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Should I retest for HSV 1?

I am wondering if I need to do anymore testing for Genital Herpes Type 1.  
I had unprotected oral and vaginal sex with a friend of mine.  Afterwards, I developed a white discharge about 3 days later.  Went to the doctor and was prescribed azithromycin which cleared up the infection immediately.  It was found that the infection was not any STI just some different bacteria between the two of us that my body didn't like, and caused me urethritis.  
Now here is where things get a bit off. I read that neomycin ointment can be used to prevent urethritis in persons using catheters, so I tried it out using a triple antibiotic ointment with neomycin in it.  I applied it generously to the tip of the urethra and around the head of the penis (circumcised).  After this episode I requested that we both be tested for STD's just to be sure.  I have only had one other sexual partner, and was clean for everything, including herpes, before this encounter.  She was tested after this encounter and was clean for everything but she did not get tested for herpes as it was not included with the standard testing.  
We had sex again about a month later, oral and vaginal, both unprotected.  During this encounter she rubbed herself against the underside of my penis. She had shaved recently and must have had a little growth because it was quite sharp, this was after oral.  Anyway, I showered after sex and went on and continued to apply the triple antibiotic ointment to the tip and now the underside of the penis.  I did this about once everyday.
Now, two weeks (13 days) later I noticed a small section of skin (smaller than a dime) next to the frenulum that looked and felt like rugburn, slightly darker, maybe rough/leathery, but maybe nothing more than sensitive skin. Didn't think much of it as I was masturbating without lube quite a bit.  
I continued applying the triple antibiotic ointment, pretty much like a moisturizer, I already know now that this was a bad idea.  3 Weeks after sex approx. 23 days I begin to have an intense burning sensation in the genitals, at this point I wasn't sure where the burning was located but the feeling was enough to keep me up at night.  The burning would subside a little but always some burning sensation was present.  After two weeks I decided that maybe the triple antibiotic ointment was causing this and switched to Lamisil and Hydrocortisone 1% cream thinking that the 9 weeks that I was applying the triple antibiotic ointment was causing a fungal infection or dermatitis.  The hydrocortisone cream really helped but then, after 5 day , I experience this intense burning sensation in the same location as above that I can only compare to putting Icy-Hot on the scrotum, previous experience. So, I stopped all medical ointments. 4 days later (40 days after sex) a small single clear vesicle appeared in the location of where I thought the skin had been rug-burned, I also experience a single nodular hive/urticaria on my thigh, itchy. Allergy or Viral Hive?  It was a Friday night so I went to my GP on Monday morning, a little over 48 hours from the development of the vesicle. It had broken over the weekend and had bled a little and scabbed over.  The Dr's visit was 43 days after sex. I was swabbed for PCR and also blood was taken for IgG.  Everything came back negative including the other STD's.
My results for IgG at 6 weeks were:
HSV1: 0.16 negative
HSV2: <0.9 negative
The Dr. told me my single lesion was atypical of herpes and that he thought that I was experiencing hypersensitivity to the ointments I was putting on myself.  Also said that it should go away within 1-2 weeks.
I figured this was a fair assessment and went on.  After three weeks (week 9) I was still have irritation but no more extreme burning episodes more of a constant sting that fluctuated in sensitivity, Dr. didn't know what to think. The skin still had the slight rugburn like appearance to me, but Dr. disregarded it as normal skin.
At 13 weeks 91 days post sex retested HSV 1&2 IgG and the results were:
HSV1: 0.17 negative
HSV2: <0.9 negative
Now the lesion healed in about two weeks but so do other sores that I get on my body, scarred also. So semi-normal.
She is HSV 1 positive and later told me that she had a cold sore about a week before our last sexual encounter. This has me quite freaked out.  She didn't know that this could happen.  
I am still having this stinging sensation in the same location on my penis, almost 15 weeks post sex.  I am worried that I contracted HSV1 and am not testing positive. I have read that the tests miss 1 out of 10 HSV1, I have also read 30%.  My doctor seems really annoyed that I think I might have Herpes.  He says that even if it is HSV it is no big deal and 80-90% of the population have it.  Obviously, I doubt it is that high as I have seen medical experts here say 57% for US population.  Would I benefit by more testing or am I needlessly worrying about this irritation that I have potentially caused myself, a fungal infection or dermatitis? I plan to visit a dermato-venerologist for a second opinion. I realize that there are parts of my story that match with herpes and parts that suggest other skin problems. I am really confused and just looking for some relief from this daily irritation.  I recognize that skin burning for a almost three weeks before a single blister is not really indicative of primary outbreaks and that hydrocortisone can make herpes and fungal infections worse.  But a single blister after 40 days seems way to long.  I feel like a dermatitis would be a little more widespread including the urethral opening and glans. And I am worried that I may be experiencing some post-herpetic neuralgia in this location, the reason for the continued stinging.  But again this seems like a small chance among herpes positive persons.  I have only taken oral NSAIDs, but discontinued use after learning that they could be causing the hives (only occurred twice).  No oral antibiotics, anti-virals, or anti-fungals.
Any insight or help would be greatly appreciated. Thank You
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207091 tn?1337709493
So first, you probably had NGU/NSU - it's an infection in your urethra that's very, very common and can be caused by normal mouth bacteria during oral sex. I'm glad it's cleared up.

It's going to be really hard to determine what is happening, since there are so many possibilities.

Yes, it could be genital hsv1, but it's not that likely. Your test was negative at 13 weeks, and while it does miss 30% of hsv1 infections, that still gives you a 70% chance that it wouldn't miss yours. (Not great odds, I know, and I wouldn't be satisfied with that, either.) However, your PCR swab was negative. That's a very sensitive test, and if it were herpes, I'd be very surprised if that was a false negative.

Could it be PHN? Maybe. It could also be an infection or inflammation in your prostate, or an anal fissure causing the burning symptoms. That could have also caused the discharge, though given the timing, I'd say not.

It's also possible that you've caused some damage with all the creams you've used for so long. You went from using a triple-antibiotic ointment, killing all the stuff that keeps fungi in check, to using an anti-fungal, killing all the stuff that keeps bacteria in check. You used both for a long time.

It could also be an allergic reaction to something, since you mentioned hives. You don't mention the timing or location of those, so I don't know when those happened in relation to everything else. Were they all over your body? Have you tried a new laundry detergent or soap or anything lately? Eating a new food?

I would suggest continuing to work with a doctor, and a derm sounds like a good place to start.

Let us know what happens.
Helpful - 0
First, thank you for your response.  I have been losing it the past few days. Just on this roller coaster of emotions.
Lamisil and Hydrocortisone cream were used for about 5 days, not overly long. And stopped after another slightly less intense burning episode. 4 days later, no creams applied during this time, a single vesicle formed, day 40.  That morning is when the first single hive appeared on my thigh, itchy went away within a few hours.  The next time I had a single hive was on my thumb about a week later, also pruritic. I was using a lot of NSAID's at the time trying to minimize the burning/stinging and stopped when I read that it could cause hives. No more appeared.
NOTE- these were not erythema multiforme.  They were urticaria that resolved/went away in a couple hours.
Crazy thing is I had new underwear, changed fabric softener, and body wash very close to this.  Those were the first things I thought of.  I discontinued all of that immediately, went commando, showered with no soap, and washed all my clothes in high heat.  This was done the week the burning started. So, no chance they caused the hives.
No new foods.
I am worried about the hydrocortisone cream maybe exacerbating what could have been an unrecognized outbreak.  Causing the single blister very close to where there was a lot of friction.
The blister had started to heal, scab over, so I'm worried that the PCR would be a false negative.
I would like to get a Western Blot to know for sure, but I am not in the US currently. Maybe soon.
I am trying to get in to see a dermatologist, maybe another week.
Also, I have been having these sensations around my perineum, feels like a bone bruise. Sort of like the feeling you get the week after you fall on your *** quite hard.  I don't know, maybe that's in my head but just something that makes me almost sure that it is HSV.  All this and I still have this semi-constant stinging around the area where the blister appeared, and burning on the inner thigh when I sit for periods of time.

I hate that I may not truly know if this is HSV1 for quite some time, that's what bothers me most. I am definitely catastrophizing scenarios in my head and I've had several panic attacks/mental breakdowns.
I read that Terri Warren states that when a serologic test misses an infection it will always miss, and the availability of tests from what I can tell aren't any better for HSV1 than the HerpeSelect ELISA I've already taken.  Are there any better ones?
I am worried that I will have to wait for another outbreak to get another swab PCR test and GHSV1 recurrence data suggest there is a 40% chance that will never happen again. So, if I can't get a Western Blot and never have another outbreak how do I move forward in potential relationships/life?
Even if I were able to obtain a positive, it will not indicate the location, although I think there would be strong suggestion.  But if the WB came back positive that would also mean my results after my relationship a year ago would be suspect as well.

Do you have any advice for dealing with all of this mentally, the waiting and the psychosocial?  I feel like a basket case and can't get this out of my mind.  I'm supposed to be writing my master's thesis, and pretty sure I could write a better thesis on herpes at this point.  
The PCR swab can find herpes when all there is viral shedding, and no sores, so if you had a healing sore, it should pick up the virus.

Okay so let's assume, for a minute, that you have ghsv1. How does your life realistically change? Probably not very much. It recurs infrequently, if at all, and sheds infrequently.

Shedding rates: (and you can find all this in the herpes handbook - https://westoverheights.com/herpes/the-updated-herpes-handbook/)

HSV 2 genital 15-30% of days evaluated

HSV 1 genital 3-5% of days evaluated
HSV 1 oral 25% of days evaluated

HSV 2 oral 1% of days evaluated

Combined, this means that transmission of ghsv1 to someone else, either orally (and herpes doesn't like to go from the genitals to the mouth in general) or genitally is unlikely to happen. Also, as you said, about half the adult population has hsv1 already, and it gets higher the older we get (up to the 80-90% your doctor mentioned). If they already have it, they can't get it again from you.

So, big scheme of it all, not that important. Certainly not as catastrophic as you're imagining. Yes, you'll want to tell your partners, but you should be having a safe sex talk anyway. This will just sort of force your hand to do it.

Chances are whatever woman you date will tell you she's had HPV, or cold sores, or something. (HPV is considered an inevitability of sexual activity now.)

Now let's consider for a moment you continue to freak out about this, and don't do well on your master's thesis. After what - 2 or 3 years of hard work to get to this point, you let a virus that at least half the adult population has mar that somehow?

I have both - hsv2 and a Master's, though I didn't have to do a thesis, but exams instead. I PROMISE you that herpes is nothing in the big scheme of it all. You've worked so hard to get to this point in your education. Don't let this f it up for you. It's just not that big of a deal.

Worry about hsv1 after you get your degree. If you still have symptoms, or they worsen, see a doctor about them, but be open to other things causing them. You'll do yourself a disservice by only focusing on one thing and missing something else.
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