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Can I have HSV1 genitally that has symptoms more like HSV2?

Hi - thanks for being here to help.
I had unprotected oral sex 19 weeks ago. A week afterwards I had tingling, urethritis and nerve/numbness in legs.
I went to a clinic and STD tests found nothing but I took Doxycyline and Azithromycin fearing STDs. Symptoms went away for a couple of weeks then returned along with a rash on the head of my penis which I attributed to yeast infection after the antibiotics. I went to another doctor but the rash had gone by then - he ran more STD urine PCR test but again found nothing. I was referred to a urologist. My main symptom was urethritis and frequent need to urinate. The urologist did various tests and diagnosed BPH. He gave me tamulosin and my symptoms seemed to improve.

Then they returned a month ago along with the same rash, which looks like herpes penis head outbreak. I had prodrome tingling, nerve tingling and numbness in my legs. A month on and the symptoms are finally abating. Again, I went to STD clinic but the rash had cleared and they said it may be fungal. I am positive it it herpes infection - and it seems to be HSV2 given the recurrence and severity. I bought some Valaciclovir and began taking it two weeks ago. It hasn't seemed to make much difference. Also, I had a very mild case of HSV 1 orally about five months previously. It was the first time I had ever had a cold sore.

However, I had an IGG blood test done yesterday (almost 20 weeks after initial exposure) which returned the following HSV 1 positive and HSV 2 negative results:

HERPES SIMPLEX ANTIBODIES
H.S.V. I (IgG) *14.6
H.S.V. II (IgG) <0.500

Serological evidence of HSV infection at some time
Negative : 1.1 Index

Questions
Is it possible to have severe HSV 1 genital infection like this?
Could the IGG be false negative for HSV 2?
Could my body be poor at producing antibodies?
Would the Valaciclovir interfere with the IGG test results or my body's production of antibodies?

I was very depressed thinking I had HSV2 infection, now I am very confused. I don't want to be too positive that I have HSV 1 genital infection if it's possible this is not the case.

Thanks in advance for any help/advice anyone can give.
3 Responses
Avatar universal
It's really the severity and recurrent rate and the fact I recently had cold sores peaky which are more suggestive of HSV 2 genitally thank HSV 1. However the blood results look quite clearly like only HSV 1 is present. I've done multiple tribe pcr tests which have been negative for everything and a swab test on healing penis rash, again negative for everything including HSV 1.
1 Comments
If someone could help meet make sense of this I'd really appreciate it
207091 tn?1337709493
COMMUNITY LEADER
Did you have your oral outbreak before receiving the oral sex?

If you did, that means you had hsv1 already, and you can't get it again. You have antibodies which protect you from this.

BPH can cause a lot of your symptoms -

https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087

https://www.healthline.com/health/prostate-infection

PCR swabs are extremely sensitive, so even though the rash was healing, it probably would have picked up on it being herpes. The next time you get this rash, get it PCR swabbed within 48 hours of it appearing. Don't take anything - stop taking the Valtrex, don't put anything on it - and see what the results say.

If this is genital type 1, you may have gotten it previously, and the BPH is triggering outbreaks you didn't have before. If it is herpes, my guess is that this, combined with the BPH, is making you pretty damned uncomfortable.

I'm not convinced it's herpes, though, so get it checked the next time it appears.
6 Comments
Yes I had two cold sores in quick succession before I had and OB.

I have had all the symptoms of hsv on, tingling, rash, numb legs, sore lower back. The swab and urine sample I did at the same time both were negative.

I've now had constant tingling, disuria for the last month. Occasionally it looks like a rash is coming but never fully breaks out since I've started the valtrex.

I'm beside myself
The dysuria could be from the BPH. Since you've been diagnosed with that, follow up with your doctor.

Stop the Valtrex and see what happens. Some people report neuralgia symptoms from it, and if you want a diagnosis, you need something to get cultured.

If you got the oral outbreaks just before your genital symptoms started, it's possible that you were infected at the same time. Had you had an encounter with someone that included kissing and receiving oral sex before the one you are now questioning? (I'm a little confused on the timeline here - it sounds as if you had oral OBs before the encounter where you received oral sex?)

So my advice is to stop the Valtrex and if you get another rash, get in immediately to get it PCR swabbed. That's really the only way you'll know what this is.

Thanks for your time.
I had the oral ob before the oral sex.
I just don't understand why the IGG would be negative for HSV 2 of it can't be HSV 1.
The BPH diagnosis was borderline I think. Examination didn't reveal particularly enlarged prostate just a tight bladder opening and some tenderness.

I just don't understand what this is.
Maybe it isn't herpes? That's why the hsv2 would be negative.

Or you have genital hsv1, were infected at the same time as you were orally, and just now started getting symptoms because the BPH is triggering it.

The only way you'll know is to stop taking the Valtrex, let something form if it's going to, and get it swabbed. The blood tests can only tell you what you have antibodies for, not where the infection is located.

Continue to work with your doctor about the BPH - maybe it's worsening?
Could the igg be false negative for hsv2?  Should I get another IGG done?
If I have continuing prodomal symptoms but no outbreak would a urine PCR show anything?
No, a urine PCR wouldn't show herpes.

You don't need another IgG for hsv2. Your 20 week test is conclusive.

I don't know how else to say this - if you want to find out if it's genital herpes, the only way to do this is to go off the Valtrex and see if you get an outbreak. Valtrex doesn't do anything except help prevent outbreaks and shedding. It doesn't help prodomal symptoms, so staying on it isn't helping you.

Avatar universal
Understood. Thanks
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