Herpes "who done it"

[Donkey42]

I had unprotected sex (twice over the past 2 weeks) with a close friend of mine whom I have known for years.  I noticed about 10 days after the last time that I had a few pimple like growths, which eventually became a small rash, similar in nature.  Itchy, but not much pain.  I had bloodwork and urine testing and while waiting for the results saw my doctor.  He looked and diagnosed it as herpes.  The next day the blood and urine tests came back negative for all STD's, including herpes.  Could the diagnosis be wrong or is it more likely that the blood and urine tests are wrong?  Is it likely that she was the one I got it from?  I have not had unprotected sex with anyone other that her (in the past two weeks) and then 18 months before that with another person.  Could I have had it without knowing it for 18 months, or is it likely that this first outbreak is the first and a result of the recent sexual activity with my friend?

[H. Hunter Handsfield, M.D.]

The diagnosis of a doctor after direct examination has to be taken seriously, so it seems like you have genital herpes.  It is common to have negative tests for herpes and still have the infection, especially if the test was a culture or PCR test to look for the virus from a genital lesion.  And a blood test could be negative during a recently acquired infection; the blood test detects antibodies, the body's immune reaction to the virus -- and it takes a few weeks for antibodies to develop.

However, there are some atypical aspects here.  Most tests for herpes -- both tests from sores and the blood tests -- take more than 1 day for results; usually it is several days.  So this makes me wonder what tests were done and whether your doctor actually is very knowledgeable about genital herpes.

Also, to help judge whether the diagnosis is correct, it would be helpful to have several more details.  You could start by telling me whether you are male or female (you describe your "friend" as her, so at least I have her sex figured out).  Also describe the nature of your symptoms -- the exact location of the lesions (penis or labia? pubic area?), how widespread the lesions were, how the rash developed (bumps that became blisters then open sores?), a small cluster of sores or spread out, if there was fever, and whether you had swelling or tenderness in the groin.

Assuming you have herpes, it seems a good bet it is a new infection and that you caught it from your recent sex partner.  Ten days is within the range of when symptoms usually start, so that fits.  On the other hand, it also may be possible you had it before, but in that case, the blood test should have been positive -- if the proper test was done.

If you can get more detailed information from your doctor about exactly what tests were done and the exact results (e.g., the test numbers on the blood test) and provide more description of your symptoms, perhaps I can be more helpful.  In addiiton, you should talk with your partner and find out whether she has a history of herpes or any symptoms to suggest it.  If not, she should see her health care provider for examination and testing -- both for her own health and because the answers could help sort out your situation.

I look forward to helping further when you have the details.  Best wishes--

HHH, MD

[Donkey42]

In response to your response to my Herpes "who done it".  I am a male and my doctor took a look and told me I had herpes.  I had my blood and urine tested at Quest Diagnostics and the results all came back negative.  My partner is a female with no history of herpes.  She got tested as well and the results came back negative, except for herpes 1, the cold sore type.  She asked her doctor if it could show up in the genital region on her partner and the doctor said yes.  Now what am I supposed to think?  My symptoms are a pimple like rash, whitheads that itch, and do break and scar.  The location is the pubic area at the base of the penis in an area about the size of a half dollar on the lower base of penis and scrotum.  Could it be the herpes 1 type?  

[H. Hunter Handsfield, M.D.]

Quest Laboratory uses highly reliable methods for HSV blood testing, so those test results are reliable.  As I said, it takes a few weeks for the test to become positive, so you could have newly acquired herpes with a negative blood test.  If you caught HSV, a repeat test will become positive in a few weeks.

As I said yesterday, the opinion of a doctor after direct examination has to be respected.  But herpes seems unlikely to me.  Initial herpes in men almost always involves the penis (or the anus if there was sexual contact, but that's an issue primarily in women and gay men), but not the pubic area or scrotum.  Pimple-like rash in those areas suggests folliculitis, a superficial bacterial infection.  Here is a clue you can look for:  If you have folliculitis, you will see that most of the individual red bumps or pimples surrounds a pubic hair.  Herpes lesions don't have hairs coming from them.

It is true that HSV-1 can be sexually transmitted, but not often by genital to genital transmission.  Almost all sexually transmitted HSV-1 comes from oral sex.  If you and your partner only had vaginal sex, it is unlikely you acquired herpes at all.  If she performed oral sex on you, that could have risked transmission. However, as suggested above, the initial lesions should be on the penis, unless there was direct oral contact with the area where the rash is.  HSV infections don't usually occur by simple contact with the skin; typically the virus has to be massaged into the skin.  That's why the inital lesions usually are at the places of greatest friction during sex.

There is one way this still could be herpes due to HSV-2:  If your sex partner was herself recently infected, i.e. if she had a new HSV-2 genital infection, too recently acquired to show up on blood test, then this scenario is possible.  But it is statistically unlikely.

I suggest you continue to work with your doctor on this.  Among other things, you should have a repeat HSV blood test, best done about 3 months from the sexual exposure.  In the meantime, feel free to give him my reasoning (you could print out my replies and discuss them with him).  He may be entirely right -- I can only assess probabilities, but he is the one who has examined you.

Good luck.

[Donkey42]

Continuing with my last "herpes who done it" story, there was oral sex involved, as well as intercourse.  There was much friction, even with lubrication, during the encounter. The rash is on the penis as well as the scrotal area.  I am wondering if the symptoms appear the same with HSV-1 and HSV-2?  I thought HSV-1 would look more like a cold sore and be an isolated one or two as opposed to a small area that is rash-like.  I will continue to work with my doctor, but I am just trying to put it all together.  Another question I have it that it is on the penis and scotum area.  Obviously I am concerned about giving it to anyone.  A condom may not cover the whole area.  Am I to assume that I am at great risk now of giving it to a partner, even if I wear a condom?  Could it mean that I should not even have sex again? (Even thought it is the way I feel at this point!!)  Thanks for you help.  You answers have been very helpful at a very difficult time for me.

[H. Hunter Handsfield, M.D.]

I suggest you not get into the "what if" questions until and unless the diagnosis of genital herpes is confirmed.  I'll just say that genital herpes, especially due to HSV-1, does not prevent a rewarding sex life; even HSV-2 doesn't do that.  You can use the search link for  many discussions about this on this forum, especially why genital herpes due to HSV-1 usually is not an important health issue or an important social issue.

Please follow the advice above, i.e. continue to work with your provider on the diagnosis, perhaps with a follow-up blood test.  If and when a genital herpes diagnosis is confirmed by lab testing,, I will be happy to answer any remaining questions.  But until then this thread is closed to further comments.