Is this Herpes

[SPPD]

On February 28th I had a safe sex encounter with a pro. She performed safe sex (oral and vaginal), and the only time she did anything unprotected was lick my scrotum for 2 seconds.

Soon thereafter, I started feeling the classical symptoms (i.e. fatigue, flu-like, tingling, burning, irritation in the penis and buttocks). Here's a
chronology of all my HERPESELECT exams:

Mid-March (Feb. 28th encounter)
HSV 1: non-reactive
HSV 2: 1.76

April 5th
HSV 1: 3.76H
HSV 2: 1.62H

May 31st
HSV 2 IGG Serum (Focus) 0.24
HSV 1: non-reactive

At first, based on my mid-March test results, I was told I had HSV 2. Now, based on my latest test, my doctor tells me I am negative. I have not had the traditional outbreak, but ever since my February 28th encounter, I've had all the symptoms; fatigue, flu-like, the prodomes (tingling in my legs and bottom of one foot), and tingling and soreness in my penis, and butt area. I have not had a traditional outbreak down there. I've also had tingling in my lips, but again no outbreak. Could it be that that I have genital HSV 1? Would it manifest itself both orally and genitally? My primary care doctor, as well intentioned as I think he is, is just saying "Negative, it's over, move on", but how can I after all these readings, first positive, then negative? And what about the symptoms? After all the questions I posed to him he told me there's not more he could do to help out, and he offered to refer me to an infectious disease specialist.

So I go to the specialist, but to my further confusion, some of
the information I received from him seemed to contradict what I had previously learned and researched. I gave him my serology history. However, since I hadn't (and still have not) exhibited
classical "outbreaks", he told me I do not herpes. He shared with me that almost all of us have antibodies for HSV in our system, and that that gauging infection through serology alone is not accurate. He basically told me I don't have it, regardless of the neurological symptoms (i.e. constant tingling in the butt area, specially when I am sitting, penile pain on and off). And the more I research, the more I find out that Post Herpetic Neuralgia, although not common, occurs on some individuals. Also, I experience penile pain after masturbation, and have not had sex since the encounter.

What do you think Doc?  Do I have herpes or not?  I am going back to my primary care physician on Friday.  It will be 6 months post-exposure now, and I will ask him to do one final round of HERPESELECT to see what comes up.  

I'd appreciate your observations and feedback on this.

[H. Hunter Handsfield, M.D.]

Your blood test result are confusing; I'll come back to that.  But first, you say you have had "all the symptoms of herpes".  In fact, your symptoms do not suggest herpes to me at all.  Prodromal symptoms such as tingly and numbness occur only in the immediate area where an outbreak is going to occur; e.g., before a penile oubreak, maybe tingling of the penis or in the groin.  But not all over the body or at distant sites.  Also, prodromal symptoms precede an overt herpes outbreak; numbness, tingling and pain by themselves are rarely symptoms of herpes.  And post-herpetic neuralgia is a problem of herpes zoster, not HSV; and your symptoms don't sound like that anyway.  Finally, the sexual encounter you describe was extremely low risk for herpes.  Had you come to me with these problems, and after that exposure, I would not even have thought of herpes, nor would I have recommended the blood tests.

But you had the tests.  And the results are incompatible with one another. The first thing is to be sure the lab actually did the HerpeSelect test.  If your doctor ordered that test, then presumably it was done, and the numbers are in the range normally seen with that test.  The rest of my comments assume HerpeSelect was done, but you should double-check with your doc, or ask him to double-check with the lab. (HerpeSelect and Focus are the same; Focus is the manufacturer, HerpeSelect the name of the test.)

The results suggest you didn't have HSV-1, then you did, then you didn't, which is impossible.  They also suggest you had antibody to HSV2, then lost it--also impossible.  Are you sure the dates are right?  If so, I have to suspect a technical glitch in the laboratory, or conceivably that one or more of your specimens was somehow mixed up with another patient's blood.  Since your symptoms don't fit herpes, I am inclined to believe the last test results and ignore the first two, but this isn't certain.

When there are peculiar or discrepant results, the Focus company will do special tests to resolve it, at no additional cost. (At least they were providing that service a few months ago; I assume it continues.)  This will require your doc to contact Focus and explain the situation; once he describes the results, Focus will probably request a new blood specimen.  With a battery of special tests, not normally offered in clinical labs, they will be able to sort out your true HSV antibody profile.  Alternatively, your ID specialist should know how to send another blood specimen to an independent reference laboratory, such as the University of Washington clinical labs in Seattle (where most of the best research on HSV antibody testing was done).

If the final test results indicate you have HSV-1, HSV-2, or both, I will still believe you didn't encounter either virus in encounter you descrribe, and that it doesn't explain your symptoms.  In the meantime, I recommend you follow your doctors' advice; and relax about herpes as a cause of your symptoms.

Good luck--  HHH, MD

[chrisaf4]

Hey i really feal for you.  Ihave been going throught the same thing since FEB.  The pain, tingling,numness,and sore butt and back, without real classic signs of a outbreak with the exception of a bunch of little bumps on my penis about two weeks after my encounter.  I trust the doctor and know he is very smart and he is the expert on infectouis desesies, but alot of other websites say including the makers of Valtrex and Famvar say this is a highly vairiable desiese and that all those symtoms you list are signs of herpes wether or not you have an overt outbreak.  I am in the same boat, icant get a desisive test restult yet i am having this same pain.  It is very frustrating!!!  I dont mean to question the DOC at all i think what he does here is truly very valuble and this is a great resorce. Thanks Doc,  But at the same time there are alot of people out there that would say your symptoms are caused by herpes.  Who would know more the doctors and scientist that develped Valtrex and Famvir, or an infectious desiese specilist like DR HHH??? I am not sure, i would like to think the DOC, cause he thinks i dont have Herpes also.  Ibut nothing else can explain why so many people on this forum and haveing these sorts of symptoms so soon after a risky encounter.  Some will say it is mental, i can say for sure in my case it isnt, cause i was having these pains and numbness amd general penis soreness, before i ever new what the symptoms of herpes were.  I always thought herpes symptems where just blisters on your penis, it wasnt until i researched the pain in my but and legs i found out about herpes.  Just want you to know your not alone with your symptoms.  And again Doc, i am not doughting you, i just dont have any other explination.  Also doc I have a follow up Q. in my post from yesterday if you could please look at it. Thanks again.  And SPPD, let us know how your next test comes out.

[Imdumb]

As wacky as it sounds, the drug companies do have a vested interest in getting as many people as possible to take their drug.  They know that for every woman who may have a yeast infection, there is at least a chance she will have HSV.  Even if she actually does has a yeast infection, just scaring her enough to get tested gives them a 25% or so chnace she will have HSV antibodies..and viloa..a new customer for life.

I would listen to the dr.  Butt and low back pain without any penis or vaginal issues is not of concern.  Especially if it goes on for weeks and weeks.  Herpes does not do that.  

I think the Dr. is the man..he isn't trying to make you into a customer for life, he is just telling the truth.  Telling it like it is.

[SPPD]

Thanks Doc.  I appreciate your rapid response.  Yes, I double-checked the test results (from Unilab, I have them right in front of me), and yes, they are HERPESELECT.  

Yes, the fact that these results are imcompatible has crossed my mind.  Like I stated I will ask for one more round of HERPESLECT testing when I see my Doc on Friday, and hope that is that.

Thank you again,

Regards,

SPPD

[SPPD]

Hey Doc, could the previous two positive tests be a result of "cross-reactivity".  I am also assuming these are low positives, and I've read that results below the 3.5 range have a high probability of being false.  Is that your observation as well?

Thanks for your feedback.  Also, I've been researching my symptoms, and they appear to be very similar to a form of piriformis syndrome and pudendal nerve damage.  Have you come accross people with these symptoms in finding out if they have Herpes or not?

SPPD

[H. Hunter Handsfield, M.D.]

Sorry, I'm not familiar with pyriformis syndrome; not sure I ever heard of it.

HHH, MD

[monkeyflower]

Among other things, I'm a massage therapist :-) Piriformis syndrome is when a tight piriformis muscle irritates/compresses the sciatic nerve, causing "sciatica". If you do yoga, the pigeon pose is a great piriformis stretch, as is the cow face pose. And of course, massage is always a great idea ;-)

[H. Hunter Handsfield, M.D.]

Monkeyflower to the rescue once again!

("Cow face"?  Yuck.)

HHH, MD

[monkeyflower]

Lol. Yeah, cow face sounds exceptionally elegant and graceful, doesn't it?

[SPPD]

Thanks Doc - what about the cross-reactivity question?  I've read that sometimes if you have HSV 1, then it's hard to gauge HSV 2 test results because sometimes the antibodies reading are hard to measure?  Let me know your thoughts about that.

You mention that a lot of the neurological problems I seem to be suffering from are not HSV related.  In your experience, I am sure you've probably come across other people with my symptoms.  Are there any neurological causes for this based on your knowledge?  I mentioned piriformis, but what about chronic pelvic irritation or something else?  I am seeing my doctor this afternoon, and I am hoping to get some feedback from you as well before I see him.

My problem just seems to be made worse when I am sitting.  Constantly burning of butt and penis pain.  When I get up, it seems to get better, or when I am sitting on a toilet.  Does this sound like anything else you've encountered/answered?

Thanks a lot to everyone.

SPPD

[monkeyflower]

The pain from piriformis syndrome is often worse while sitting (especially if you keep your wallet in your back pocket) and climbing stairs. I can't imagine it would cause pain in your penis, though, since the sciatic nerve doesn't innervate that area. Do you bike? If so, some studies have recommended switching to a recumbent bike or a split seat, since for some guys the pressure of the seat against the perineum can cause nerve damage (namely, numbness and ED). Don't know about pain, though.

Hope things went well with the doctor and things are cleared up soon :-)

[nycprofessional]

ok doc here are my symptoms
small little white dots almost blisters but never fully became blisters never burned never itched , no pain at all in urination just white spots some just barley rose from the surface
the only pain was coming directly from my prostate my doctor said prostitus and prescribed doxycicline so now i guess there will be no chance of anymore symptoms
he also ran the std blood test and im waiting( cant sleep)
please let me know is this outbreak common, Have u ever heard of an out break from prostitus  ( by the way i did have unprotected sex a mth ago aug 12th maybe )