Ambiguous Symptoms

[Metanoia]

Doctor,

I'm an 18-year old uncircumcised male taking azithromycin for acne. About two weeks ago, I had unprotected oral and vaginal sex. Three days after, patches of small (1-2 mm) faded red bumps began to appear on the head of my penis - there was no pain or irritation associated. After about two days, the red bumps began to subside, and clusters of tiny (<1 mm) white papules began to appear on the ridge of my penis, under the foreskin, and have persisted since. The symptoms look very similar to pearly penile papules, but I'm suspicious as they appeared only after the unprotected sex. I'd seen a doctor before the appearance of the papules; he said it probably wasn't herpes, and advised me to come back if the symptoms worsened. Today, I'd had the papules examined by a nurse at the local Health Department; she wasn't sure what to make of the symptoms, but suggested that it might be a bacterial or fungal infection.

I'd been concerned that I'd contracted herpes, especially after reading that most initial symptoms are either minor or nonexistent. Now, I'm not so sure what to think. What's your take of all of this?

Thanks.

[Edward W Hook, MD]

You've been examined by two clinicians, neither of whom thought herpes was likely.  I am inclined to agree with them.  I suspect your concern is based on extrapolation of the observation that most people who have herpes do not know it. That does not mean that they acquired it without knowing it.  While that probably happened in a small proportion of cases, it is much more likely that they had symptoms which they attributed to something else and then went away, having never been examined.  You on the other hand are being vigilant and have sought not one bet two medical opinions, neither of whom thought herpes was likely.  That makes it unlikely.  If I had to guess, I would favor pearly penile papules but admittedly, that is only a guess since I did not have the opportunity to examine you.  I think the advice to not worry about it further unless your symptoms get worse is sound advice.  Hope this helps.  EWH  

[Edward W Hook, MD]

The average time to a positive blood test is about three weeks but it can take six months or more for blood tests to become positive (about 90-95% of tests are postive at 6 months).  Of course, if your test is positive, you still don't know who give you the infection unless you have been tested in the past.  I'm not sure testing would do you much good but it's your call and your money.  EWH

[Metanoia]

Thanks a lot.

I'm considering getting a blood test for HSV. How long would I have to wait after the hypothetical infection to do so?