New developments on an old question

[concernedaboutazit]

Dr. H.,
I have some new developments on an old question.
I had unprotected sex 4 weeks ago - my partner, who I have discussed this issue with assures me she is clean and tested, but I intend to further discuss the issue with her (there are no others partners worth discussing due to time frame and protection).  
5 days after sex I developed a single whitehead on the head of my penis.  
3 days after that (after a few masturbation sessions) I developed some "raw" spots on my shaft and some swelling of the skin.
9 days after seeing the pimple it went away as normal pimples do (no scabbing).
9 days after the observing the raw spots they effectively went away without any scabbing - though remained slightly tender and slightly swollen skin folds.
I was tested during this time (approx. 10 days after sex)and the results were IGM-non-detected, IGG HSV-1-positive(2.97), IGG HSV-2-negative (.31).  My Doctor thought the zit may look like a recurrent outbreak at the time of blood being drawn, but blew off the raw spots entirely.
10 days after the "whitehead" disappear I masturbated and afterward noticed a new red pimple on my shaft (was not there before as I have been paying close attention) and the raw spots reemerged.
During the entire time I have had no other symptoms -i.e. flu-like symptoms, muscle aches, etc...
My question does the timing of the new pimple or recurrence of the raw spots indicate anything to you.  Does this sound like an initial HSV-2 outbreak that was not picked up by the test due to the short time frame(in which my partner may not know that she is positive in spite of her claims), a recurrent genital HSV-1outbreak, or something completely different?  I have read that an initial outbreak can cause a second round of sores, but does 19 after the appearance and 10 days after the disappearance of the first sore sound right?  Thanks for your help.

WR

[concernedaboutazit]

As always, thanks for all your help and information.

[H. Hunter Handsfield, M.D.]

Probably not herpes then.

[concernedaboutazit]

BTW, let me mention that the new red pimple and raw spots have not changed in color of or consistency over the past 3 days (i.e. has not become a fluid filled blister).

[H. Hunter Handsfield, M.D.]

Your previous thread ended with consensus that herpes seemed unlikely but could not be definitively ruled out.  That remains the case.  Your description of both the earlier symptoms and the new "red pimple" are typical for herpes, but herpes can be quite variable in appearnce.  Friction doesn't trigger herpes outbreaks, but if an outbreak was on the verge, masturbation could irritate it and make the lesion more prominent than it would be otherwise.  If the spot is herpes, over the next day or two it probably will develop a blister-like appearance, with clear fluid inside.  If that doesn't happen, herpes remains unlikely.  Another atypical aspect is the early recurrence, only 2 weeks after the initial event.

Your partner's belief she doesn't have herpes is useful information and argues against that diagnosis.  However, routine STD testing usually doesn't include HSV blood tests, so she might not know for sure.  But if she had a blood test that was negative for both HSV-1 and -2, you will know for sure your problem can't be herpes.

All things considered, I continue to doubt you have herpes.  But diagnostic lab tests are the only way to know.  If the new bump develops into a blister or pimple-like lesion, return to your provider's office ASAP (within a day, while the lesion is fresh) for reexamination and possibly a viral culture or PCR test.  If that doesn't happen, or if things remain uncertain, sit tight and have another blood test in a few weeks, preferably 3 months after the sexual exposure, to see if you have developed HSV-2 antibodies or the HSV-1 ELISA ratio has risen.

Regards--  HHH, MD