Follow up to Curious if I should be 100% sure it's HSV.

[manhattanlife]

Question was originally for Dr. H. Hunter Handsfield, M.D.

My original string of questions was at http://www.medhelp.org/posts/STDs/Curious-if-I-should-be-100-sure-its-HSV/show/1867275#post_8656634

I am currently waiting for my 16 week follow up test for HSV1+2 (4 weeks away). Five days ago a rash on my penis tip seemed to have developed. It began as a red patch which became a bump. Then it seemed white but not as obvious as a typical whitehead. I never saw puss oozing but A small scab has gotten bigger - to the size of 2-3 millimeters wide. This morning I have also seen another pimple like whitehead (one milimeter in diameter at the inside edge of my meatus. There is no pain when urinating. No pain while walking, rubbing, poking it. It seems to exhibit that one millimeter of white circle or nothing at all...changes by the minute.

I went to the urologist yesterday and he prescribed Nystatin and Triamcinolone because he didn't know if it is herpes or a fungal infection. He also administered an IGG test. I am waiting for the IGG HSV1+2 results (5 days away).

I'm curious if there is any insight on this?

A sign has come back since what I thought was my original OB...is it herpes for sure?
Dr H. Hunter Handsfield, M.D.said "You can expect your 4 months follow-up test to remain negative.  In the meantime, you should go forward with a high degree of confidence you don't have genital herpes."

Could it be caused by yeast in the vagina from that previous encounter? The female with BV.

If anyone could help I'd be extremely grateful.

This discussion is related to Curious if I should be 100% sure it's HSV.

Doctor I am extremely anxious because of this new sign.

[H. Hunter Handsfield, M.D.]

Thanks for the follow-up. But honestly, it's a little premature; I'll have more definitive thoughts after your repeat HSV blood test result is available.  Based on the information you have provided so far, both here and in your earlier thread, I continue to think it's unlikely you have genital herpes and expect your new blood test to also be negative.  (I also would have recommended a PCR test for HSV from the lesion you describe.)  In any case, I can't speculate about other causes of penile rash -- there are too many possibilities.  A fungal infection is one of them; it might be likely if you are uncircumcised.  But you're going to have to rely on your own doctor for a diagnosis, assuming the final HSV test in fact is negative.

So let me know the latest blood test result when you have it, and we'll take it from there.

Regards--  HHH, MD

[manhattanlife]

Doctor,
I understand that when my test results return I'll know where I stand regarding herpes. I am investing energy and resources here with the hope that you may be able to explain what could possibly cause this and why you believe it isn't HSV in the meantime. What are some infections that mimic the seemingly visual symptoms of herpes?

When I first went to the doctor in December to examine the original lesions he said, "If it comes back it's definitely herpes". Was he incorrect, meaning that some sort of rash/lesion can develop more than once and the cause not be herpes? Are general doctors unaware of more obscure infections so they're too quick to call it herpes?

The swollen lymph node also returned on monday when that bump showed up as well. The urologist this week said, "swollen lymph nodes are not associated with herpes usually". Is this true?

I am not circumcised and the urologist mentioned balanitis but I had never had any symptoms before December's symptoms.

I assume the PCR test was not an option because the bump became a scab very quickly. Unlike the first signs in December there was really no open wound.

I'd like to know if you think it isn't herpes because it isn't painful to urinate? The lesion is right at the meatus so urine definitely comes in contact with it.

Thank you.

[H. Hunter Handsfield, M.D.]

Why are you flagellating yourself about whether or not this is herpes when a highly reliable answer will be available in a few days?  For now, I'll just say that most genital rashes, including recurrent ones, are not herpes; and that your description has several atypical features for herpes.  And in uncircumciosed men, both nonspecific balanitis and yeast balanitis are among the most common causes of recurrent rashes involving the head of the penis or underside of the foreskin.

That's my last comment until and unless you report the new blood test results.

[manhattanlife]

Doctor,
The tests came back today.
IGG for HSV 1 & 2 were negative.
The titers (I believe that's what it's called) antibody test which tested for LGV came back positive. The LGV Chlamydia. The prescription calls for 3 weeks of Doxycycline 2ce per day.
So that seems to isolate the issue as far as I know. Is there anything I should be aware of? Or inquire to the doctor about?

[H. Hunter Handsfield, M.D.]

So the herpes issue is resolved.  You don't have it.

Why in heaven's name was a chlamydia/LGV blood test done??  These tests do not diagnose active infection -- a positive result only means someone has been infected at some time in the past.  Further, the result is equally positive whether the past infection was with an LGV strain or the other, much more common chlamydia types.  Finally, there are non-STD chlamydia bacteria that cause respiratory infection; these also give positive results on the "LGV" blood test.

Therefore, based on this test, no treatment is needed.  Your doctor should know this; and you should not request doxycycline or any other antibiotic.  The only possible action that might make sense is a urine chlamydia test.  If that's negative, then no treatment is recommended or necessary.

[manhattanlife]

The blood test pertaining to LGV was the titer antibody test and the result was that that LGV was identified. You seem to be saying that LGV doesn't necessarily pertain to chlamydia but I assume my doctor identified it as chlamydia due to empirical observation? i.e. the lesion at the penis tip and enlarged lymph node.

The conversation, when receiving the results, happened quite fast but the assistant said: the test came back positive for LGV - a type of chlamydia.
It seems logical that I was infected in late November during the first sexual encounter I described. I forget if I mentioned that it took place in my home country of Romania. I also never mentioned it was with a prostitute/escort. Would this explain contracting the LGV Chlamydia strain which is more rare?

I took a chlamydia urine test on December 8th when the first symptoms were observed, as well as last Wednesday - both were negative.

If LGV isn't the case then how does one explain the zit/pimple-like lesions in December. The ones last week as well. All accompanied by the swollen gland and burning or tingling sensation when urinating. There were also the enflamed glands on the penis tip after masturbating roughly 1.5 months ago. The ones which lasted only about 24 hours. All these symptoms were never seen before the exposure in late November.

[H. Hunter Handsfield, M.D.]

LGV is extremely rare in industrialized countries, except as an infection of the rectum in men who have sex with men.  However, I cannot comment on the situation in Romania; LGV may be more common there.

I don't know how to explain your "pimple-like lesions" last December.  LGV does not cause this sort of problem.

I suggest you follow your doctor's advice. This forum cannot help you any further.  I will have no further comments or advice for you.

[manhattanlife]

If I didn't get these results pertaining to chlamydia, what would you have recommended? You said 'we'll take it from there' following the results. Assuming the igg hsv tests were negative, what would one speculate regarding these lesions and lymph node?

You've said that, " I can't speculate about other causes of penile rash -- there are too many possibilities." You seem to be vehemently against the LGV diagnosis and prescription, but now no alternative answers are possible.
These symptoms couldn't have occurred for no reason.

[H. Hunter Handsfield, M.D.]

No distant online expert can make a specific diagnosis; we never make a specific diagnosis on this forum.  See your doctor.

That's definitely all for this thread.