Possible GHSV-1 but inconsistency in symptoms...

[whyme82]

Hello Doctors,

I started seeing a girl in summer of 2010.  She told me that at times she gets cold sores (HSV-1).  Actually, until recently, I haven't seen one of her breakouts.  Before we began having sex, she was tested for all STD's, including HSV-2.  It all came negative, obviously except for HSV-1.  All of a sudden starting in August 2010, the weird tingling/pain/itching/burning/soreness of the shaft began.  It comes and goes, no longer than 3-6 days.  No lesions, ulcers, cuts, bumps and sores have ever appeared on my shaft.  We have sex consistently but I received oral sex no more than 6 times (mainly cause I'm a hypochondriac).  Went to Urgent Care in the early fall, dismissed it as jock itch.  I was convinced, as I still am now, that this is GHSV-1.

Fast Forward:  November I get extreme pain and itching and soress in penis.  Go to another Urgent Care, tells me he sees no sores and its not herpes even though I'm in pain.  I get blood work for type 1 and 2, came out negative.  Another one of my pain/burning "outbreaks" happen in January for about a week.  Went to dermatologist, she says she sees nothing and dismisses it as some kind of dermatitis.  Fast forward to now (in between having random bouts of pain/burn but small), I have another extreme pain/burn/itch/soreness "outbreak".  I've had it and I'm going to go to a urologist.  The relationshp w/the girl is over so I want to be sure what my status is as a single guy, but apparently I have difficulty getting answers.

I'd like to know your opinion on my situation, and if there is anything specific I should ask the urologist.  No one really ever takes me seriously cause I don't have those classic blisters.  I for sure want to take the blood test again for reassurance (maybe initial "OB" was right before I took the test the first time).  I feel like I have GHSV-1 through my 5-6 time oral sex exposure, but these symptoms are so inconsistent.  Your thoughts, doc?

[Terri Warren, RN, Adult Nurse Practitioner]

You can, especially for HSV 2.  The ELISA test for HSV 1 picks up 91 out of 100 cases, so not as good as HSV 2.  If you want to be more certain, you could get a western blot antibody test.  That will be tricky through LabCorp though.  Is it slightly more sensitive for HSV 1 than the ELISA.  If both are negative, I would say you are not infected.

All of your timing is great.  No risk from lapdances with clothes on.

Given the symptoms that you have had and have not had, I don't think you have herpes.

Terri

[whyme82]

Took the igg antibody testing from labcorp, and to my surprise, received <0.91 for both types 1 and 2, suggesting I"m negative for both. I'd like to use this test as the reason for me to move on, but I wanted to confirm with you that I can do so given the following scenarios in relation to proper timing of testing.  I took the test on April 27th.  My potential exposure to herpes are the following:

Unprotected sex with partner of unknown status - 10/2007 (almost 3 yrs ago)
Recipient of oral sex with partner of known HSV-1 - 11/2010 (about 5 months ago)
Fully clothed lapdances - 1/2011 - (a little more than 3 months)

Can I have faith in my IGG test that I am negative for both types?

[whyme82]

Thanks. I will surely keep you posted.  One quick question though.  Let's say the results are positive for HSV-1.  Do I assume its genital?  I understand the potential difficulty in distinguishing oral vs genital, especially with the absence of sores.  Is it reasonable to ask the urogist to swab the skin, as it may be shedding during this theoretical "outbreak"?  

Thanks again.

[Terri Warren, RN, Adult Nurse Practitioner]

I think redoing the antibody test is a good idea.  If you are really worried, you could request a herpes western blot through the University of Washington, can be done through Quest labs, test code 34534.  It is a bit more sensitive for HSV 1 than the regular type tests.  

My personal opinion is that your symptoms are not at all consistent with genital herpes type 1.  It rarely recurs with symptoms and really should, at some point, present with sores.  You are having frequent symptoms and no sores.  I'm hoping an additional antibody test will reassure you, and allow you to move on from this hopefully, incorrect, belief that you are holding and also, that you can get some explanation about where these symptoms might be coming from.  Keep us posted!

Terri