Incubation 1 vs 2 - blood tests neg

Hi Doc,

Here is my question(s) then I'll explain.  What is the longest possible incubation period for a man before the 1st outbreak? (asymptomatic aside)  I hear 2-7, 2-10, 2-20 days standard.

Talking genital infection, Is incubation different for type 1 vs 2 in length?  

What's the longest period from infection to the time a blood test will show positive?  Like can it be negative 2 months later?

Can a culture come back positive for herpes simplex but be incorrect?  If so what would they have mistaken it for?

I had sex with 2 partners unprotected at the same time...(yeah stupid I get it now) anyone both of them are just SWEARING that they got blood tests and they both came back negative.  I got a culture that came back positive.  I showed my 1st signs exactly 7 days and 9 days respectively, from last intercourse.  So did one of them give it to me???  Can there be any other explanation?..at all?

I had another partner about 4-6 weeks before but used a condom.  To make it more confusing the infection sore was at the base of my penis where the condom would potentially not be covering.  She also preformed oral no protection.  Is it possible I got it form her then showed signs 6 weeks later but still had a negative blood test?  

I'm trying to do the right thing here and inform my partners...but let's be real...I REALLY only want to talk with those who may have been at risk.

Lastly, after several weeks can I get a blood test to see if it is type 1 or 2?  I suppose since it was only one sore I have a chance that is may be type 1.  I know, I know it's all the same medically speaking...but not socially.

Thanks for the input.

[H. Hunter Handsfield, M.D.]

There are three take-home messagess here.  Together, I think they cover all your questions:

1) Having had a penile sore with a test from that lesion showed HSV, then you have genital herpes.  Lab error in this situation is rare.  You should ask the provider (who in turn may need to speak to the lab) to make sure the specimen is tested to see if you have HSV-1 or HSV-2.  Having only one sore doesn't say anything about type 1 versus 2.  And the difference between them is not just "social", but also medical.  It makes a big difference in predicting how often you can expect to have recurrent outbreaks and the chance you'll transmit the infection to future sex partners--and, for those reasons, whether or not you should consider ongoing suppressive antiviral therapy.

2) It takes up to 4 months for the blood test to become positive.  If the virus from your lesion was not typed, the blood test can help determine whether you have HSV-1 or -2.  However, you do not need the blood test to confirm you have genital herpes; the diagnosis is solid from the positive swab test.

3) Symptoms usually start 3-10 days after exposure, occasionally up to 3 weeks, but rarely longer.  There is no way to know which of your two most recent partners was the source.  If you caught it from the first one, the second was at risk of infection from you, so both need to be informed of your diagnosis.  It is technically possible you were infected by the parter 4-6 weeks earlier, but unlikely.

I hope this helps.  Best wishes--  HHH, MD