Avatar universal

Confused about test results


I was wondering if anyone had any advice about what to make of my results.

I started seeing a new partner who has genital HSV 1. She rarely gets outbreaks, only once a year, for which she takes valcyclovir. First outbreak was three years ago. I am well aware of asymptomatic shedding, but also the low transmission rates during those times. Anywho, we had sex about three to four times. I used condoms of course everytime. I am also aware that condoms do not eliminate the risk for transmission.

Throughout this time with her I was generally feeling completely normal. May have had some itches here and there, but pretty minor - nothing seemed significantly out of the usual. Cool beans. But after the last time we had sex I started to think more and more about the HSV transmission possibilities and that's when I started Googling all about it after seeing a patient teenager who was having a primary HSV episode and I started worrying about it a lot. The next two days after I had sex with her I then noticing myself having a variety of symptoms - itching, weird tingling, burning, etc - generally coming and going throughout the day and it varied. I also felt rather sick and didn't want to eat dinner. Now granted as well - it was my first day on a different hospital rotation and it was a very busy overwhelming day and I did not get to sleep very much as I had to wake up much much earlier - so I already wasn't feeling great. I frantically kept checking my skin and there was nothing at all resembling a classic herpes outbreak or anything else for that matter. My mind was certainly in a frenzy. I hadn't shaved down there in a while and sometimes I know that has bothered me in the past if its too long and I have had just the usual skin sticking around the region before so I figured maybe it was something to do with that. My skin is generally pretty sensitive and I know the same thing happens on my face sometimes with the hair irritating and drying the skin underneath if it gets too long.

On day 3 post-coitus I went to the doctor and got the antibody bloodtest. He too commented that he could not see anything concerning. Coming back home I trimmed up down there and felt a little better. I did not use a razor, but an electric trimmer with adjustment settings so it was short but not not completely shaved. With a better view I still couldn't see anything that was concerning. But I continued to have just kinda weird feelings down in the perineum area, the occasional twang of sting - which I've had from maybe trimming too short and the hair pokes against your thigh or working out and being sweaty and it's in general a kinda mashed up area - but it just seemed more than usual and poorly timed. I tried wearing looser boxers and shorts when I got home as I usually wear boxer briefs. Anywho, those feelings I was having really would come and go, sometimes change with position, generally worse with sitting. But never as bad as that second day post-coitus. On another day I masterbated but came barely erect (doesn't really happen much, but guess I wasn't in the mood enough) - anywho, that ejaculation was kinda forceful and I think not being erect it sorta pushed out pretty hard so the head of my penis was kinda tingling for the next two days. I think ultimately that symptom is rather unrelated and explained for then. Anywho, flash forward and I got the results back on day 8 post-coitus: HSV 1, 2 IgM positive. HSV 1 IgG positive. HSV 2 IgG negative.

Now I'm well aware of notoriously how unreliable the IgM test is - at distinguishing between 1 & 2 or at even being accurate that HSV is even present at all. I don't even know if the IgM test really was distinguishing between either anyway. Its titer was barely positive as well. The IgM concerns me less since I know it's not very reliable. However, the thing that is strange to me is the HSV 1 IgG positive. I've never had cold sores or anything resembling genital herpes. Granted, 60% of the population would have gotten the same result. I suppose I get buccal mouth ulcers a lot, but I'm pretty certain they're canker sores. In any case, my first sexual intercourse encounter with this girl was a little over two weeks prior to testing. In all likelihood then, I've been exposed to HSV 1 before this girl as the IgG takes anywhere from 3 weeks to 6 months to develop.

It is now day 11 post-coitus. I still think I am experiencing weird herpes-like prodromal symptoms down there with itchiness in the region or "tingling" in my penis generally relived on urination but I do not see any skin findings similar to herpes outbreak. The only skin findings I see are what appear to be very tiny red dots that - as far as I can tell - are all associated with a hair follicle. They have not swollen, are not crusting, do not look like blisters on a erythematous base or blisters for that matter, don't seem to be distributed clumped together or on skin without hair follicles, and are not present on hairless areas (penis shaft, head). Furthermore, they are not constant. For example, if I check a few hours later I'm not likely to notice the same red spot in the same location and there is nothing where it was before.

This doesn't sound like herpes outbreak at all, but given the recent possible exposure, weird blood test results, and the fact that I'm noticing these spots a lot more than before I'm still just very worried about it. I really am scared about it. I know the outbreak typically occurs 2-5 days following exposure, so I guess I made it past that window. The next likely cutoff is 12-14 days, which I guess I am approaching. If I make it to 20 then I guess it's just more and more unlikely that what's going on has to do with herpes. But if that's the case, what is it? A topical folliculitis mixed with contact dermatitis? It's really driving me crazy cause everytime I feel these stings I always think to myself "okay, this is it - the outbreak is going to be starting down there" and then I look and just nothing.

The closest any of the skin findings I mentioned resembled anything like herpes was just earlier today when I felt itchy on my upper inner thigh and scratched the area. When I looked a little later there were a few red spots somewhat clustered in that area and, again, I was convinced "yup, this is it. Here it comes." I sat on a bus for a while feeling it sorta sting or just be uncomfortable. Sure enough, when I got to the bathroom at this restaurant and checked again - there was nothing there.

Am I overthinking this? If I get past day 20 and no visible eruptions or outbreaks, is it just not likely to be herpes then (I understand theoretically a primary episode could occur months and months later, but it's certainly less likely)? What could it be then? I want to stop thinking about it and rest somewhat assured that it's probably just not herpes but it's hard to do when I still feel these stings and what not, feel rushed to look, look and then not really see much of anything, you know? Thoughts?
11 Responses
Avatar universal
I have what I hope will find good news.
You have an oral HSV1 infection and have had this probably since your youth. This is true for 70% or more of the population. Do you recall oral cols sores?
As a male, this means that you are essentially immune to a genital infection. There are no confirmed cases of a male with an established oral HSV1 infection  subsequently obtaining a genital one.
The infection rates in this situation are incredibly low if existent at all. If by some freak occurence you were infected, you would not experience symptoms to any magnitude at all given your immune system.
You are hence stressing over normal things for your body and adding them to much more than they are.
Rest easy, you will not become infected genitally.
Avatar universal
That does make sense and is certainly a relief, so much so I've definitely felt better.

Suppose, however, for the sake of being thorough, that it was genital HSV 2, not HSV 1 that my partner had and I was having the symptoms described and the recent positive IgM titer. Would that increase your index of suspicion? I think I've certainly felt better since reading your post and the reassurance, but not completely without wondering here and there what a certain sensation is throughout the day. Does the herpes symptoms usually stay and last longer rather than coming and going so randomly and quickly anyway?

I'm having my partner really find out for sure that it was genital HSV 1 for her - checking the old records and what test was done and if need be her getting another blood test. She should be aware of it anyway. Apparently, however, her last partner did get herpes from her, though they were going out for many years and were more reckless in terms of safe sex. She believes she got herpes from someone months before that partner way back who had a cold sore and then she had the outbreak much later - but isn't sure.

Either case, it's now day 13. I do not see any sort of rash or vesicular-like anything. If she with complete certainty has HSV 1 I will be be getting a rather unnecessary repeat blood test at 12 weeks which I know what the results will be and that will be that. If it was HSV 2, should all go well checking I will get a repeat in 3 weeks. Should that be okay I will then do 12. Should that be okay I will do 16. After that maybe 24 but that will be it.
Avatar universal
I think HSV2 is unlikely, but if you need comfort then a 16 week test will do this. Hopefully she can confirm the genital HSV1 infection to remove all doubt.
Avatar universal
Update for anyone: still was not feeling completely normal down below and noticed what appeared to be two somewhat red tracks on both sides right where the thigh meets the groin skin fold. Not typical finding of HSV at all. So at the time was starting to think it was just a bit of skin irritation that I was hypervigilant to when the mind starts going crazy. Went to the dermatologist yesterday who commented didn't see anything concerning or pointing to HSV, but agreed he did see some of the red I saw and agreed with me it's probably just skin irritation: intertrigo. Going to keep putting vaseline on in the mornings and lotrimin on at night for two weeks and see how it improves. It is now day 18 and no HSV-like outbreak, so this may have just been some poorly timed intertrigo is all. I will still try to get a confirmation on partner's HSV status and a blood test around 16 weeks out.
Avatar universal
Update for anyone: I'm now around 6+ weeks post exposure. All in all "symptoms" are pretty similar...rather on/off (mostly off) pattern of sudden pinch or prickly feeling, "burning" (use quotations because not sure if best way to describe it). No HSV-like skin findings. Occasional red dots as aforementioned, but not really that many. Currently waiting on a repeat serology study. The last few days have been more of an "on" phase, i.e. the annoying and strange sensations. I've read online how primary genital herpes usually doesn't have the burning, tingling sensations like recurrent does. The length of time of weeks of this and rather back-and-forth intermittent nature of the sensations, not to mention their generally bilateral diffuse all-over-the-place distribution, concurrent with the previously mentioned fact, does not seem likely to be HSV.

However, I am nervous about the test and have been feeling this stuff more lately again. Hopefully I will have the results as soon as tomorrow. HSV IgG serology this far out is upwards to 70-80% accurate in detecting positive titers, so while it won't be as confirmatory as something like 12-16 weeks out it's pretty darn close.

Should also mention regarding the intertrigo that I sort of do think I'm having another episode of that and never did routinely apply the vaseline and lotrimin for two weeks. I've started to go back to this with lotrimin at night for two weeks and OTC hydrocortisone at morning for one week with vaseline as needed and possibly neosporin for one week at some point in there too.

Anyway, does the length of time of these vague symptoms, lack of outbreak, intermittent and changing nature of the feelings, and distribution in the region make HSV unlikely at this point? Will post the 6+ week serology report when I have it. Keep fingers crossed.
Avatar universal
No this still doesn't sound like herpes.

Remember only HSV2 is a possibility here. And that is only if the partner you refer to has HSV2 which apparently she does not.

Further people with an established HSV1 infection do not experience much beyond minor symptoms if infected with HSV2. A couple of itchy sores for a week and that's it.
Avatar universal
Update for anyone: great news. Just got the second round of titers back.

HSV IgM I/II Combination: <0.91
HSV I IgG: 1.17
HSV II IgG: <0.91

(Negative = 1.09)

Of course on this timeframe, 6+ weeks isn't confirmatory but it's pretty darn close for the initial assessment.

Avatar universal
Sorry correction negative 1.09 (not sure what happened with the text there!)
Avatar universal
Okay I wrote it out but it keeps posting that that way. Basically IgM negative, 1 IgG positive, 2 IgG negative.
Avatar universal
Hello to anyone still reading - I just had a serology test done again. This was 13 weeks. We didn't bother with the IgM.

Basically HSV1 IgG positive still (as expected - value was a little lower at 1.13 interestingly) and HSV 2 IgG was still negative.

Still think I get weird little "symptoms" sometimes, but eh probably nothing then. Suppose reinfection with HSV1 is theoretically possible but doubt it - everything I've seen pretty much backs up what Fleetwood20 mentioned. Spreading HSV1 genitally is pretty rare, the HSV1 in genital region is much milder anyway outside of its "home zone," and I've been IgG positive probably forever making that infection even all the more unlikely. Still want to find out which one the partner had. I'll get another blood test in a few weeks probably at like 17 weeks, but I think it's probably pretty much safe to say I dodged a bullet and can cross this worry off the list.
Hello all - update for anyone still reading. I had another test at 16, 17, 18? weeks out, I can't even keep track anymore. Same results - positive HSV1 IgG, all the rest negative. I'm going to find out from the partner which HSV she had, but essentially there's nothing to worry about here. Still think I've felt "funny" sometimes down there, but yeah guess not in actuality haha. If I find out partner's HSV I'll update here just for sake of completeness, but otherwise that'll be it.
Avatar universal
If you want conclusive results, you can order a Western Blot from the Westover Clinic. It is 99% accurate.
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