Is this Herpes?

[itsjakes]

I am involved with an ex-girlfriend on and off. I have sex with her occasionally and sometimes unprotected and we have never had any problems. I went out of state for a month. I did have sex with this ex-girlfriend about a week before I left. While I was away I met a girl and we had unprotected sex a few times. When I came back I some how got involved with the ex again and had unprotected sex. The very next day it stung when I went to urinate.The doc told me I might just be irrated and prescribed Urised Tablet Pol. I took that and within 3 days I felt fine. The girl from out of state and I had sex since then. Within a few days the ex-girlfriend says she has has a positive herpes culture and an outbreak. I went for std testing. Everything came back negative in the blood and even the swab but then they said my titer showed an initial infection. I haven't had any symptoms and neither has the out of state girl. Someone told me titer could just show a recent exposure with herpes but not necessarily herpes,is this true? I need to know: do I defintely have herpes? Since me and the ex-girlfriend have had sex several times previously does that mean I got it from the out of state girl? The girl from out of state had a blood test and tested negative. The ex-girlfriend says she hasn't had sex with anyone else in over a year and I believe her. I need to know how likely it is that she has an outbreak and I had the urine problem right after we had sex when I got back from this trip. =

[H. Hunter Handsfield, M.D.]

It is conceivable you have genital herpes, but certainly not 'definitely'.  The transient pain on urination is an unlikely manifestation of an initial genital herpes infection, but conceivably could have been a recurrent outbreak if you are chronically infected without previous diagnosis.  (Some people with genital herpes remain asymptomatic for a long time, then start having symptomatic outbreaks.)  If so, conceivably you were the source of your partner's infection.  However, most people with recurrent herpes have the classical external blister-like lesions and open sores.

A blood test ('titer') can show whether or not you are infected with herpes simplex virus type 1 (the usual cause of oral herpes and sometimes genital), HSV-2 (the usual cause of genital herpes), or both.  There is no such thing as being 'exposed' but not infected.  If a blood test is positive, you are infected with the virus, have the potential for recurrent outbreaks, and can transmit the infection to other persons.  However, it takes several weeks for a blood test to become positive, so if you have a new HSV infection, it might not show up for a while.

To confuse the issue futher, your test showing 'initial infection' may be meaningless.  Most likely that means your provider did an HSV test for IgM antibody.  (The standard tests look at the IgG antibody class.)  Although a positive IgM test is said to indicate a new HSV infection, in fact it doesn't work that way, and many positive IgM tests are false.  But you probably will require additional testing (for IgG antibody) in the future to know whether you in fact are infected.

Most likely your out-of-state partner doesn't have it, based on her blood test result. (If you are infected, you could have infected her and the blood test will show it later--but that's not likely if she hasn't had any symptoms recently.)  As I said above, people can have genital herpes for long periods without knowing it--so the fact that your ex-gf hasn't been very sexually active recently doesn't say much about when and where she was infected.

Another point:  You don't say much about you ex-gf's symptoms.  If she had a relatively minor outbreak--only a few lesions without a lot of pain etc--then she likely has a chronic infection.  If her diagnosis is brand new and she presented with multiple painful lesions, lymph node inflammation in the groin, and/or fever or other systemic symptoms, then almost certainly she only recently acquired the infection.  If that's the case, then you can assume you are chronically infected and were the source of her infection.

To put it succinctly, the situation is complex and there are several potential explanations about who is and isn't infected, when, and by whom.  The 'by whom' part shouldn't matter; there is no point in playing a blame game--it doesn't appear that anybody was behaving irresponsibly.  In any case, your best strategy is to find a herpes-knowledgeable provider who, applying a combination of clinical judgment and blood test results, should be able to determine whether you are infected and make recommendations to you and both your partners about future management, preventing further transmission, and the like.

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

[itsjakes]

Thank you, your answer made things more clear. Like I said the herpeselect test was negative for both types. Like you said the HSV IGM Ab titer said detected. I did these tests on June 27...when should I go back for another blood test? It seems the blood test is the only sure way since IGM may not mean anything.

[H. Hunter Handsfield, M.D.]

Wait until 3-4 months after your last possible exposure.  Most people with a positive IGM test and negative IgG are not infected, so the bet is a repeat test will be negative. In the meantime, stay on the lookout for typical symptoms and have an exam if they appear--but most likely you aren't infected.

To the person who tried to post a new question: You have to use the Post a Question link.  As many as 100 people try to ask questions each day and only a limited number (3-5, depending on how busy I am) can be accepted.  The site opens up at random times each day.  You have to keep trying.  Anyway, nobody can diagnose anythhing on line. The only way to know what you have is to see a health care provider.

[huphupholland]

About a day and a half ago I received oral sex.  Today I noticed redness on the head of my penis and some small red bumps that are not raised.  I questioned the girl about having any STD's and she said she is sure that she doesn't have anything (although she hasn't been tested).  She also said she did not have a cold sore in her mouth at the time and has never even gotten one.  My question is, can you get herpes from someone who gives you oral sex but doesn't have a cold sore in their mouth?  Also, does my case sound like herpes?  I am really scared, and I have never even had sex before, other than oral.  Any help is appreciated.

[itsjakes]

What symptoms should I be on the look out for? Why does that false positive sometimes happen with the IGM test? Is there an online source that could list herpes knowledgable docs in my area? Also I know you said painful urination is unlikely for an initial symptom...is it possible that there could be some other bacterial problem or irration due to sex with her if not necessarily herpes? I didn't test positive for any other stds and I had a swab and blood work done...would this cover all possiblities?

[H. Hunter Handsfield, M.D.]

In my original reply I said "...most people with recurrent herpes have the classical external blister-like lesions and open sores."  Those are the symptoms you should be on the alert for.

For information about IgM testing, use the search link and enter "IgM" and/or "herpes diagnosis"; you will find many discussions about it.

I don't get into speculating about causes of symptoms other than STD, and of course I cannot know which STDs you were tested for.  If in doubt, return to the health care provider who did the tests.

[theanony]

while on the subject, I have the same situation as itsjakes but what is the latest you can find any symptoms. I've done research cause I have small bumps..about 10 in my pubic region but all are white and pop like a pimple and it's been 10 months since I've been with anyone. I'm hoping it's just "pubic acne"

[WLG]

iv had thease little wight dots to with a red base.and what i thought was a little chafing on my butt right in the middle of both cheeks. i had safe sex less than a mounth ago, so idk. iv done some research and it could possibley be herpes. i havent had a fever, i had a sor throught for about a day, no burning urination, no tingling just the red bumps and  i had a zit(wight head typ thing) on the inside of my thy but just one. counld i have herpes.any help would be usefull. thank you

[WLG]

i forgot to say that my last partner she got PID and im currently being treated for that. i was told that i cant get sick from it but males are just carryers. i was just wondering if PID has anything to do with this at all

[H. Hunter Handsfield, M.D.]

New questions are not permitted in existing threads. You need to use the Post a Question link to start a new thread.  Or take your question to the STD Support forum.  No replies/responses here, please.

[Terrified Paula]