Concerned about test results for hsv2

[StanLee532]

Doctor,

I had unprotected sex with a woman almost 3 weeks ago. Two days later I noticed what looked like pimples on my penile shaft. There were 4 and they were scattered and pretty red. I applied a topical antibiotic and after 5 days with it seemingly getting worse I went to a dermatologist who diagnosed it as folliculitis and prescribed a 10 day regimen of Keflex (500 mg 3 times per day). After the 10 days the infection seemed to clear up but the "busted pimple" or volcano like looking things remained but not that inflamed red color. I went to see a different dermatologist after that and he took one look and said molluscum contagium. Meanwhile I had a full blood and urine workup for sexual diseases and they all came back negative except the HSV2 test which was .92 equivocal. Naturally I am concerned about a herpes infection will get retested but if I have the molluscum virus could the antibodies generated from that cause an equivocal test result for hsv 2? Also how ling should I wait to get retested for hsv2?

[StanLee532]

I read it and reread it and I don't see how I took it out of context nor did you explain how I took it out of context but I guess I used up my $15 so thank you (you may want to work on that bedside manner a bit)

[Edward W Hook, MD]

You did take it out of context.  Read the entire thread, starting with the question, not just the parts that support your anxieties.  Then read my answer sto you above.  This thread is going no where and it is time for it to end.  No further questions please.  eWH

[StanLee532]

Thank you sir. The question was really what is the likelihood, meaning if you get one could you not then get another at the same time? that kind of thing. Naturally I am concerned. My question was not meant to be facetious. I don't think I took Dr. Handfield's reply out of context but please read the Q & A and tell me what you think.  http://www.medhelp.org/forums/STD/messages/3911.html

[Edward W Hook, MD]

I suspect you are taking Dr. Handsfield's comment out of context.  A low positive or equivocable test can sometimes indicate a developing antibody response. In your case, as low as your test is, I am rather confident that your result will prove to be a false positive.

As I'm also quite sure you are aware, to expect a precise answer as to how likely it is to get molluscum and HSV-2 at the same time is silly.  It is certainly an uncommon event.  
Even if it were to occur, the incubation times for the two are different and HSV wouldbe seen far in advance of molluscum.  EWH

[StanLee532]

Thanks again. One of the other doctors - Dr. HHH had stated that " Equivocal HSV-2 results are not related to time.  The time since you might have been infected doesn't mean anything one way or the other."

Is that the conventional thinking? I have heard that an equivocal score could mean a recent infection. If so what are the chances of getting molluscum and hsv2 at the same time?

[Edward W Hook, MD]

The 0.92 test result is just a fraction above negative and is in a range where over 95% of results prove to be negative with further investigation.  If your problem is molluscum, it would not change test results. Having said this, let me repeat, your test is almost certainly negative and when taken in the context of your situation this is even more likely.  I urge you not to worry and just go on and get re-tested at 3 months as suggested.  EWH

[StanLee532]

Thanks for your prompt repsonse. As a follow up I guess my concern is that one dermatologist said folliculitis, another said molluscum. Neither mentioned herpes but do you see any significance in the .92 equivocal result of the test and if so could the molluscum virus be ressonsible if that is in fact it?

[Edward W Hook, MD]

The lesions that you describe could be herpes from here but I will always defer my opinion to that of a trained clinician who had the chance to look at your lesions.  The accuracy of someone who can examine you is just about always going to be better than an opinion gained over the internet.  If a dermatologist told you that you had molluscum, then that is most likely what you have.

As far as your blood tests are concerned, they are negative and should not concern you.  You are right that you were tested a bit early to have complete confidence in the test result however.  I would suggest that you get re-tested at around 3 months following your exposure.  I suspect your test will again be negative.  AT that time you can re-assured that you did not get herpes from the exposure you describe.  Please let us know what your follow-up blood test shows.  Until then, take care. EWH