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Question about Herpes diagnosis
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Question about Herpes diagnosis

I recently had blood work done to test for hsv1 and hsv2. The tests came back positive for hsv1 (which I knew, I've had cold sores for years) and negative for hsv2. At the time of this test, my previous sexual encounter had been 10.5 weeks prior.

About a week after I got my results, I went home with a girl. The night is fairly fuzzy but I am 99% certain we did not have sex. She confirmed my belief that we did not have sex. All we did was mutually masterbate each other. This took place 9 days ago.

Today I woke up with some soreness/tenderness on my left testicle. The area is a little sore, but not really painful at all. If nothing slides against that side of my testicles, nothing feels wrong. I went to the doctor who said she saw vesicles beginning to form and took a swab. I could not see any vesicles but the angle for me wasn't that great. She said she was 90% certain that this was herpes. I told her about my previous blood work and the fact that I did not have sex during the only sexual encounter after the test. She mentioned that this could be type 1 herpes or that it was herpes simplex virus (as opposed to hsv1 or hsv2). She said that there is no blood test for simple herpes simplex virus.

I am very confused. I was under the belief that without actual penetration, one could not get herpes. I've been wracked with anxiety about a possible transmission for months, and doubt that I would have had unprotected sex right after the relief of having a hsv2 test come back negative. I've read that the virus cannot be passed via her rubbing my penis or my rubbing her vagina. I've never heard of herpes simplex virus without an associated number - always herpes simplex virus 1 or herpes simplex virus 2. I was wondering if someone could shed some light on this?
Tags: Herpes
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

Normally I would respect the views of a physician after direct examination.  
But in this case, I am very skeptical and doubt you have genital herpes.  First, I have never seen or heard of herpes vesicles that the patient couldn't see.  Second, it is extremely unlikely you caught herpes from the mutual masturbation encounter a few days earlier; as you learned in previous discussions on the herpes community forum, that almost never happens.  Third, initial herpes almost always shows up at sites of maximum friction during exposure (the virus usually has to be massaged into the skin for infection to take hold) -- usually the penis, and rarely the scrotum.  Fourth, having oral HSV-1, it is exceedingly unlikely you could have acquired genital HSV-1.  Finally, know from your recent blood test that you don't have HSV-2 and therefore cannot have recurrent herpes due to that virus.

It also is clear your doctor does not understand HSV and genital herpes, or you seriously misunderstood her.  But I suspect the problem is hers, not yours: from your previous threads and this one, you clearly understand that there are only two types of HSV, 1 and 2; there is no separate un-numbered herpes simplex virus.  And she obviously misunderstands HSV blood testing.

So I am very confident you don't have genital herpes and that the swab test will be negative.  Please return with a follow-up comment to let me know that result, but in the meantime, stay relaxed about it.

If you have occasion to return to that doctor or clinic, you might consider printing out this thread as a framework for discussion.  She might appreciate a diplomatic suggestion that she educate herself about HSV and genital herpes.

Best wishes--  HHH, MD
8 Comments
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One last note: when the doctor popped the vesicles, she said for sure that fluid was secreted and that she got it on the swab.
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239123_tn?1267651214
I remain skeptical, but let's see what the test shows.  Other kinds of scrotal skin rash -- allergy, folliculitis, dyshidrosis, miliaria (blocked sweat ducts) -- could also explain small vesicle-like lesions.
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Avatar_f_tn
Thank you very much for your prompt reply. I will certainly let you know what the test results are. I did want to mention that she indicated that the test would likely not be positive because she said she get so little fluid on the swab. As this would be my first outbreak, I wonder if a small amount of fluid that wouldn't support a positive test result was possible?

I did have two additional questions: could you please elaborate what you mean by this statement: "Finally, know from your recent blood test that you don't have HSV-2 and therefore cannot have recurrent herpes due to that virus."

Would you suggest having blood work done regardless of the outcome of the swab?

Thanks again for your input
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239123_tn?1267651214
No matter how small the fluid amount, almost all patients with new first-episode herpes would have a positive result, regardless of the fluid amount.  A negative result will be very strong evidence against herpes.

Also, it it is new herpes, in the next 24 hours the vesicles will enlarge, become painful, and be visibly obvious, even from across the room.  If that doesn't happen, it will further confirm my confidence against herpes.

If I recall what I saw on previous threads, you've been having unnecessary HSV blood tests for a long time.  If you were my patient, if the swab test is negative, I would recommend against starting another round of blood tests.  However, you also now have the new uncertainty of a professional diagnosis.  It's probably wrong, but I would understand if you choose to have more blood tests to confirm the expected negative results.  I'm sorry you're now been put in this position.  (In a way, it's your fault.  I don't mean that in a blaming way -- but I suspect it is your chronic anxiety about herpes that led you to the doctor.  Based on your description and the exposure, I would have recommended against being examined in the first place -- and you wouldn't be in this position!)

In any case, blood testing is up to you.  If you do it, I would suggest testing twice -- in about 6 weeks and 3 months.
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Avatar_f_tn
Thank you doctor. I think I will hold off on getting a blood test in the event the swab result is negative. I've looked at the soreness and still don't see any vesicles forming or any sort of cut, lesion, or opening. I don't know where she got the fluid from. And the tenderness has remained the same, if not gotten better.

Again, I appreciate your input and will let you know the swab results.
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Avatar_f_tn
I had originally scheduled an appointment with another doctor to take a look at what's going on. However, as you indicated, the vesicles (if any) haven't increased in size or pain despite it being 24 hours since I first noticed them. If anything, it feels less tender/noticeable. So I cancelled my appointment so to not let this hysteria control me. And I don't think I'll follow through with a blood test if the swab is negative. All this is to say thanks again Dr. Handsfield.
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239123_tn?1267651214
Thanks for the thanks.  I think that's the right decision.  To wind up this thread, let me know when the swab test result is available.
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