Herpies + with - testing?

[lolkitteh]

Hi Docs, I’m trying to figure out if im + or not. Im sure you guys get this all the time…

About 3 months ago I got a few small red soars around my penis, were never blisters just soars appeared and left after a few weeks leaving me with very dry, itchy flaky skin in a few area, never had the classic flu like symptoms. I had a culture done which was neg. And a few weeks later had my own out of hmo bloodtest done with a supposedly good, accurate test that costs 200.00 which came back as marginally positive @ 1.23. Waited about 6-7 weeks and had another blood test done at hmo which came back negative. Now, once again I have the same red spots show up in pretty much the same location…no blisters just red spots that broke open, im assuming from masturbation or sex….not sure if its possible im allergic to something, but that doesn’t make sense if they are in the same spot….do I just have herpies and not testing +? First test info is below which is a low positve, doc didint provide second test which he said was -.



Test Description Result     Range   Units   HSV 2 IgG, Type Spec163153  1.21     0.00-0.90   index  
Negative 1.09
.
Note: Negative indicates no antibodies detected to
HSV-2. Equivocal may suggest early infection. If
clinically appropriate, retest at later date. Positive
indicates antibodies detected to HSV-2; coinfection
with HSV-1 cannot be excluded without type specific
testing.
HSV 1 IgG, Type Spec164899 <0.91     0.00-0.90   index  
Negative 1.09
.
Note: Negative indicates no antibodies detected to
HSV-1. Equivocal may suggest early infection. If
clinically appropriate, retest at later date. Positive
indicates antibodies detected to HSV-1; coinfection
with HSV-2 cannot be excluded without type specific
testing.

[H. Hunter Handsfield, M.D.]

This is straightforward.  You don't have genital herpes.  Your symptoms don't suggest it, both because there apparently was no blistering or ulceration; herpes doesn't leave behind dry or flaky skin; and herpes lesions cannot last for "a few weeks".  2-3 weeks is the maximum and most clear up in around 10 days, leaving no scars or skin abnormality.  If your description is accurate, it's pretty sure I would not have done the herpes culture test nor would I have recommended a blood test.

Second, your test results are definitely negative.  The first was technically borderline positive, but at a numerical value that almost always turns out to be negative.  The repeat test was a clear negative.  In circumstances like yours, you don't need a tie-breaker or any further testing; for sure you aren't infected.

In rare circumstances, the blood test never turns positive.  But combining your description of the penile rash and the blood tests, you can be absolutely certain you don't have genital herpes.

So congratulations -- all is well with respect to herpes.  Of course continue to follow up with your health care provider if the rash persists or recurs, to learn the real cause.  Eczema and any number of other skin conditions are possible explanations.  If not certain about your primary care provider's expertise, see a dermatologist.

Best wishes--  HHH, MD

[lolkitteh]

Thanks for the info doc -

My MD think its herpies from the visual, even with flaky skin here and there and doesnt want to refer me to a derm. I may have to find my own, are there several other things that can cause soars to come and go?  And how long do the blisters take to pop in herpies, my MD seems to think im not catching them before they pop....thx for the info, makes me feel better but still upset -=/

[H. Hunter Handsfield, M.D.]

If your doctor is familiar with herpes, that has to be taken seriously.  But I remain skeptical, for the reasons I said above.

With a fresh outbreak, each individual lesion typically progresses from red bump to vesicle (blister) within 1-2 days; if not popped intentionally, the vesicle usually remains intact for 2-4 days with the fluid inside becoming thicker, i.e. evolving toward a more pimple-like appearance; then it scabs and heals.  This is the classical pattern and there are plenty of exceptions-- but If your penile rash isn't behaving this way, it's all the more reason to ask your doctor for referral to a dermatologist for a second opinion.

[lolkitteh]

It is in some ways behaving that way, not sure if im poping them via sex etc....typically, how long does it take to show a + in blood tests, im going on 3-4 months now.

[H. Hunter Handsfield, M.D.]

Over 90% of infected people have positive blood tests by 3 months.  That's one of the reasons I believe you don't have HSV-2.

I don't follow your comments about popping lesions by having sex.  Of course if you think you might be having a genital herpes outbreak, you shouldn't be having sex, unless you know your partner already is infected or has told you s/he doesn't mind catching it.

It should be a pretty easy thing to observe your lesions from start to finish and see how they evolve.  Recurrent genital herpes always clears up entirely within 2 weeks; then the skin looks totally for a few weeks, until the next outbreak; and such outbreaks never occur more often than once every 4-6 weeks, typically every 2-3 months.  My bet is that this pattern also does not describe your situation.

I strongly suggest you stop searching on line for a definitive answer, on this forum or any other internet site.  See my comments above about getting a second opinion, perhaps from a dermatologist.  Feel free to return with more information after you have done that.  But until then, I really can't help further.