HSV 2- QUESTION for Dr. Handsfield!

[jessscar]

Hello- I am new to this forum, and appreciate your help- Needless to say, Like all individuals with questions, I am extremely stressed!!!!!!

I had protected vaginal sex with a sex worker aprox 15 days ago.  She told me the several days later  that she has been diagnosed with HSV 2 and HSV 1. Approx 5-6 days post exposure, I had genital itching mainly on the scrotum. On the second week - perhaps day 12  I began to have pain in the inguinal groin area, middle tingling/or discomfort and noticed  some swelling  left side inguinal area ( when I put pressure on the swelled area and cough- I can feel a bulge)  There are no signs of any outbreaks on the penis or surrounding areas from self examination.  I understand that the itching could be stress driven, but the groin swelling is certainly real !

Since groin lymph node swelling could be a sign of herpes infection ( I am HSV 1 positive and HSV 2 negative from a test in January 2014)  

1) Could this be a symptom of transmission ? What percentage chance would you associate that it could be a symptom of herpes with out supporting symtoms?? Like you stated- " But I can't say it never happens"
2) Dr. Handsfield - you wrote the following :  Have you changed your opinion 9 years later?

Jun 15, 2005
In 30+ years in this business, I have never seen a case of inguinal (groin) lymph gland enlargement, without genital lesions, that turned out to be herpes.  But I can't say it never happens.
HHH, MD

I have read numerous studies and fully understand the transmission risk percentages, however, we all know that statistically, some people "beat the odds"  and my concern is that I am one of these unfortunate people...  Thank You

[Edward W Hook, MD]

Good question.  My recommendation is the same as that of the CDC- routine screening (testing) for HSV is not currently recommended.    I do not routinely recommend HSV serologies because of the unreliability of the test and the fact that so many patients are not mentally prepared to deal with false positve results. Further, should your test be truely positive, this does not mean that you acquired HSV from the exposure you mentioned.  Since over 20% of adults have HSV but most do not know it, the average American male has probably had sex with someone who had HSV, whether they know it or not.  EWH  

[jessscar]

Thank you for your concerns.  I already have been tested positive for HSV 1 and negative for HSV 2 in January 2014.

I do not fully understand why there are false positives on HSV 2 but recognize the possibility..

My QUESTION  is - Why should not I be responsible and take a test since I have been exposed to an HSV 2 person.. isn't it my obligation to determine my status so that I do not expose future people???  I respect fully your thoughts...

[Edward W Hook, MD]

In my opinion, testing is a mistake.  Should you choose to test, it is stattistically likely that you, like over 60% of Americans will find that you have HSV-1 even if you have never had a cold sore.  You could have a false positive result for HSV-2 as well.  EWH

[jessscar]

Thank you for your quick response. I will try not to worry, but my stress is likely going to win in that mind battle... I do plan to be tested- just for peace of mind, and will inform you as to the outcome.  My information/results may help someone in the future manage their stress.  

I do plan on testing at the 25 day (50% accuracy) and 46 day (65% accuracy)  and 120 day (83% accuracy) - statistically, these time offer the best results..

http://journals.lww.com/stdjournal/Fulltext/2003/04000/Time_Course_of_Seroconversion_by_HerpeSelect_ELISA.7.aspx

[Edward W Hook, MD]

Welcome to our Forum. Dr. Handsfield and I share the Forum and take questions based on our availability.  This allows us to provide responses to clients in a timely fashion.  We have chosen to share the Forum because, while our verbal styles vary, we have worked together for more than 30 years and agree 100% on our management advice to clients.

AS you already know, the risk of getting herpes from a single sexual encounter with an infected partner is quite low- less than 1 infection in 1000 encounters and is lower still in your case since you used a condom.  When persons do get an episode of HSV, they typically experience an outbreak of lesions at a site of exposure within 4-14 days of the exposure.  From the sounds of things, this has not occurred for you.

I do understand that learning that you may have been exposed to HSV leads you to look for signs of infection but without lesions, you need not worry.  Itching is most typically a sign if increased focus as one looks for symptoms in an area and lymph node swelling (that is what your groin swelling sounds like to me, and apparently to you as well) is a totally non-specific problem that could have any number of causes occurring from your toes to your abdomen.  Lymph node swelling without lesions however is NOT a sign of herpes.

As for your sp[ecific questions:
1) Could this be a symptom of transmission ? What percentage chance would you associate that it could be a symptom of herpes with out supporting symtoms?? Like you stated- " But I can't say it never happens"

Considering all that you have describe, your symptoms and the nature of the exposure, your likelyhood of having acquired herpes from your exposure is far less than 1 in a thousand and probably far lower.


2) Dr. Handsfield - you wrote the following :  Have you changed your opinion 9 years later?
I agree with Dr. Handsfield's comment.

I suggest you do your best not to worry further.  Certainly there is no testing warranted.  EWH