Time sensitive: Recently Diagnosed - Many Questions

[plzanswerme90210]

Hello,

Please note: The 1st question is time sensitive.

First of all, thanks for taking the time to read and answer my questions. This has been a stressful time for me and I truly appreciate anyone who volunteers even a small amount of their time to help.

Now, some background: I’m a male and had vaginal sex (with a condom) late last Friday night. Over the next couple of days my scrotum was somewhat itchy and a little red (although not so much that it seemed out of the ordinary or alarming). Then on Sunday night I discovered two red spots on my scrotum. The next day I went to a nearby clinic. They took a sample and verified under a microscope that it was herpes. The doctor assumed that it was Type 2 because the location of the spots was on the genitals. This is my first exposure to the virus.

The doctor prescribed me with the drug Acyclovir to be taken both orally and topically. Five times a day I take a 200mg pill and at the same time apply the drug topically to the infected area. The doctor prescribed this treatment for a duration of five days.

I've noticed some inconsistencies between information available online and that given to me by the doctor, plus there are some other things I'm still confused about. Therefore I have many questions.

I apologize for the volume of information that I am requesting. Some of the questions may appear common but my confusion with those issues has to do with various nuances as well as some inconsistencies in the information I've gotten.

TIME SENSITIVE 1) Is taking Acyclovir for my primary outbreak for only five days enough or should I take it for 7-10 days (as CDC recommends)? Also, should I even be applying the drug topically? Is it of no consequence or could this be detrimental?

2) Is it true that since this is my first outbreak, taking Acyclovir now will significantly reduce future outbreaks, possibly even eliminating them?

3) Has the virus definitely embedded itself in the nerve cells of my spinal cord? Does taking antiviral drugs so soon after initial exposure reduce or eliminate this possibility? Is there any way to verify this?

4) Now that I’ve been exposed to the virus, will I definitely develop antibodies and test positive for the virus for the rest of my life?

5) How long will it be until the antibody is produced in my body? Do I need access to antiviral drugs until then?

6) Since I'm receiving treatment so soon after exposure to the virus will this eliminate or significantly reduce asymptomatic shedding? Going forward what is my likelihood of shedding the virus without showing symptoms?

7) How contagious am I during asymptomatic shedding, i.e. what is the probability that I will spread the virus to a partner if I am shedding without symptoms?

8) Is there any way to find out how often and/or when I am shedding?

I actually have more questions but that's enough for now.

And again thank you for your help.

[gracefromHHP]

a month post encounter doesn't mean anything.

[plzanswerme90210]

got IGG testing exactly 4 weeks after exposure. results were:

Type 1 : 0.25
Type 2: 0.24

Does this have any relevance for 4 weeks after exposure? If I did catch HSV would the levels be higher than this after 4 weeks (but still not conclusive)?

FYI, all other STDs came back negative and dermatologist ruled out fungi.

Thanks again.

[gracefromHHP]

unfortunately nothing else to do but wait and repeat your testing.    follow up with your provider should you get any further symptoms.

[plzanswerme90210]

In the absence of any new lesions is there any way for me to verify the diagnosis other than getting an IGG test in 3 or 4 months?

I fairly certain my symptoms are consistent with HSV. But could someone please double-check the following (I know no one here can diagnose me, and I still need to see my doctor):

-on the night of 8/05/11 I had vaginal sex using a condom (I'm male)

-over the next couple of day (saturday and sunday) my scrotum area became slightly itchy and slightly red, but these symptoms where very mild. I also experienced tightness in my back.

-that Sunday night (8/07/11) I noticed 2 'red spots' next to each other on my scrotum. They looked similar to bug bites but were a darker red color than bug bites.

-other than the red spots, I didn't experience any other symptoms. no pain

-On Monday (8/08/11) I went to a clinic. The doctor said it "looked like herpes" and what I believe is a tzanck test, which he claimed confirmed that it was herpes. (I understand this test is unreliable)

-after 5 days of treatment with Acyclovir, symptoms improved (the red spots shrunk and redness disappeared).

-a few days after I finished taking the Acyclovir, I again experienced tightness in my back, followed by minor redness on my scrotum and minor itchiness in the same area

Are the above consistent with HSV, could it be something else?

Again, thanks so much for your help.

[gracefromHHP]

you never want the herpes igm test done. it's a greatly flawed test and current cdc recommendations are that it not be used in adults for the purpose of diagnosing herpes infections.

make sure the igg testing you get done is type specific too.

[plzanswerme90210]

Thanks again Grace.

I contacted another hospital via their website for an appointment and gave them the same info that I provided here. In their reply they suggested these tests:

Herpes simplex IgG
Herpes simplex IgM

Each takes about 4 days. Those are the correct tests right?

Also, is there anything I should bring up with the doctor or any questions I should ask?

Thank you.

[gracefromHHP]

no it doesn't confirm that it's herpes at all. it has a very high false positive rate which is why it hasn't been used to diagnose herpes for quite some time now.

the provider who told you that treating the first ob reduces the number of future ob's is misinformed.  

[plzanswerme90210]

Thanks so much, Grace.

A few more questions:

Does the tzanck smear at least confirm that I have SOME form of one of the herpes strains?

I agree that preventing shredding is very important and one of my paramount concerns for the future.
However, the doctor at the clinic said that treating the initial OB with an antiviral drug would make future outbreaks less likely.....is he just simply wrong? (sorry to ask the same question twice but I'm getting conflicting info)
If anyone knows of data/research studies about this I'd appreciate it.

I let the partner know about this after I found out. Unfortunately, at this point I can't get into contact with her, she's left the area - we're both travelers/backpackers.

I return home in a week and a half so I might just wait until then for more tests.

Thanks again.

[gracefromHHP]

it was the tzanck smear I'm sure. Darn shame they are still using such outdated and inaccurate methods to diagnose folks :(  

at this point all you can do is take the 5 days of medication and follow up with proper igg blood testing.  if in a week or two you get a new batch of genital lesions, be seen elsewhere and get a lesion culture and typing done.  don't worry about getting more medication at this point, it's more important to get an accurate diagnosis.

no, treating the first ob makes absolutely no difference in the number of future ob's or on future shedding ( which is far more important of an issue than actual recurrences too ).

you also might want to seek out a type specific herpes igg blood test done this week and then repeat it in 3 or 4 months too.  

any chance you can get the partner in question to get herpes igg blood testing and share their results with you too? odds are they've never been tested for herpes before to know their status.

grace

[plzanswerme90210]

Hi,

Thanks for your response.

I don't know the name of the test. It was done at a clinic for traveler's, so it didn't take long.

They took a sample of the infected area, then we had to wait for about 15 minutes (they had to do something to the sample). Afterwards the doctor looked at it under a microscope (and showed me as well) and said that he had confirmed it was herpes.

What kind of test is that?

On the chance that it is herpes, should I insist that I take the antiviral drug for a full ten days or until my 'red spots' go away?

Thanks.

[bobrope45]

I guess that before getting your answers, you still need to confirm your status.
Can you get a copy of your results with your doctor? The test you had was most probably a Tzanck test, which is not a fully reliable test. You doctor should`ve had a PCR swab, or a culture. Typing the virus is also important, and your doctor was so wrong to assume it was HSV2. So it would be better to double check what kind of testing you had before assuming you have herpes.