Very Anxious About HSV

[TomGuyWalters]

Stupidity, ignorance, and selfishness do not begin to describe my behavior.  My actions were in retaliation to being hurt so badly by the one I love most (10 yr relationship).  

BACKGROUND:

30 / bi-male / 10 yr sober sex addict / Fell off wagon as of 8 weeks ago / 12, different, one time male sexual encounters since.  All encounters were from sensual male massage therapists with hand or oral release at end.  A shower was performed immediately after.  

I received:

Oral sex 9X (< 1-2m)
Body contact 6X
Analingus 1 time (5m)

I gave:

Oral sex 2X (< 2m)
Insertive anal sex (no condom <1m (barely inserted))

11/24, I shaved my scrotum bare.11/26, I saw two small red bumps about one centimeter apart on scrotum (One, 2mm, the other 1mm).  I decided to squeeze them because I thought they were NORMAL blocked pores.  Both produced a small bit of substance.  One was difficult and I had to dig my fingernails under top.  I THINK some skin tore off.  Both bled a lot.  Prior to or postpopping, there wasn't ANY pain, itchiness, tingling experienced.  Two days later, one is simply a small flat red mark.  The other, is raised (.5 mm), appears to be almost perfectly round and also has a darker center (kind of looks like a doughnut or crater).  Both have TINY pin sized darker centers.  Neither is painful.  

I went to a clinic last night.   I asked PA if she thought this could be HSV or Syphillis.  She asked if I had any flu like symptoms, fever, chills, tingling, itchiness, etc. all to which I answered NO.  Based on the examination and lack of symptoms, she didn't think it was HSV but couldn't be certain without labs.  She cultured both lesions, and drew blood for BOTH STI's.  

Based on the info provided, what is the likelihood this is an initial outbreak of HSV?

I am glad I had the lesions cultured, did I need to have had the bloodwork for HSV drawn (have read mixed views on this)?

Is there anything else that I should be worrying about?

[Edward W Hook, MD]

Welcome to the Forum. Before I address your concerns, let me encourage you to address your tendency for anonymous sex with multiple partners- while I see little evidence that you have acquired HSV at this time (see below), if you fail to address this going forward you luck in avoiding STDs is likely to run out.

Now for  your HSV related questions- Being seen and tested will provide useful information.  Culture of the lesions you are concerned about was a good idea but I anticipate that the cultures will be negative.  The scrotal lesions you describe, these do not sound like HSV. HSV is rather rare on the scrotum, the appearance you describe does not sound like HSV, and HSV lesions typically appear in clusters, not as 1 or two lesions. Please do not squeeze these lesions however as doing so will put you at risk for infection of the area by skin bacteria.  

Answer continued below EWH

[TomGuyWalters]

THE RESULTS ARE IN (based on the tests performed thus far)

Panel Name: Culture, HSV With Typing

Test                Observation             Results
Source:  *****                                  Final
HSV Culture:  *****                         Final
HSV Type 2:  No Result                 Final
HSV Type 1:  No Result                 Final

Panel Name: RPR (STS)

Test                 Observation Reference Interval Status Abnormal Results
RPR (STS) NonReactive NonReactive         Final

Panel Name: HSV-2 IgG, Herpes Type-2

Test                                         Observation Reference Interval    Status
HSV-2 IgG, Herpes Type-2 0.14 ISR         0.0-0.9                   Final

Sorry if it is difficult to read.

If you wouldn't mind, will you please help me to interpret these results, specifically the new one (the Culture, HSV with Typing).  It shows the results for both HSV 1 and 2 to be "No Result".  Does that mean negative?  If not, what does it mean?

I know you had suggested in your last post that I should have had blood work drawn for HSV-1.  Based on this new information, should I still go ahead and do so?  

Lastly, I don't know if this helps, but the two lesions referenced in the original thread of this post are virtually if not completely gone...

I thank you again for your time and expertise.

[TomGuyWalters]

My apologies.

I just heard back from a NP at the clinic who was able to interpret my results.  She informed me that the RPR (STS) test was for the syphilis NOT the culture of the two red marks as I had thought.

I guess I am still waiting.  

Please forgive my misunderstanding.  I will keep you updated.

Thanks.

[TomGuyWalters]

Thank you again for your time and expertise.

Based on the research I did (granted, Internet based) I was under the impression that a 0.14 ISR result was considered negative because it is less than 0.9.  Is this incorrect?

As far as the HSV 1 test is concerned, I was not tested for this result because it is not offered at the clinic I attended.  I can, if you recommend, seek out a different testing center that provides this test.  Please let me know if I should do so.  I will also inquire about and take one of the two tests you recommended in the last post.

In regard to the other lab result, the RPR (STS) the result came back a being non reactive.  Am I right in thinking that this wa the swab test performed on the two spots and that it came back negative for the virus?

Thank you again for all of your help and time spent responding to me.  I have tried to communicate directly with the clinic I visited but am not able to get a response.

[Edward W Hook, MD]

There are no test results here for HSV-1 so I cannot comment on this.  Your HSV-2 test is in the numerically so-called "low positive" range which turns out to be a falsely positive result in about 80% of persons such as you with levels of the sort you report.  In a minority of persons this would be indicative of a pre-existing infection.  Your test does not particularly suggest that recently acquired HSV.  

You still do not have all the information you need.  As I said, there are no results for HSV-1.  Further, the low positive test for HSV-2 can be resolved by testing with a second, unrelated test such as the Western Blot (through the University of Washington) or with an unrelated test such as the Biokit test for HSV-2.  

If your result is falsely positive, it may be a transient falsely positive or may turn out to be longstanding.  In many instances there are not good explanations for why false positive tests occur. the problem of false positive test results is why we do not routinely recommend blood tests for HSV.  EWH

[TomGuyWalters]

Good day Doctor,

I received my results and am thoroughly confused.  If you could please help me to understand the results, I would appreciate it.

TEST: RPR  (STS)

Observation - Non-Reactive
Reference Interval - Non-Reactive


TEST: HSV-2 IgG Herpes Type-2

Observation - 0.14 ISR
Reference Interval - 0.0 - 0.9

I am extremely nervous...

[Edward W Hook, MD]

thanks.  Will look forward to hearing your results. EWH

[TomGuyWalters]

Thank you Dr. Hook for your reply to my concerns.  

Since posting, I have sought professional help for my behavior and am going to start SAA.  

To answer your question, I don't know for certain that I have HSV 1 as I have never had a breakout from what I can remember or confirmation from a blood test.  I have had canker sores, lots, at various times throughout my life.  I assume I have HSV 1 due to the fact that the percentage of people who are infected is so great.

Although I am still waiting for the two herpes results, (I should get them today or tomorrow), I did receive a negative result for Syphilis (though if anything, I would much rather have contracted that).

Once I receive the lab results, I will update you with the numbers.

Thanks again for your time, it is sincerely appreciated.

PS... As of today, the two spots are definitely smaller with one being almost non existent.  My fingers are crossed...

[Edward W Hook, MD]

continued-
As for the blood work this will provide you with useful information but most of that information will reflect past infections that you may not know you have.  For instance, there is a good chance that even if you do not get cold sores, you will find that you have antibodies to HSV-1, indicating that you have this infection.  We can help you interpret your blood test results once they are back if you like (too complex to do at this time, until you know your test results)

Since the majority of the exposures you describe relate to oral sex (giving or receiving),  this raises the question of whether or not you already have HSV-1 (cold sores)?  The reason I ask is that if this is the case, there is no real risk for HSV from any of the oral contacts you have received as the immunity developed because of your cold sores would protect you.  On the other hand, if you do not know you have HSV-1, there is a VERY small risk of developing HSV as the result of oral contact. The overall risk is less than 1 infection/1000 sex acts if lesions are not present (and probably closer to 1 in 10,000).  If you do not develop HSV lesions/outbreak in the 10-14 days following your exposure, you can be confident you did not get HIS.

I hope these answers and comments will be helpful.  I suspect that you are not likely to find that you acquired HSV through the exposures you describe.  EWH