thank you for your reply.

When he said it was viral, I asked him if he thought it could be a herpes lesion. He said he thought so, but that it could also be a genital wart.

Chlamydia and gonorrhea were both negative, yes.

I've not had a urethroscopy; if the spot is still there after the five days of Valtrex (and so far it is...) then I'll discuss that with my doctor. I have an appointment for a second opinion next week so hopefully he'll be  able to offer his opinion as well.

I will say that the conditions appears to be improving, but I can't say whether it's the Valtrex or the levofloxacin... strange to be in a position where I hope one of my medications DOESN'T work, hah.

[Terri Warren, RN, Adult Nurse Practitioner]

That's kind of the problem with doing two medicines at the same time.
I would also stress that if this goes away with Valtrex, it does not constitute a diagnosis of herpes.  For an accurate diagnosis, you need either a positive type specific antibody test or a positive swab test from a lesion.

Terri

[lostlatenight]

Yes indeed... Thanks for your help Terri. I guess I'll just have to wait a few weeks and get a proper testing. You've been very reassuring!

[Terri Warren, RN, Adult Nurse Practitioner]

I'm glad.

Terri

[maybelle81]

can you please post your results? it's amazing that i cannot find a single follow up to people who display indeterminate - positive igm and negative igg results... I just want to find a single person who has had an indeterminate igm and negative igg at three weeks who turned out to be negative for herpes in the end.
*** I find it cruel that so many sites say to disregard igm as it should be clarified to say disregard igm results when your igg is positive... in all other cases i cannot find any studies that suggest indeterminate - positive igm is unreliable when igg is negative.

[lostlatenight]

Hi maybelle81,

I sympathize with your frustration. I too found it difficult to locate much in the way of 'follow-up' for situations such as mine.

This is probably because, in cases like ours, nothing is known, so nothing is posted, and eventually such posts are forgotten -- either because we don't have HSV and we no longer have to think about it, much less the forums we posted on desperately seeking advice; or, because we DO have HSV, and the internet-time we spend on it is more about support and management, not 'do I or don't I?' since that's taken care of now.

I fully intend to post my results... when I know them. I hope that I'm negative and can be a light of hope for those who, like myself, trawl these forums looking for some sign of optimism.

I'm only five weeks into my 'problem', one that manifests as more than a blood test but with actual symptoms (though they are not traditional herpes symptoms). In two weeks I am going to take the the IgG HSV I and HSV II blood test and see what's going on; that will be seven weeks post-encounter. While this is not a 100% reliable timeframe, if I am unequivocally positive (>3.5) then at least I will KNOW.

Of note is that Valtrex did nothing in particular for my symptoms; they continued generally unabated, though lessened over time -- however, my prostate infection (which was once again ultrasound'd again today) has also lessened considerably, which may be why the mild burning in the tip of my penis/urethra/intrameatus is also considerably less, well, burny, and less common.

My doctor prescribed another two-week, 500 mg/day round of levofloxacin for the prostate, another 1g/day of Valtrex for five days, and a self-applicable cream for the growth just inside my urethra (which, while not as red [much like the rest of my intrameatus, now], is still there). The pharmacy was out of Valtrex and it's the only place I don't pay an arm and a leg for it, so I'm going to see how things go without the antivirals. As I previously stated, taking multiple meds has only served to confuse my diagnosis, and me.

On the other hand, when I questioned my urologist's choice to re-prescribe Valtrex, he said he would challenge me to offer another diagnosis, and that it is almost certainly herpes. Of course, this is the doctor who said Valtrex can aslo treat genital warts, since they're also viral.

Needless to say, I'm going to go get a second opinion soon.

Keep an eye out here and feel free to remind me to post in a few weeks.

[maybelle81]

thank you... for some reason i don't get any alerts when people respond to anywhere i've posted... i'm back to losing my mind because I came across this, this morning: http://www.medhelp.org/posts/Herpes/Been-tested-5-timesmany-questions-remain/show/1680368

so now aside from worrying about a low positive, there is such a thing as a high negative... and since my igg was a .3 i'm convinced i "obviously" have hsv2

[Terri Warren, RN, Adult Nurse Practitioner]

There is no reason to believe that since you have a 0.3 result that you definitely have herpes.  I believe you are overreacting.  

My suggestion is it to wait 4 months from the time of a concerning sexual encounter and retest, you can do it with the ELISA.  While you are waiting, don't take any antiviral medicine.  Many people with these higher negative values never become positive.  

I know patience is very difficult here, but you do need to just be patient.  Involve yourself in other activities and get off the internet, fast.  

Terri

[maybelle81]

While I appreciate your comment Terri, you DID say that "normally" the people who come to your clinic who test a true negative wont have an AB count higher than "maybe" .2. For me that's like saying, "normally people don't win the lotto when they buy a lottery ticket." This sort of statement would not make me more hopeful that I will be one of the few people who will win the lotto anyway.

Additionally, you have said that while IGM can be wrong, sometimes it can be valid.

I tested an indeterminate IGM numerical value at the the 3 week mark. That coupled with a .3 seems to weigh more on the side of on my way to seroconverting.

[Cookie2011]

Hi!  Just wanted to share a thought...  I too tested "questionable" on my first test and then instead of other testing opted for "the best" (which is the Western Blot) to determine my status.  No more testing and you know for sure and go on with your life.

[lostlatenight]

I suppose I may as well inquire: did you test positive or negative, Cookie2011?

[Terri Warren, RN, Adult Nurse Practitioner]

The number of people who test negative between 0.2 and 0.5 are way more than those who win the lottery.  

While it is possible that you may be infected with herpes, I still don't think it is likely.  There is really no better way to sort it out than just waiting for another test.

This will be my last post on this thread but you are welcome to post final results if you wish.

Terri

[Cookie2011]

Both came back positive.  I'm glad that I did the test so that I would know for sure, one way or the other.  H doesn't define who you are, it's a skin condition/virus.  

[Terri Warren, RN, Adult Nurse Practitioner]

I'm glad, Cookie, that you got that reassurance.  

Terri

[maybelle81]

What was indeterminate? Your IGM or IGG?

[lostlatenight]

Hi maybelle81,

It's nine weeks in now, so the following test is 75% accurate, but here's my latest Herpes blood test; unfortunately it's not the same test, so the numbers aren't 'comparable', but the take-away is that everything showed negative, including the HSV 2 IgM (which is what showed equivocally positive last time). This was simply described as a type-specific Herpes I & II ABS test. I assume it tests for the antibodies, but measures them differently than the test I received before.

HSV1 IgG = 8.8 U/mL (Negative)
HSV1 IgM = 3.8 U/mL (Negative)
HSV2 IgG = 12.1 U/mL (Negative)
HSV2 IgM = 3.2 U/mL (Negative)

While this test is not 100% accurate, given that I have no ulcers/sores/lesions, nor do my symptoms 'recur' but rather continue to 'persist' for ever two months now, I am fairly confident in saying I do not have HSV.

I've learned a lot about my sexual health in the process though. Good luck to you, maybelle, and anyone else reading this. When I get a 4-month HSV test (or uh, whenever I get insurance again, as I'm going to be quitting my job shortly...) I'll post those results for other worried folk trawling the internet, searching for hope.

[maybelle81]

So nice of you -- thank you!! And congratulations!!! :)

I too will update! (So scared.)