Could it be HSV2?

[LewisMiller0909]

Hello doc. I'm a 30yo male. I had oral cold sores since very young. But recently I have concerns about HSV2.

Exposure:
In the past year I had about 10 protected vaginal, 3 unprotected oral, and some mutual masturbation with several CSW. My last protected vaginal and unprotected oral was about Apr 10 this year. After that I had several mutual masturbations until mid June. No activity after mid June.

Symptom:
- May 10
Found about 10 bumps on the left ridge of glans. Disappeared in a few days without treatment.
- Jul 3
Found about 10 similar bumps in the same area, with balanitis.
Both times the bumps were small (< 1mm), didn't feel superficial, and didn't look like blisters, just small bumps. They didn't cluster like in typical herpes pic, but had some space between them. They didn't hurt or break. I masturbated several times with them present and hardly noticed. Only when I rub with force it hurt a bit. On Jul 3 I applied vinegar and their tips became a bit white. Jul 4 I went to a dermatologist who said was herpes. (I talked with doc Hook who thought maybe the vinegar misled my doc)
- Never noticed similar bumps before May

Test:
1. Feb 10 (Requested for oral herpes ob. Possible by Trinity, in same lab as test 2)
HSV 1: lgm -, lgg +
HSV 2: lgm -, lgg -

2. Jul 4 (3rd day after bump found. By Trinity but no index value)
HSV 1: lgm -, lgg +
HSV 2: lgm -, lgg +
HSV 2 DNA: - (doc broke a bump with needle and swabbed the fluid/blood)

3. Jul 13 (By Euroimmun ELISA)
HSV 2: lgg +, 22.7 RU/mL
= 22.0   Pos

I suppose if the bump in May was HSV2, it would be recurrent since my last 'risky' exposure was 1 month before? And in the Jul 13 test it's been 3 months and 22.7 is just above cutoff. My doc said it's 'low viral activity', but could it be a false positive?

My questions:
What is the chance do you think it is HSV2?
Do you recommend WB confirmation?
When counting window period, should I count mutual masturbation?

[Terri Warren, RN, Adult Nurse Practitioner]

Either way is fine, they both get the same test.  And yes, you can order a test kit from UW - I'm not positive they send kits overseas, though.  You should ask.  

I can't give you the odds of your being infected based on the Trinity test because I have no index value.

Terri

[LewisMiller0909]

Thank you for your reply doctor. I would like to do a WB confirmation test, but not sure which is the best way to do it from outside the US. I'd love to send blood to you if it is best way and also convenient for you. I also found some info on the HHP website on how to get a UW WB test done by myself. But the info is a bit old, and I'm not sure if things changed.

Could you give me some advise on which way is better for me please, to send blood to UW myself or through your clinic? I don't concern much about cost. I just want to have the test done.

I noticed you have changed the 'answer' to my question into the most recent reply. Does my Trinity test result change your evaluation on the possibility of HSV 2 infection? May I ask please personally what do you estimate is the chance that I have HSV 2? (like 50%? 80%?)

Thank you very much for your time and help, doctor. I really appreciate it.

[Terri Warren, RN, Adult Nurse Practitioner]

I think since you have a positive Trinity test you do need confirmation by western blot.  I am not aware of any Euroimmune western blot.  You can send blood to me and I can send it for western blot if you would like to explore that option.  We actually receive blood fairly often from places far away and out of the US for transport to UW.

Terri

[LewisMiller0909]

Thank you very much for your reply, doctor.

I'm sorry the text on Euroimmun test was not displayed properly. It's a HSV2 type specific IgG ELISA. My result is 22.7 RU/ml, with equivocal range 16.0~22.0, positive range > 22.0.

May I ask a follow up question please?

I had similar rash again a couple of days ago. Started with balanitis, then similar bumps at the same area as before. Because this time I paid attention to hygiene the bumps was smaller than before, but still looked similar. I didn't use vinegar this time. My dermatologist diagnosed as non-specific balanitis by visual exam. I also swabbed for HSV 2 PCR the same day I noticed the bumps, result was negative (the test broke three bumps to be more sure).

So perhaps the bumps that caused this herpes concern was not due to HSV. But I still worry because after all, I do have a positive qualitative Trinity test, and a low positive Euroimmun test.

My question is:
1. From a pure medical perspective, is it safe for me to move on, believing I do not have genital herpes? Or should I get a confirmation test to be sure?

2. I live in Europe, and can only get a Euroimmun Western Blot test. Do you recommend this test as confirmation?

Thank you very much for your help, doctor!

[Terri Warren, RN, Adult Nurse Practitioner]

When counting the window period, forget about mutual masturbation. That does not represent a risk for herpes.
I've read your interactions with Dr. Hook and I agree completely with him.  This seems very unlikely to me.  Also, when reviewing your risk for acquiring herpes, it is low.  Not zero, but low.  And I agree that your symptoms sound more like balanitis than herpes.  You could have irritated those little pearly papules that occur in some men around the head of the penis.  
You can order a western blot through our clinic or directly through the University of Washington if that would help you feel more settled about this.  I'm unfamiliar with the Eroimmune test.  

Terri

[LewisMiller0909]

Oh one more information. I talked with Doctor Hook before I did the Euroimmun test. Here is the link for your reference:
http://www.medhelp.org/posts/STDs/Confused-about-HSV/show/1971551

Thank you very much for your time and help, doctor!