Herpes for sure?

[Andrew321]

9 weeks ago, I had a brief unprotected sexual encounter with my 19 year old friend.  She promised me she had no STDs,  and even went and got tested for everything a month after the encounter.  She came back negative for everything, including herpes.  

So I relaxed, especially when I had no symptoms or anything.  However, I had made an appointment to get tested right before I went back to school.  So I went ahead and got tested (this is at the 9 week mark from exposure)  - I tested negative for all STDs except herpes.  I did the HerpesSelect Test for HSV 2 (I did not do the one for the HSV 1)    and the result came back 1.14, and anything above 1.09 is positive.  The guy said the scale goes up to 14, so this seems really close to me.  Can I be sure that I have HSV-2?   or should I re-test/not worry about it?  I do not know my HSV-1 status,  but believe my friend when she told me that she tested negatvie for herpes and has never had symptoms.

Finally,  I just noticed a few little pinkish/redish part of skins on my penile shaft.  There is no pain or itchiness, but they have satyed there for the past few days.  I initially thought it was just irritation from dry mastrubation, but should I get them cultured for herpes?  THey look nothing like the pictures of herpes I have seen online.

THanks
Thanks so much

[Edward W Hook, MD]

I agree.  As I said, it is unlikely that you have herpes.  EWH

[Andrew321]

I talked to the girl and she claimed I was the only guy she was with the 4 months prior to her negative test for herpes.   And I am sure I was clean before that incident (my only other partner was a virgin)     So, I am still a little freaked out by the low-positive result,  but I am thinking it is ok to proceed with safe sex w/ a new partner and just keep an eye out for breakouts?

[Edward W Hook, MD]

The topic of herpes is a complex one.  The disease is common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans.  For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else.  I will do my best to answer your questions but in general, many of these questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).  

Please realize that Herpes blood test results must be taken in context.  By that I mean that all blood tests have both false positive and false negative results from time to time (the goal is to minimize this and know when it is likely, that is a large part of my job).  Now on to you and your results:

You very well may not have HSV-2.  There is an ongoing debate in the expert community about what the cut-off for a positive HerpesSelect antibody test I presume this is the test you had) should be with many arguing that the current cut off is too low and that, in low risk persons (thus this may pertain to you), the cut off should be in the neighborhood of 3.0.  Your result is what we in the business call a "low positive", and may represent antibodies to HSV-1 (even if you do not remember having cold sores in the past) or some other virus unrelated to HSV.  Given the low nature of your test results, I would suggest you do one of two things –either to accept that this is likely a false positive and, unless you have an outbreak in the future, not worry about it further (this is what I woulld suggest you do) or, repeat he test in 2-4 weeks.  If this is truely an early herpes infection in which your blood test is just beginning to be positive, the result the next time you test should be much higher (above 3.0)

As for the spots you've noticed, while herpes can take many forms, your lesions certainly do not sound like herpes.  There would be no harm in having them cultured or at least examined by a clinician but I suspect they are not herpes.  

Hope this helps.  EWH