Confirmation testing?

[VeryConfused2]

So here's my story. In December 2011 I had 3 sexual encounters.  In order they were:
1 unprotected intercourse (Dec 21st)
1 unprotected oral (Dec 23rd)
1 genital-to-genital contact without penetration (New girl, Dec 31st)

The morning after the final bout of stupidity (New Years Day) I noticed about a dozen red dots mostly on the left side but all around of the head of my penis.  I would describe it as if someone had taken a red sharpie and dotted it.  I am circumcised. They weren't raised or otherwise problematic.   The next day, an urgent care doctor looked very closely at the dots and said that they didn't look like herpes. Pain and burning in my urethra came on a few days later and has come and gone for about 2 months now, each time lasting a few days, preceded by leg and lower back soreness for about a day.

I visited 3 doctors during the 1st week including a dematologist and starting on week 3 a urologist who all think I'm stuck on the wrong problem.

So far my results have been:
Swab test at urgent care (day two of rash): negative

17 days (urgent care lab)
    HSV-1 IgG 0.07
    HSV-2 IgG 0.15

    HSV 1/2 IgM < 1:20 (not reactive)

4 weeks (PCP Lab)
    HSV I/II Combined IgG 0.38

8 weeks (urologist's Lab)
    HSV I/II Combined IgG 0.58

The urologist has no interest in retesting and can't seem to prescribe the type specific test from his list of available lab tests. Should I pay the $150 and get the type specific test done by somewhere like tSTD?

I should mention the only girl I actually had unprotected vaginal intercourse with went straight to her OB/GYN and tested negative for everything including herpes.  To me it implies 3 possible infection scenarios:
  1. I picked it up from a few seconds of genital-to-genital rubbing (and had a rash 12 hours later)
  2. The OB/GYN didn't perform the correct test or tested too soon (the girl claims she had an IgG test)
  3. I caught it from an old girlfriend (last protected encounter on 11/23)

Thanks

[Terri Warren, RN, Adult Nurse Practitioner]

I believe that you are not infected with herpes.  You symptoms are due to something else.  I don't what this could be but I believe, based on your test results,  you can take herpes off of your list.

This will be my last post on this thread.

Terri

[VeryConfused2]

Terri,
  I got a little impatient and tested again at 15 weeks and 2 days. I was absolutely sure it would be positive. I tested at LabCorp and the results were negative (less than 0.91). I called the provider and the lab but neither could give me the actual numerical value. Simply that it was negative. I haven't touched the anti-virals since the 5 pills I took just after the 8 week test.
   Are you convinced this isn't herpes? I can accept (kind of) that a stinging sensation on the head of my penis that started with a rash, happened after unprotected sex with a new partner, keeps coming back, seems to be preceeded with sciatic like soreness in my butt and one leg; is not herpes if an expert in the field says it is not but I need relief. As I type this the skin on the head of my glans is inflamed and sore. I had to leave work early today because of the discomfort and the only thing that seems to bring relief is to wrap my goods in a cold wet rag then stay reclined in boxers keeping things cool and dry. There is literally nothing to see except that it looks a little more red and scaly than what I would call usual. I would say it burned a little to urinate today and the pain seems worst in the hour just before and after voiding. In fact the worst of the stinging seems to occur about an hour after lunch.
  I would assume I'm done blood testing. Since I don't get lesions or ulcers I don't really have anything to swab. Am I simply doomed to be uncomfortable 2 weeks out of every month until my body figures out how to deal with this?
  The only actual diagnosis I've had is blantis. Could that keep coming back? I've noticed that, once the stinging has started, its worse when I'm stuck sitting hunched over for long periods of time.
  I seems when reading the 'hopeful stories' out there of the confirmed sufferers of herpes the capacity for leading a happy life is very highly correlated to getting the symptoms under control. That's starting to make a lot of sense. Would trying supressive therapy, even as a placebo effect, be worth a shot? I assume it would negate any future testing unless I develop lesions to swab.  Should I look into daily PCR swabbing? How would I set that up?

A this point anything you can recommend would be greatly appreciated.
  

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, the discharge should be swab tested.

Terri

[VeryConfused2]

So once again I'm dealing with this strange phenomenon of soreness in my lower back and back of my legs followed about a day later with a stinging, incredibly uncomfortable feeling in the urethra and meatus around the tip of my penis.  I managed to get an appointment with my urologist for tomorrow though, except for some clear sticky discharge, there is nothing besides the usual inflamation to see.  The leg and back soreness completely goes away a couple hours after the stinging starts.  My god this is gross.  Terri I don't know how you read this stuff day in and day out.  Would it make sense to ask him to swab the discharge?  What should it be tested for.  I'm actually on a 5 day course of Azithromicyn for a sinus infection so I can't imagine it's bacterial.  

[Terri Warren, RN, Adult Nurse Practitioner]

I think that CPPS could cause these symptoms, yes, it would definitely be worth getting that checked out.

Terri

[VeryConfused2]

Terri,
  In the time since I posted those values I've had a really strange relapse of the same symptoms that keep cropping up. Thursday night my butt and legs started inexplicably aching again. By Friday night the skin at the tip of my penis, just behind my ureatral opening, began to feel raw and sore. There is no visible broken skin or anything I can specifically see besides some patchy discoloration (and I've really, really examined) but I put some Lanacane anti-bacterial first aid spray on the area and the pain almost instantly subsided.
  With all the negative blood tests I'm willing to accept that it is not Herpes but what could this possibly be? I'm not doing or eating anything out of the ordinary. I talked to a dermatologist who looked at my symptoms during a previous bout and could only guess that it is some kind of referred pain from an infection deeper in my system. Would prostatsis or CPPS manifest this way?

Thank you for all your help so far.

[Terri Warren, RN, Adult Nurse Practitioner]

Seven days of medicine is not going to change the time to serconversion.  

I think you're doing great, and the odds are very good that you aren't infected.

Terri

[VeryConfused2]

I got a anxious and had blood drawn at 11 weeks and 3 days using tSTD at a quest lab again. I know I should have just donated that money to charity since its before 16 weeks but the negative results are below.

HSV 1: 0.04
HSV 2: 0.06

I feel silly about it now but to see if it had any effect on my symptoms I ended up taking the last 5 days of the valtrex between the 8 week test and this most recent test (finished 7 days before the blood draw). Could this affect the results? There seems to be a lot of conflicting opinions about that.

I know 16 weeks is the magic number but nearly 12 weeks for someone without either strain seems like a long time. My doc was content with testing at 4 weeks.

[Terri Warren, RN, Adult Nurse Practitioner]

These are results are definitely negative.  And I would certainly call it encouraging.  

I like people to wait 16 weeks before having a final test.  People who have neither HSV 1 nor 2 can make antibody slightly more quickly, so it is a very good thing that you are still negative.  

Terri

[VeryConfused2]

Terri
  Just got my negative results back from the tSTD test. The levels are below. This would be at 8 weeks and 5 days past possible exposure. I went to a Quest lab.

HSV 1: 0.09
HSV 2: 0.24

I assume I can call it encouraging. Can I consider this enough testing given all the other doctor evaluation? Is it concerning that it is higher than the first type specific test or that the HSV 2 titer is higher in the second test? The first test was done at a focus lab. Do I still need to test in 4+ weeks?

[Terri Warren, RN, Adult Nurse Practitioner]

The discharge is more consistent with a urethral infection than with herpes, as is the pain you experienced.  The fact that you are getting better speaks to the effectiveness of the antibiotics.  Cipro is not the first choice, by any means, for urethritis. But hopefully, it will take care of things.  The first choice is azithromycin or doxycycline.

Terri

[VeryConfused2]

I didn't see any breaks in the skin but there was a thin white discharge following urination in the first week on one occasion.

I scheduled a herpeselect test through an online source so I should have those results in a few days. If the titer is much higher I guess that's the answer.

I took 4 days of Valtrex when the rash showed up (I begged an urgent care doc to prescrib it which he did under protest)

There was a sore spot on the right side near the top but my primary care doctor looked at it and didn't believe it looked like anything.

[Terri Warren, RN, Adult Nurse Practitioner]

I really don't think that candida would cause teeth gnashing discomfort, so that doesn't fit.  

I did notice that your negative titers were climbing, but that may or may not mean anything at all.  Difficult to say.  Have you taken any anti-herpes medication?

So other than the rash on the head of your penis, have you had any breaks in the skin in the genital area?  Are you having any discharge from the end of the penis at all?  

Just not sure what might be going on here, but again, 70% of those who are going to become positive on this test will do so within 6 weeks.

Terri

[VeryConfused2]

Thank you for the information. Hearing an HSV expert say I have a 70% chance of being truly negative is for some reason more relieving than anything I've heard so far.

I was treated with a 7 day course of cipro and an anti-yeast pill. Flucosinol I believe. Neither seemed to make a difference on the burning or the rash though the first round of pain subsided a day or so after the antibiotic started. I was tested for clamidia, syphilis and gonorrhea via urine, urethral swabbing and blood tests.

After a recurrence of everything but the rash last weekend (back and leg soreness, followed by penile inflammation, a painful burning sensation and stinging in my urethra) I requested the most recent HSV test.

Could candida keep recurring like this in a male? I've not seen the same rash recur but I keep having these periods of teeth gnashing discomfort.

Is it not concerning that my negative titer values are high and climbing for each test?

[Terri Warren, RN, Adult Nurse Practitioner]

Your red dot symptoms don't sound like herpes, they sound far more like candida balanitis.  this is a type of fungal infection.  Also, herpes doesn't show up the day after contact, it takes longer than that.  but obviously, the person who evaluates you in person has a much better idea of what is going on.  I guess they also don't think you have herpes.  Your combined test is negative.  The combined test is not useful if it is positive, as it is not distinguishing between HSV 1 and 2, but it is useful if it is negative for both, which yours is.  A negative test 8 weeks out, suggests with 70% certainty, that you don't have herpes.  If you are still worried, you can retest at 16 weeks post-exposure, but I seriously doubt that you will become positive on this test.  Only time will tell, though.

If and when you do retest, I would suggest using an online testing service that can get you the correct test ordered, type specific HSV 1 and 2.  

Have you been tested for gonorrhea and chlamydia?  The urethral burning is of some concern.  Did the urologist treat you with any antibiotics?

Terri