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Maybe Herpes?
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Maybe Herpes?

I received unprotected oral sex and had brief protected vaginal sex with a sex worker who looked to have redness (maybe a herpes outbreak) around her mouth. I had a small cut on my penis.

Symptom

1. Day 3 after exposure a blister formed at the site of my penis cut. Several other blisters formed over the next few day.
- Blister was seen by experienced ER DR who said he never saw herpes look like that so 100% sure not herpes but another STD.I tested negative all stds
- Was seen by Dermatologist who said might be Herpes but was not sure.

2. Day 60 saw redness on penis felt tingling & then saw 2 blisters form in the same area on my penis head as the initial outbreak. Irritation has remained for weeks, and made worse by masturbation.

In between theseoutbreaks, I had a tremendous amount of penis head skin irritation including redness, white spots, cracks etc. I was examined by several  DRs who saw my penis without blisters but with the irritation. Some said it looked like a yeast infection (tested neg for yeast), and others said like eczema or some sort of dermatitis. The redness is made much worse from the friction due to masturbation.

Testing-

I took one 7 day (twice a day) course of Valtrex, three days after noticing the symptoms.
• Herpeselect 1 and 2- Neg tests 3, 10, and 12.5 weeks
• Biokit- Neg at 12.5 weeks after onset
• Culture-Neg  taken 3 days after outbreak.DR said lesion was a bit dry


1. What is probability I have Herpes?
2. What further testing should be done & when should I take these tests?

I plan to get a PCR test done if another blister appears.



239123_tn?1267651214
Welcome to the forum.

The herpes blood tests are very reliable -- more so than examination even by an experienced doctor, such as a dermatologist. With negative tests for both HSV-1 and HSV-2 12+ weeks after the last exposure, both by a standard lab-based test and Biokit, herpes is exceedingly unlikelhy.

That said, taking anti-HSV drugs like valacyclovir (Valtrex) sometimes can delay development of a positive blood test.  To be maximally certain, I advice you take no more such treatment and have a final HSV blood test at 6 months.  But I'm certain the result will remain negative.

I also agree you should have a PCR test in the event you develop another penile "cut" or blister.  But I'm pretty sure that won't happen.

I hope this has been helpful.  Take care-   HHH, MD
3 Comments
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Avatar_m_tn
Great, thank you.

I just wanted to add that the single 7 day Valtrex course I took was after my initial symptoms. I took the course from 3 days after symptoms until 10 days. My negative Herpeselect and Biokit test was at day 88 after symptoms. So there were 78 days between the ending of Valtrex course and my negative 12.5 week test. I have not taken any additional Valtrex.

Questions-

1. Let me know if this new information changes your recommendation, or if I should still take the final test at 6 months post symptoms to get the most certain result. How much more accurate would this be compared to testing at 4 or 5 months?

2. I was planning on taking a Herpeselect and Biokit for my final test. If I instead decided to get a western blot , how much more accurate would the result be?

3. What is the probability that the 6 month result would turn positive after a negative 13 week negative IGG test and Biokit?

4. How likely I contracted HSV-2 from receiving oral sex or am I only at risk for HSV-1?

Thanks again.
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239123_tn?1267651214
1) This information doesn't change my opinion or advice.  There are no good data on how long HSV treatment can delay seroconversion, only experts' best guesses.  I haven't a clue whether 4 or 5 months would be equally reliable, and therefore suggest you stick with 6 month testing.

2) That is not how the WB should be used.  HerpeSelect and Biokit are more sensitive than WB.  The purpose of WB is to confirm uncertain IgG tests, not to be the main standalone test.  In other words, negative HerpeSelect and Biokit tests will be stronger evidence you didn't catch HSV than WB would.

3) Nearly zero, in my opinion.

4) HSV-2 is almost never acquired by oral sex, since few people with HSV-2 have oral infections; and when they do, asymptomatic viral shedding and overt oubreaks are uncommon.
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