Atypical symptoms, at a loss

[Duder]

Hello, I'm a 27 year old male who has had 2 unprotected vaginal sex encounters in the last year.  The first was 11 months ago and the last 7-8 months ago.  I posted a question earlier this year because I was concerned about Herpes and thought I had visible signs.  That time it turned out just to be papules so I decided I needed to give myself a break since I'm a bit of a hypochondriac.  However, after noticing a dicolouration on my glans 2 and a half weeks ago I got concerned again.  After this went away completely 3 or 4 days later, I was again relieved.  Unfortunately, 10 days ago I noticed some discomfort after masturbating but ignored it.  In the morning I had small, maybe 4mm diameter, red spot on the soft tissue on the underside of the shaft near the head.  I couldn't really ignore this because it was quite sore to the touch.  The mark was significantly less noticeable the next day but was still quite tender.  For the next week, and even up to this day, I still seemed to be able to notice tenderness there but could not find any visible signs anywhere.  I wouldn't write in again, but this was a definite sore that I couldn't really explain.  I would go get tested, but the STD clinic here in Calgary, Canada only does swab tests on visible sores and the mark was completely gone in couple days before I could go in.  I haven't yet found out whether herpes blood tests are even available in Calgary but I am still looking into it. Since this is my only medium right now, I thought I'd ask a few questions:

1)  Do Herpes sores behave this way?  A visible sore appearing quickly and then dissappearing quite fast again, but remaining tender for some days?    
2)  In general, how often is herpes associated with physical sensitivity while not demonstrating visible signs?
3)  How often are flu-like symptoms associated with outbreaks?  I had a nasty headache, sorethroat and congestion develop 6 days ago, but this might just be a cold.
4)  Can Herpes sometimes show up only as healed over scabs?  The only other visible marks I can think of is a scab that appeared in spring without any other accompanying signs and dissapeared in a few days, and another super tiny one I noticed recently that seemed go away in a day and a half.

It's rather frustrating to think that an outbreak might happen without anything really conclusive becoming noticeable.  Anyway, thanks in advance for the help and for the great forum.

[titojazz]

So here's my story:  I was with a girl for about 6 months, during which time we had unprotected sex after getting tested for std's  (everything but herpes).  I've never had a lesion on my penis in the past or during the time we were together.  We broke up and had some ex sex in February, neither had been engaging in sex otherwise.    A few days later I had a weird discomfort in my urethra, no discharge or pain, just discomfort and tingle without lesions.  This was intermittent for about 3 weeks and passed slowly.  In mid April, I had sex with a girl after a long night of partying.  We used condoms but the second time the condom broke and we didn't notice for at least 15 minutes.  In the morning we had sex and used a condom but there was some foreplay where there was some intimate touching without actual penetration.  Anyways, about 3-4 days later I noticed an itch in my penis.  Felt like the earlier symptoms but more severe.  It actually woke me up at night.  In the morning I noticed 2 small pustules about 2 mm each in diameter on the glans.   No blisters, no fluid seen, just 2 red bumps that filled with puss in about 24 hours.  Never felt any pain associated with it and had no fever or flu like like symptoms.  I also had no enlarged painful nodes.  Nonetheless, the very next day I went to a clinic and the doctor said it didn't look like herpes, he gave me the full work-up and gave me some zithromax.   I felt fine in less than 24 hours and the bumps healed in another day or two ( 4 days total).  History, physical, and clinical response was reassuring.... then 10 days later the second culture came back positive for HSV 2 !!!  (the first was inconclusive.)  I never had anything like this and the girl I was with tested negative, or so she says.  Anyways, I was DEVASTATED by the results.  I'm aware of the physical signs and symptoms of HSV and had a low index of suspicion going in.  
I'm wondering:
1.  Is the culture possibly false positive?  I know it's the gold standard but is it possible that there is contamination or another virus in the herpes family giving a false positive? No diagnostic test is perfect after all...  What is the significance of the inconclusive first result?

2.  How likely is it that I've had HSV2 for a while and the April symptoms were unrelated while I was actually shedding virus coincidentally?

3.  How far are we from a vaccine?   If there is a vaccine on the horizon then having it won't be a big deal right?

4.  Should I have the antibody tests done?

[stdnurse]

I am one of the nurses at the STD Clinic in Calgary and serological herpes testing is available. Keep in mind this still may not tell what caused this particular sore or even if herpes is present in the genital area as it is a blood test.

[H. Hunter Handsfield, M.D.]

Your symptoms are atypical for herpes and I do not that is the cause.  Canadian STD clinics have what I consider to be an unfortunately (and highly inapproprite) perspective on HSV blood tests.  But the tests are approved and on the market in Canada and any provider (e.g., your personal physician) can order it if the STD clinic refuses.  Alternatively, return to the STD clinic within a day the next time you develop a genital lesion that concerns you.

1) Herpes lesions cannot come and go in 3-4 days.  Once a lesion is present, it will take 7-14 days to heal.

2) To my knowledge, herpes never causes tenderness/sensitivity without a visible lesion.

3) Fever, muscle aches, headache ("flu-like" symptoms) are common in the initial HSV infection but do not occur with recurrent outbreaks.

4) True scabs cannot appear out of nowhere; an open lesion has to be present first.  Herpes could present with only as "healed over scabs", but only if you failed to notice the earlier stages of the outbreak.

Bottom line:  Almost certainly herpes is not the cause of your symptoms.  But if another lesion appears, follow up with the STD clinic; or find a provider who will do an HSV blood test.

HHH, MD