Did I contract HERPES?

[Bigtimeworried55]

I had unprotected/protected sex 3 different times with a woman HSV1 positive. She had this virus as teen and resulted in a rash on her forehead. She has had this rash 3 times in her life, last being 3 years ago. She had 0 symptoms during these encounters and never had a cold sore.

After 2 weeks from last exposure, I experienced a "tingling" and itchy sensation on my penile shaft. From there a small raised area formed that was red/dark. It itched, but never blistered/ulcered or looked like herpes from what I gather. It was persistent and lasted off/on for 4 weeks. Three doctors examined the lesion and stated it did not look like herpes and no swab was done due to not being a "sore." It has now gone completely.

From there a burning sensation formed on my perineum, anus, and buttocks. It felt like chafing when walking and lasted 2 weeks. The skin on my buttocks was also red and burned. A single, small blister formed on my perineum during this time. Foolishly, I popped it and rushed to have it swabbed within 30 hours. Doctor advised it was not herpes and swabbed the entire area/lesion. Result negative.

I also went to separate STD clinic once my perineum area burned more intensely. Area was vigorously swabbed and result negative. My current CONCERN is the night sweats I have experienced for 2 weeks straight and the "tingling" sensation on both my legs. My legs constantly feel slightly asleep. This scares me. Please review my bloodwork.

HerpeSelect IGG (2 weeks post encounter)
HSV1: 0.29 HSV2: 0.06

*IGM HSV Combination (3.5 weeks post exposure)
NEGATIVE

* IGM HSV Combination (6 weeks post exposure)
NEGATIVE

HerpeSelect IGG (6 weeks post encounter)
HSV1: 0.31 HSV2: 0.08

HerpeSelect IGG (8.1 weeks post encounter)
HSV1: 0.29 HSV2: 0.04

All blood and swabs NEG. I plan on testing at 12 weeks, but what's going on? Help.

[Terri Warren, RN, Adult Nurse Practitioner]

My final thoughts are that this should be your final test.

Terri

[Bigtimeworried55]

Terri,

Can I get your final thoughts on the above to close my thread. Thank you.

[Bigtimeworried55]

Terri, I just received the results of my IGG 16.1 week test today. The results were as follows:

HSV1: 0.22
HSV2: 0.07

My symptoms have died down to just leg spasms and minor buttock burning. I had a lesion on my buttocks swabbed 2 weeks ago, which was positive for "Enterovirus," but negative for HSV. My infectious doctor said to not worry and that's a virus that the body eliminates on it's own. He also suggested if any lesions occurred, burning, or had any symptoms due to HSV, the fact they go away or fade is a result of an immune or antibody attack to fend the virus off. Since my symptoms have started to go away and my blood has remained negative still through 16 weeks, my ID doctor said with certainty to move on and I do not have herpes.

Do you believe in his logic behind this? Can I take this 16 week test and move on Terri? My antibody count has remained almost the same and actually went down for HSV1 at 16 weeks.

Is a WB necessary at this point given my low antibody count and repeated negative result? Please let me know your FINAL thoughts. Thank you.

[Terri Warren, RN, Adult Nurse Practitioner]

I would say that the odds are very high that you are negative for both HSV 1 and 2, but you are correct, the WB is more sensitive for HSV 1 than the ELISA.  I don't have statistics on how much more sensitive it is, however.  

From there, I would simply refer you back to my response prior to this one.

We are really done here unless you wish to post results at 16 weeks.

Terri

[Bigtimeworried55]

Terri, I believe I would be fine accepting my ELISA results at 16 weeks considering I've taken so many at this point. From what I gather, a WB is slightly more accurate at finding HSV1, but with my consistent negative ELISA result, I wouldn't expect a different result with a WB. I've never been in the equivocal range.

My last question, if I was a patient at your clinic knowing what you know about my situation and my negative repetitive testing results, would you advise against unprotected oral sex with my girlfriend??

We have been together a month and I'm hesitant to have intercourse because of my situation. She prefers unprotected because she is on BC and she is clean of HSV1+2 and all STD's, but I've been dodging it for obvious reasons.

What would you advise and must I stay protected forever moving forward with a negative HSV tests??

[Terri Warren, RN, Adult Nurse Practitioner]

No, no concerns about your HSV 1 score based on your history, your symptoms and your test results.  

We do testing on our patients to offer reassurance as well as for diagnosis.  In my experience, people are often so worried they simply cannot accept a negative ELISA screening test but do accept western blot results.  If you think you can accept the negative ELISA tests and move on, then no need for western blot, but if you are still worried about the ELISA missing your HSV 1 infection, do the western blot.  However, if your HSV 1 is positive by western blot, it will not tell you where you are infected, orally or genitally, nor will it tell you if the symptoms you are describing are due to herpes.  Just more good for thought.

Terri

[Bigtimeworried55]

Terri,

I recently spoke to Lisa at your clinic via a phone consultant and she was absolutely excellent. Was worth the money and time. Wish your clinic was in FL. She also agreed my symptoms do not indicate herpes.

Anyway, I decided to take a 12.3 week full panel STD test to see it anything was missed at 2 weeks when I took this. It was for all the major STD's, including HSV1 and HSV2.

My results were NEGATIVE for every major std. My HSV results were as followed at 12+ weeks.

HSV1: 0.26
HSV2: 0.02

Terri, obviously my concern is HSV1 genitally, but my antibody count for both types actually went down from my 8 week test, but have remained extremely consistent from 2 weeks through 12.3. I will take a final 16 in 3 more weeks but I'm pretty sure this will stay negative. Any weight to put on my high hsv1 count vs my hsv2?! Is that an area of concern?

I will be seeing an infectious disease specialist in 2 weeks to figure out what's wrong with me. Still have intermediate pinching and discomfort on my penis head and still a slight chafing feeling around anus.

Any thoughts on my current tests? If I was a patient at your clinic, would you advise a WB at 16 weeks knowing all my tests results but still experiencing symptoms. Let me know.

[Terri Warren, RN, Adult Nurse Practitioner]

I am not aware of herpes causing twitching in the calf area.

Let's wait until 16 weeks to discuss this more.  Then let me know your results.

Terri

[Bigtimeworried55]

Terri, this will be my last update before retesting at 16 weeks, but I wanted to share that after less than a week of Doxycycline my symptoms have reduced substantially. Discharge went away, along with the burning around anus and penis. Could I contribute this to the medicine or the possibility if it's HSV1 it just now decided to go dormant? I'm thinking it's the medicine.

Also, the only remaining symptom I have is my right leg frequently has nerve twitches/muscle twitches throughout the day all through the leg, specifically in the calf area. I never once had these sensations prior to this sexual encounter. There is no STD to my knowledge that causes these symptoms outside of Herpes. What are your thoughts on this??

You mention this is a sign for recurrent herpes, but have anyone ever complained of this at your clinic that just experienced the virus for the first time?

I'll update at 16 weeks. Hope I stay negative.

[Terri Warren, RN, Adult Nurse Practitioner]

My thought is that you likely to not have herpes.  Discharge can be a symptom of herpes, but if it was, the doxy would not make it better.

Terri

[Bigtimeworried55]

Terri,

I wanted to provide you an update on my situation. I had a burning sensation since my last response to you around my anus and penis. Both at the same time. What really concerned me was that for the first  time I had what looked to be a clear, sticky discharge that came from both my anus and penis. It almost resembled semen in a weird way, but clear.

This along with the burning prompted a visit to the Urologist. The doctor reviewed my HSV testing blood work and also examined me. I had no lesions and he suspected it was bacterial based and that he truly didn't believe it was Herpes. He prescribed Doxycycline and I have been on that for 2 days and already feel relief from the burning.

My question, is anal and penis discharge a common herpes symptom in your opinion?? I had it both at the same time which is odd I think.

More importantly, I couldn't wait and decided to test with HerpesSelect Immunoblot at 10.3 weeks. I never did this test and from what I gather it's more accurate for HSV-1, which is what I believe I have. The result was NEGATIVE for both types.

I am now currently negative for all bloodwork 10+ weeks post exposure, yet still have nerve twitching in my right leg and burning off an on (relief may come with this Doxy). What are your thoughts Terri?? I plan on testing at 16 weeks. If still negative, would you recommend I put this behind me? I recently read where some won't show positive until 6 months!! That seems crazy to me. Please advise.

[Terri Warren, RN, Adult Nurse Practitioner]

If you have cuts around the anus, I would encourage you to have a health care provider look at these.

TErri

[Bigtimeworried55]

Terri,

I thought I was done asking questions, but this morning the burning around my anus returned. It feels like a constant, steady burn throughout the day. I grabbed a mirror, but see no lesions down there. However, I noticed multiple cuts, almost like fissures, inside the opening of my anus. Granted, I have had constipation issues lately, I still worry this could be a symptom of HSV1 genitally.

Why would my anus burn and have small, multiple cuts inside the opening? Does Herpes typically present itself this way in this area??

I did not have anal sex clearly, yet I have experienced burning in this area for a few weeks. What are your thoughts? Is it possible to have a suspect lesion on my penis and then the virus spread and cause issues in the anus and perineum. I'm so confused and I'm very concerned. No lesions, just cuts in anus and burning around and on the area. 16 weeks can't come soon enough.

Thanks Terri for all your responses. Your expertise helps me tremendously.

[Terri Warren, RN, Adult Nurse Practitioner]

You know, I really can't even answer that question with any accuracy because of the problems with the IgM.  And when you retest, DEFINITELY don't use the IgM to retest.  I think the likelihood is low that you would test negative at 12 weeks and positive at 16 weeks.  Especially with the screening ELISA.  We ask patients to wait until 16 weeks from exposure to do a final test but we are awfully careful about this.  No other way you ask this will get a different response. ;-)

Terri

[Bigtimeworried55]

Terri,

You have been great. I have one final question before I sit tight for 2 more weeks before testing again at 12.

I understand the logic behind the issues with IGM testing, but in my case, since I used this test at 3.5 weeks post exposure and at 6,7 weeks during heavy symptoms, is my negative IGM result of ANY value.

I keep reading how the test is inaccurate because it can cross with other viruses and can't distinguish between the types, but what about for someone known negative for HSV1 and HSV2 like myself...who then tests negative during what is believed herpes related symptoms with this test. Can this test provide any value to me?? Also, should I retest with IGM AND IGG at 12 weeks to completely rule this out?

If I'm negative at 12 weeks, would you personally recommend me retest at 16 if my numerical values have stayed the same? My symptoms are clearing up which is great news, I just truly wish I knew what could cause that red, burning sensation on my buttocks and perineum for 2 weeks if not herpes. I'm baffled.

Let me know if you believe I should retest at 16 weeks if negative at 12. Thank you so much for your input. That's all I need for now.

[Terri Warren, RN, Adult Nurse Practitioner]

There are really two reasons to test later.  One is to pick up the very few infections that might reveal themselves later but the other is to reassure people who are still worried.  I think the odds of you getting infected in this experience are very low indeed, but if you are still worried, you may wish to test again.

Terri

[Bigtimeworried55]

Terri,

Thank you. One last thing if I may. Would you recommend I test at 12 or 16 weeks knowing what you know about my situation?

Should I avoid any sexual contact with anybody knew during this time for fear of the unknown at this point or possible transmission?

Also, in your experience, for someone negative for both herpes types, have you seen a case where someone is negative up to 8 weeks via IGG and than turn positive at 12 or 16 weeks?

Please provide your opinion on if retesting is necessary knowing my situation and the odds of me staying negative at this point. Your opinion is valued. Thank you.

[Terri Warren, RN, Adult Nurse Practitioner]

Tingling and itching for four weeks is not consistent with herpes.  Herpes outbreaks and symptoms are far more time limited.
Generalized redness is not consistent with herpes.  
A small single blister might or might not be herpes.
Night sweats are not consistent with herpes
Leg tingling can happen with recurrent herpes, muscle twitches are not consistent with herpes.
The numeric values of your negatives are consistent with normally negative results.  
When I consider whether people are at risk for having herpes, I evaluate the risk of the situation, the symptoms described, the duration and nature of the symptoms, the sexual history of the person and information about the possible source partner.  
I think you will likely test when 16 weeks have passed since this contact for certainty.  I hope your results continue to be negative.  

Terri

[Bigtimeworried55]

Terri, I'm very happy that you responded to my situation. I have read tons of information on herpes from you and have a few questions.

I thought my symptoms clearly describe herpes:
- Tingly and itchy lesion on penis that persisted for 4 weeks. (Never blistered or ulcered)
- Severe burning sensation and red, inflamed skin along perineum and buttocks.
- Small single blister on perineum that healed within 2 days.  
- Frequent night sweats
- Leg tingling and random muscle twitches in legs.

I understand my bloodwork has yet to show a positive antibody result, but I keep reading that some people won't develop them for up to 6 months!! Why is my case any different in your opinion? Based on my symptoms, what could this be to your knowledge if not herpes. I tested for all STD's after 2 weeks post exposure and was negative for all.

This all happened after intercourse with this woman and no she is not my first sexual partner, however, the first I have ever had these physical issues with. Also, her sister is a nurse and confirmed the herpes rash she has had on her forehead as a teen. So rare, I must believe this as true.

Also, does my numerical value for my HSV1 and HSV2 have any substance? I noticed they have stayed almost exactly the same from 2 weeks through 8 weeks. Please advise Terri. I'm still very concerned about my strange symptoms. Thanks a ton.

[Terri Warren, RN, Adult Nurse Practitioner]

The likelihood that she was shedding virus from her mouth that could infect you on three different occasions is very small indeed.  The rash on the forehead being herpes is also quite unusual.  I'm wondering if that's accurate?  Anyway, the symptoms that you describe do not sound like herpes at all to me.  Nothing at all like herpes.  More confirmation that this isn't herpes are repeatedly negative antibody tests over this time period.  I would bet many many dollars that your ELISA will stay negative over time.  

Is this your first sexual encounter?  If not, you've likely had sexual contact with people who are HSV 1 positive over time, as 56% of the population in the US between the ages of 14 and 49  has HSV 1.  Most of those don't know it so will not tell you.  

Honestly, I think you can relax about this, but for future sexual activity, be aware that you will likely have sex with people who have HSV 1 infection as it is so common in the population and you could spend a lot of time worrying.  I also think you are likely being very aware of all body sensations that you are experiencing in light of your experience.  If you didn't know this woman was HSV 1 positive, you might have not even noticed these body sensations that you are describing.  Hard to know for sure after the fact, though.

I hope you can let the negative results wash over you and sink in so that you can relax about this.  In my experience, most people who are negative for both HSV 1 and HSV 2 make detectable antibody sooner than 12 weeks when they get new infection.  

Terri