Herpes is still haunting me! All the symptoms yet negative blood tests

[BadDay1972]

Dear Dr. H.,

Hopefully you can help me come to a final decision as to whether or not i have genital herpes. I've now had 4 pos hsv1 (i get cold sores) and 4 neg hsv2 blood tests (3 of which were definitely herpeselect tests). My exposures were as follows:

3/3/06 - initial exposure where i thought i may have been exposed was in early march last year - unprotected one night stand. That was 10 months before my last blood test.

7/15/06 - received protected oral sex and masturbation from a stripper 5 months prior to my last test

9/20/06 - unprotected sex with girl i know (all of my symptoms started before having sex with this girl although)

10/10/06 - protected sex with girl i knew for about 2 weeks

My last test was about 3 months after my unprotected exposure on 9/20 and 2 months after protected exposure on 10/10.

I plan on having another blood test in mid january which will be about 16 weeks or 4 months after my last exposure which was the protected sex.

You once told me that all of my symptoms (burning in my genital area, raw feeling of penis, tingling in tip of penis, discharge from the tip of my penis, tip of my penis sticking together, subtle burning when urinating, itching for 1 day on 2 spots on my penis, itchy anus, sharp pains in my genital area, sore back and inside of legs, red spots on penis) all of which have come and gone were not that of herpes - yet everywhere i read including this website say that these many of these are symptoms of genital herpes. I guess I'm confused - are they or are they not symptoms?

I want to be 100 PERCENT sure that I don't have genital herpes...

So my questions are:

1) Do my symptoms actually suggest herpes and should i plan on testing positive at some point here in the near future?

2) Does it sound like i might have urethritis? I've tested negative for chlamydia and ghonnoreah so wouldn't herpes be the only logical cause of that's what it is?

3) Why does the herpes select miss picking up antibody sometimes? what causes that? too early testing? too low antibody? is it very common?

4) Should i see another doctor? If so, what type?

5) Do you think i should do daily pcr swabbing based on my symptoms or do you know of any other idea?

6) Should i ask to have a herpes western blot test done or do you think it's unnecessary?

7) What are the percentages of people who do not produce antibody on the herpeselect but actually have hsv2?

8) Can i continue to have sex with my girlfriend (i always wear a condom) without worrying that i will infect her with hsv2? or something else that could harm her) That is by the far the MOST IMPORTANT concern here...If i were to ever infect her with anything I could never forgive myself - especially with something she would have for the rest of her life - genital herpes.

Thank you for your time! Happy new year.

[quirino_diogo]

to complete, I felt a discrit itch another day

[quirino_diogo]

Hi, I am brazilian, sorry by the wrong words.
In 11-27-06 I had a lesion on the "neck of my penis", the skin became absolutly big and inflamed.  One week later apeared some ulcers, not blister, only ulcers, more than 11.
I thougth that was herpes, many doctors said that, but when I made blood exam it was negative and culture exam said that was staphylococus aureus.  The ulcers took one month to desapeared.
This year, 01-01-07 I have fever when i slept during 4 days, on day 01-04-07, I had a disturb emotional, in the same day, apeared a blister, but was more for a swell, big, so big, it was not like theses blisters full of some liquid, there were litle sore.  So when a took my bath, it has romped.  Some hours late I used latex and make sexy normaly, it didnt hurt.  Another day have apeared more 3 ulcers on the other side, some doctors said that it could be again staphylococus bad killed by treatement.  So again I made blood tests and culture, and the result was sthaphylococus haemoliticus.  So In these last 2 years I have only a girls frind I asked her to make exam blood, and the result was negative as well.  Futhermore, the ulcers have been reproducing and affecting all the "neck of my penis"
Until today 01-28-07 my state didnt get normal.
Yesterday I made biopsia "they cut a peace of my ulcers" to see if there is some thing different on the cell.

Two days ago, 01-26-07 I woke up and felt a pricked on my penis, in the same day a heat, and after apeared a new ulcers, 3 to exact.

today 01-28-07, I see two little blisters, so I put a gauze (curative) only to see, and they blew up, so i passed this curative on the ulcers and it hurt.

Can you help me with this complicated case.

[BadDay1972]

Hey Doc,

I know your probably not going to answer but I thought I'd give it a shot anyway...just got back for the urologist today...He did a prostate exam and I've been diagnosed with PROSTATITIS...he said I had A LOT of white blood cells in my urine after he examined me...what exactly does that mean? He put me on antibiotics - doxycyline - I believe for 3 months to see if it helps but that 30-35% of the cases turn into chronic prostatitis. Hope I'm not one of the 35%. Does this mean I've had a bacterial infection all along and that it rules out herpes? Does herpes cause prostatitis? Is this something I can pass on to my girlfriend sexually?

Listen Doc...I know you said this thread was over but I just hope you can answer these last couple of questions for me and I'll leave you alone.

Thanks.

[H. Hunter Handsfield, M.D.]

Re-read my original reply and my first follow-up reply (1/3/07).  Your problem is not herpes, it is your compulsive fear of that possibility despite all evidence.  If you cannot shake that conviction and move on, it suggests a need for profesional counseling.

This thread is over.

HHH, MD

[H. Hunter Handsfield, M.D.]

80-90% of infected persons will have antibodies by 6 months by Western blot; more with HerpeSelect, probably 90-95%.

"Gold standard" tests often are less sensitive than other tests, but more specific.  Less senstive meaans a test misses some infections; more specific means a positive result is more reliable.  That's the case for HSV antibody testing, which is why initial testing should be with HerpeSelect, BiokitUSA, Kalon, etc and WB should be reserved for resolving atypically positive results.  But WB rarely is helpful when the initial test is negative.  This is the also case with syphilis blood tests.  The confirmatory "gold standard" syphilis tests like FTA-ABS miss some infections that are picked up by standard screening tests like RPR or VDRL; but when FTA-ABS is positive, it is definitive proof of syphilis antibody.

HHH, MD

[BadDay1972]

Well then Doc if that's the case...how are you 100% sure that I am negative for HSV2? From what you tell me it can take even longer than 6 months for many people to develop antibodies. Doesn't sound like I'm out of the fire yet! Do I need to retest after 1 year post exposure?

[BadDay1972]

Can you please answer my last couple of questions doc??? Last couple of questions...please!

[BadDay1972]

Hey Doc/GDE,

I know you are trying to help GDE and I'm not trying to be rude but the more you comment about your situation to me the more worried I get about mine and that I may actually have herpes but still need to keep testing...so, thank you for the info, but please let me just talk to the Doc so I can put this behind me.

Doc,

What I don't get is...if the Western Blot is the "gold standard" for herpes blood testing than how does it miss more times than the herpeselect? That doesn't make sense to me. This makes me think that all herpes blood tests are just not very reliable and with what GDE says I may have to try another type of test. What do you think?

Also, you say in your FAQs that 1 out of every 5 people who will test positive for HSV2 will take 6 months for antibodies to show up on the test. How is this so if you tell me that you have never seen anybody test positive after being negative at 3 months? When exactly is testing final and complete!?

[GDE]

You may try the other test called Immunoblot ( I think that's how it is spelled).  I was tested twice using HerpeSelect, first time on the 4th month after the unprotected exposure (oral) and second time on the 5th month.  Both times I tested positive only for type 1.

[GDE]

Another suggestion, get your Gf tested for Herpes right now.  You will then know if she was ever exposed to either type.  Then you know if you need to take proper precaution.  

[H. Hunter Handsfield, M.D.]

See my initial reply; none of the follow-up comments changes my advice.  Herpes is not your problem.  It is never appropriate to use somebody else's atypical experience as the basis for your own diagnosis.  And you misunderstand western blot:  that test actually misses more HSV-2 infections than the standard antibody tests.  The purpose of WB is to confirm a positive or atypical result, not to recheck a negative standard test.

You don't have herpes.  Drop it.  If you cannot, you need to consider professional mental health evaluation to address your compulsive concerns despite overwhelming evidence.

HHH, MD

[BadDay1972]

Doc,

With what GDE said about his wife only testing positive on the Western blot...do you think I should test with western blot because maybe the herpeselect isn't picking it up? I started to feel good about my chances but now I'm worried again because of what happened to GDE's wife...what if I'm one of the unlucky ones who just doesn't show enough antibody or seroconverts late or has oral and genital hsv1. Wouldn't I at least show a weakly positive or equivocal herpeselect score if I were to actually test positive on a western blot test? This is what worries me about these tests. I really have no way of knowing 100% whether or not I have genital herpes do I?

[GDE]

I know how you are feeling. The other day I read that even if you have oral HSV1 when you are a kid, it's still possible to get genital HSV1 when you are exposed to it in adulthood.  And you can pass it genitally to your partner.  That apparently happened to me but my wife somehow got the type 2 too though it is so mild that only the Western Blot could determine it's positive.

[H. Hunter Handsfield, M.D.]

It may be possible, but it is very rare for someone with HSV of either type to catch a second infection of the same type.  It is statistically very unlikely that GDE in fact had a genital HSV-1 infection on top of a previous oral HSV-1 infection.

HHH, MD

[H. Hunter Handsfield, M.D.]

Why don't I think you have herpes.  Because your symptoms don't sound at all like it!  And because of the negative blood test!  How many ways can I say it??  And no, having HSV-1 has no effect on how fast an  HSV-2 test becomes positive.

Stop worrying about herpes, which isn't such a big deal to be consuming your energies anyway.  Drop it and move on.  No further comments/discussion on this forum, please.

HHH, MD

[Born]

Doesn't sound like herpes, but if he has oral hsv1, couldn't it be ghsv1?

[BadDay1972]

Hey Doc,

I'm glad that somebody FINALLY had the "balls" to tell me that I 100% don't have genital herpes. It makes me feel a lot better to hear you say those things. Just a couple more questions if you don't mind.

1) As far as the symptoms I listed in relation to my genitals - every time I look them up all I come up with is herpes, herpes, herpes...Why is that? If it's not herpes than what is it?

2) When I first thought I was exposed and I had a very weird bout of the flu about 10 days after exposure I also had pain in what seemed like my inner thighs (lymph nodes) and pain in between my anus and penis underneath...what would have caused that if not herpes?

3) I also forgot to mention that I've had times of burning in my calf and lower back randomly - with most of my symptoms having recurred after a couple of months wouldn't that only suggest herpes and not something else?

4) I had a sore on the very base of my penis that was painless and i popped it but no liquid really came out - more like a zit - it left an ulcer that was painless and it seemed like a hair came up through it and it healed within a couple of days...sound more like ingrown hair or herpes sore?

5) Why is it that you don't think my symptoms sound like herpes?

6) You say I don't need to test anymore but doesn't having previous hsv1 antibodies slow down the development of hsv2 antibodies?

Thanks again.

[H. Hunter Handsfield, M.D.]

As I start this reply, I have only looked at the title of your thread ("All the symptoms yet negative blood tests".  That means you don't have herpes and your symptoms are due to something else.  Period.  Now I'll go read the rest of your message.

And my response hasn't changed.  Your symptoms really do not sound like herpes, not even a little bit.  You cannot simply look at a list of symptoms for a disease, see that you have many or most of those symptoms, and conclude you have the disease.  Lists of symptoms on the internet and other places are only clues, not definitive; and they typically don't tell the whole story.  When symptoms are atypical, the test results tell the truth--not the symptoms.  Thus, to answer your opening question:  yes, you can be 100% certain you don't have genital herpes.

As to the other questions:  1) Your symptoms don't even hit at herpes.  2) I doubt you have urethritis; seeing a health care provider is the way to know, however.  3) The reasons for occasional false negative tests are not known.  4) If you want another opinion, see an STD specialist, such as at your local health department.  5,6) You don't need further testing, swab tests, western blot, or anything else.  7) I can't quote exact figures.  In my 30+ year STD career, to my knowledge I have never had a patient with negative HSV blood test (more than 3 months after exposure) who turned out to have genital herpes.  It happens, but it is rare.  8) You can continue to have sex with your girlfriend, with or without a condom; you don't have herpes and almost certainly no other STD either.

HHH, MD