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Two negative cultures for genital herpes; positive blood test for HSV1. What is it?

Thanks for your time and help. I’m a 37 year old, white male, who by all known measures is in good health.

At 19 I had an outbreak of what was thought to be HSV-1. Within a day of the outbreak I had an urethra swab done. That swab was tested and came back negative (I’m not sure if it was a test for more than just HSV or not).

The effects of the outbreak included three painful sores that looked like herpes as well as painful urination. I was put on an anti-viral and the symptoms soon subsided.

A few months later I was diagnosed with ocular herpes. It’s worth mentioning that prior to these outbreaks I’d never had an issue with any sort of cold sores.

After the original genital infection and outbreak I had multiple ocular outbreaks, but never anything genital again until 2006. At that time I had what was thought to be a herpes outbreak on my penis with similar (although less severe “spots” in the same place as the original infection). However, this particular flare up DID NOT include painful urination like the first.

Fast forward to 2016 - over a span of 10+ years I’ve continued to have ocular outbreaks, but none genital. That year I had a blood test done that came back positive for HSV1, which explained the ocular herpes.

My thought process has always been that I contracted HSV1 through intercourse (no oral sex was engaged in) and during the antibody phase manged to accidentally rub the infection into my eye.

Most recently (2018), the symptoms from the original infection returned with the same spots on the shaft of my penis. They were preceded by itching that I’ve always understood to be prodrome. They were moderately painful leaning more towards uncomfortable, and the biggest difference is that this time one of them showed up on the base on my penis as well as one on each of my inner thighs.

I returned to the doctor before starting any medication (my antiviral that I have for my eye) and had a HSV swab of the sores for 1 & 2 done. Again, just as the original urethra swab, the results came back negative.

My doctor did mention that there is the chance of an incorrect result. If so, I’m wondering how likely of an outcome that would be considering these particular circumstances...

Also, there is one caviat: Along with the original outbreak (of whatever this is) I also, within a few months, developed one single wart at the base of my penis. It was froze off in 2016 but returned six months later. I’ve never been tested for HPV, but am pretty confident that’s what it is. I’m currently using Imiquoid for that wart. I suppose there is a possibility the “outbreak” is related to HPV and/or the use of the cream.

However, I have researched similar HPV images and aside from the wart at the base of my penis (which is consistent with the cauliflower cluster) the spots from the “outbreaks” are not raised in any way, but instead just red and look more like those of herpes images.

What are the chances I have HSV1 genital, but these tests continue to come back negative?

And, if not, HSV1 genital, what does it sound like these symptoms may be consistent with?

Thank you.
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