Herpes or just recurrent yeast?

[paranoid_guy2012]

6 mnths ago, sex with friend.  In 6 days, I had redness inside my foreskin (I'm uncircumcised). Lot of tests, including herpes (Igg and IGM). All negative. Diagnosed yeast.

Some pain at tip of glans. On ketoconazole over 1 wk and 1 wk diflucan.

5 wks reran tests; all negative.

Pain at tip of glans continued 2 mnths; diagnosed prostatitis. Said VERY slim possibility of urethritis (I think due to intermittent, clear discharge); antibiotic for urethritis and 2 weeks of Cipro.

After meds, developed yeast. Redness, slight pain, and itch focused in a red line about 0.25 inch long following base of my glans along the right hand side. Cream and diflucan healed it.

Month later, prostatitis back. Urine to lab for analysis, urine culture, gono and Chlamydia; put me on 30 days of doxycycline. All tests clean.

Near end of meds, got itchy; soon redness, pain, and itch focused in same spot as previous yeast. Used cream 2 weeks. Doc put me on lamisil. 10 days to heal. Started taking a probiotic (Syntol) when started the doxycycline.

5 months after affair, tested with HS ELISA HSV-1 and HSV-2 and also for HIV. All negative.

NEVER had yeast infection prior to affair. Late Dec, stopped Syntol. Days later itching started. Redness returned to same location yesterday. Started with cream yesterday; greatly reducing symptoms. Prostatits coming back (dripping).

So, my questions for you:

1. Herpes outbreaks can look like yeast from my reading. Do these sound like real yeast?
2. Read herpes cause UTI’s. How about prostatitis? If so, would something clearly show in numerous urinalyses I’ve had done?
3. I’ve read herpes can cause yeast infections. Is that true, if so does this seem to be the case here?
4. Does negative HSV-2 result in December (21.5 wks) pretty much eliminate that? Friend tested in Dec; negative HSV-2 positive HSV-1 (from childhood; no visible outbreaks while we were together).
5. At 5 months, about a 15% possibility of false negative for HSV-1?
6. What’s your take?

[Terri Warren, RN, Adult Nurse Practitioner]

There may be 100% concordance with the samples in the study, that 100% of those positive by Immunoblot are positive by western blot, but it is the reverse situation that matters in terms of sensitivity.   We find many ELISAs (that is the same platform as the Immunoblot) that are negative for HSV 1 and positive by western blot.  

First infection oral herpes often presents in the mouth, often accompanied by external sores).  HSV 1 can be shed from inside the mouth, certainly, but normally presents with sores on the lip, nares or chin.  Traditional canker sores are not caused by herpes.

Terri

[paranoid_guy2012]

Thanks again for your input Terri,

Two more follow-up questions, then I promise I'll quit bugging you.

Out of curiosity, the specification sheet provided on Focus' website shows the immunoblot to accurately identify 100% of HSV-1 cases that western blot identified (http://www.focusdx.com/pdfs/pi/US/IB0900G.pdf page 6 top).  However, the confidence interval is as low as 91%.  Is the CI the reason you don't feel it's any more accurate than the ELISA, or are there other studies that aren't necessarily in the public domain that also support that low sensitivity?

Also, you mentioned that I may already have had HSV-1, which makes a lot of sense, particularly with a few year stretch that occurred to me in college.  I broke out in VERY painful mouth sores (covered the whole inside of my mouth, including the back of my throat) about once every month for a couple years.  It trailed off after two years until it hardly ever happened 5 years after it began.  My dentist looked at them during one outbreak, and upon hearing the recurrent symptoms, immediately diagnosed herpes.  I've seen there is a form of herpes (called herpes gingivostomatitis caused by HSV-1 on some sites) that affects the mouth, but many other sites say HSV-1 never affects inside the mouth.  What's your expert stance on that?

Thanks once again for your input!

[Terri Warren, RN, Adult Nurse Practitioner]

The immunoblot is no more helpful than the traditional HSV serology.  It is the western blot that is more sensitive for HSV 1.  

If you tested positive for HSV 1 by the western blot, you won't know how long you've' had it.  If the ELISA missed it the first time, you could have had it for years and didn't know it.  

I would skip it.

Terri

[paranoid_guy2012]

Thanks Terri.

She was tested negative for hsv 2 in december (5 to 5.5 months after we had sex. However, she has been positive for hsv1 a long time - likely from childhood. She occassionally gets mouth sores - my understanding is they must be canker sores rather than herpes due to the location, and has no memory of any cold sores. She did not have any sign of mouth sores or cold sores while we were together.

Would it be worth getting tested with immunoblot to further rule out hsv-1?

[Terri Warren, RN, Adult Nurse Practitioner]

I agree that you can rule out HSV infection.  You've waiting long enough for accurate results.  I think you're into a cycle of antibiotics, fungal infection, more antibiotics, more fungal infections.  The chronic prostatitis is driving this issue.  Sometimes, people end up taking antibiotics for months before this clears up.  It may not be completely coincidental that you have prostatitis after contact with another partner, even though you have none of the traditional STDs.  Very hard to say.  

Have you considered asking her to be tested for HSV  to really set your mind at rest?

Terri

[paranoid_guy2012]

Sorry for the shorthand above.  It's very difficult to abbreviate 6 months of experiences and tests into 2000 characters or less!  Hopefully it all makes reasonable sense!  In a nutshell, since sleeping with a friend, I keep getting yeast infections and have also been diagnosed with prostatitis (which I think was brewing beforehand, but definitely got much worse a month or so after we had sex).  Prior to sleeping with her, I had never had a single yeast infection, but I've also never been on so many antibiotics for the prostatitis, either!  I'm paranoid that this could be genital HSV-1, but think I can safely rule out HSV-2 at this point.

Thanks for any insights you can offer!