Herpes Outbreak Symptoms But Test is Negative

[scala2112]

I'm 38 years old. My last sexual activity was .8/22.  I see someone once a month and we engaged in unprotected oral sex and sex with a condom. About 48 hours later a tender spot appeared at the base of my penis which I thought could have been an ingrown hair (I shave that area with a razor). Sure enough a small, hard lump appeared feeling almost cyst like. It was tender to the touch but otherwise painless. The next day it had become quite large... and I almost thought about going to the ER to have a doctor lance it. Again it was sore but not particularly painful. That night I had a slight fever and already my thoughts were turning to STD. The next day I awoke in horror as the area was covered in red blisters. By the afternoon of 8/26 the blisters had opened creating an open sore. I made an appointment at my nearest Planned Parenthood and had an STD test. The PA examined it and remarked how quickly for a first outbreak it seemed to be shedding and scabbing over quickly. She indicated that it could have been HSV-1 or HSV-2 delivered through oral sex. She prescribed a week's worth of Vatrex and told me to call back in a week.
I started the Valtrex.I didn't feel any significant improvement. In fact either a result of the drug or just my anxiety I felt lots of fatigue and mild flu like symptoms (loss of appetite).  Finally sometime yesterday it seems the swelling has subsided some, although the  burning from the sore still remains. Yesterday was my last dose of Valtrex and I didn't feel any significant difference  in taking it. So imagine my surprise when I called this morning for my results. Negative on chlamydia, gonorrhea, (through urine) HSV-1 & HSV2 direct culture all negative. I am going back for another blood test on Thursday to rule out it out completely. At this point I am not sure what my options are?

[Terri Warren, RN, Adult Nurse Practitioner]

It is possible that you have herpes and the culture was negative, yes.  It is also possible that it is something else.  However, your description of one sore then blisters forming around it sounds very concerning for genital herpes indeed.  Getting a blood test may or may not answer questions that you might have.  If you have new infection, the blood antibody test won't pick it up, perhaps for another four months.  The test is also notoriously bad for picking up HSV 1 infections.  It could miss at least one of 10 cases, or more.  

It is possible that you acquired it recently or it could have been a month ago or years ago.  Hard to tell at this point.  

The flu symptoms do sound consistent with new herpes infection also.  

If you do have HSV 1 genitally, you may not have another outbreak for quite a while as it recurs infrequently.  In other words, if it is new infection and the antibody test doesn't pick it up, and it recurs infrequently for swabbing, it may take quite a while to know what is going on here.

For sure, if you get another one, get in the very first day to have it evaluated and ask for PCR swab testing, not culture.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

And taking Valtrex daily can definitely alter the results of your antibody tests.  My suggestion is to completely stop the Valtrex.  If you get another lesion, have it swabbed using PCR if possible, and then you can retest when four months have passed, for greatest accuracy.

Terri

[scala2112]

Also wanted to mention I am voluntarily taking Valtrex as a suppressent. One dose every other day.

[scala2112]

So my blood tests have come back negative on both HSV-1 & HSV-2 Specific Ab, IgG

My sexual encounters with three partners occurred:
Partner A-July 27 (unprotected oral, protected sex)
Partner B-Aug 15 (unprotected oral, protected sex)
Partner C-Aug 22 (unprotected Oral, Protected sex)

Aug 24 a small lump appeared,
Aug 25 swelling increased with fever
Aug 26 Swelling produced red blisters which opened 12 hours later
Aug 27th-Had Culture taken... Urine & GC Combo-NEGATIVE Prescribed Valtrex for seven days
Sore remained open until Sept 12-13 began to heal
Sept 20th had blood test for HSV-1 & HSV-2 Specific Ab, IgG- Negative
As of today 9/27 the lesion is still healing. It's an inch long across the shaft midway when erect. My penis is still slightly swollen and discolored (purplish around the base of the head and thick and some what leathery in the midsection of the shaft)

What should be my next steps. Should I completely avoid sexual contact. For how long. When should I get another test done? How do I approach previous partners if I still don't have a positive diagnosis?

[scala2112]

Thanks for the feedback. I am scheduled for a blood test on Monday. In my heart I know  that this is a new infection. This came on quite severe. The fever only lasted a night but it coincided with the swelling. If thois was an initial outbreak I would think it was quite severe. I had lots of fatigue by mid to end of week. 7 days after the initial swelling was probably the worst in terms of pain and burning. My penis was so swollen that it made urination difficult. The swelling and pain has since subsided but I still have the open sore that's quite large.

Should I go back on the Valtrex? I didn't feel like it really did anything over the 7 days. On Monday I go back for the Blood test and also test for syphillis. In my head I know is herpes... I just could not imagine getting it from this particular partner.

If this was a recent infection, how far back would I have to go from the first symptoms to identify possible partners? I had oral sex from two different partners within 10 days. One 2 days after the first symptom. If I test negative how do I let them know something has happened?

[scala2112]

If lesions are present and a culture is taken how could the test still turn up negative for HSV-1 & 2?

Today is the first day that the swelling has subsided almost completely. I ran out of Valtrex on Tuesday. I'm scheduled for a blood test on Monday. Should I wait that long or should I continue on a new prescript for Valtrex?

[scala2112]

If I still test negative on the timeline, is it possible to establish a baseline on the time of infection. I received unprotected oral sex from three different partners within four weeks of the outbreak. The first occured 7/27, the second 8/15 and the 3rd 8/22. The first symptom showed on 8/24. Is it possible I contracted it as far back as 7/27 and spread it to two other people in that time? How long does this virus take to show up in testing?

[cheymaj]

that's kind of what happened to me I went when I saw the sores took the medication it went away that I took another blood test and multiple times in with the doctor told me I was clean...