Std question

[wrongtrust]

Hi Dr. HHH
First, thanks for you guys to provide this service which help us a lot.
I (I am a male high 30s) have unprotected sex with the female, the exposures had happened on Jun 4th and Aug 6th 2008.  I have an outbreak on my body close to the root of my penis in July, and another one in Aug, but I didn’t pay attention on it, I get HIV antibody test around 8/18, 13 days after last exposure, result is NEG, at the end of Aug, I got flu like symbols with rush on my neck, and painful urination, cloudy discharge ( I didn’t pay much attention to urination at this point). I read lot of message on HIV forum, 6 weeks result is 95% reliable, so I did antibody HIV test on 19/09 at my family doctors office, 45 days after last exposure, the result come back NEG, so I thought that may not be HIV. I start reading the message on STD forum. And realize that I potentially has genital herpes and other STD . So I wait for 12 weeks to 10/30 (exactly 12 weeks from last exposure), I got full STD screen.  HIV 1/2 NEG, HSV 1 > 5, HSV2 NEG (didn’t ask for number, use herpeselect).  Syphilis NEG, Chlamydia/Gonorrhea NEG  
1. Just confirm that 12 weeks NEG antibody blood test for HIV will be considered conclusion even I have Herpes type 1 infection.  Right?
2. How reliable the 12 weeks HSV 2 test?  Should I trust the result, I don’t have HSV-2 ? or I need more test on 6 months.
3. I don’t have Syphilis with 12 weeks NEG result, it is conclusive, right?
4. Why I still have discharge from time to time even with Chlamydia/Gonorrhea NEG?  what should I do next? Get retest?
5. How can I prevent spread HSV-1 to my wife and kid. My wife plan to have another child next year. Is it ok for us to have another kid?
Thanks

[H. Hunter Handsfield, M.D.]

People with HSV are immune or at least highly resistant to getting a new infection with the same HSV type.  Having oral herpes due to HSV-1, you are not likely to catch genital herpes due to HSV-1.

Since you have experience with oral herpes, you might be able to make a pretty good judgment of the genital area "outbreaks", since herpes looks pretty much the same wherever it occurs and with either HSV-1 or HSV-2.

[wrongtrust]

Thanks for your quick response. I will follow your instruction. one more quick question.
Can people have both genital herpes and oral herpes which are all caused by HSV-1.?
I have a recurrent painful "outbreaks" on my face which is on and off for past 10-20 years. my doctor saw it and say that is the herpes

Many Thanks

[H. Hunter Handsfield, M.D.]

I forgot to answer the last question, about having another child. It's not a problem.  Simply having HSV-1 (or HSV-2) is no reason not to bear children.  The main thing necessary to protect newborns from the rare possibility of severe infection during delivery is to tell the obstetrician of the herpes concern.  With that information, it is pretty easy to take whatever steps might be necessary to protect the child.  But I suggest you wait to cross this bridge if and when either you or your wife is found to actually have a genital HSV-1 infection.

[H. Hunter Handsfield, M.D.]

I'll try to help.  Presumably you didn't show the genital area rash ("outbreaks") to your doctor, which would have been helpful and would have gone a long way in determining whether herpes is possible.  Also, you say nothing about the nature of your female partner and any clues about her STD/HIV risks.  With those limitations, I will do my best.

1) HSV of either type has no effect on reliability of HIV testing, and HSV-1 does not increase the risk of catching HIV (unlike HSV-2).  Your negative test is proof you didn't catch HIV.

2) About 90% of people with new HSV-2 infections have positive tests by 3 months, so that result is very reassuring but perhaps not definitive.  This is where it becomes important to know more about the genital area "outbreaks".  The value of additional testing depends a lot on the degree of suspicion based on the nature of the rash.  (The location is atypical for herpes, which involves the head or shaft of the penis more often than the base.)

3) Syphilis blood tests are conclusive at 3 months.

4) You might have nongonococcal urethritis (NGU), which is an STD.  Chlamydia is the most common cause, but still accounts for only about one third of cases.  Another possibility is that the discharge is from the prostate gland -- sometimes an indicator of prostate gland disease, but sometimes also occurring on its own or when straining at stool.  It’s hard to say more about it without professional examination.  

5) A blood test cannot tell when and where HSV-1 was acquired.  Most infections are oral, usually acquired in childhood.  I suppose it is possible yours is genital, perhaps related to the "outbreaks" you describe. If you have any further genital "outbreaks", avoid sex at that time; or if you have recurrent oral herpes (cold sores), don't kiss or perform oral sex on anyone until it heals.  Your wife could have a blood test to learn whether or not she already has HSV-1, as do half of all adults in the US (even more in most other countries); if so, she can’t catch it again and there is no transmission risk.

The bottom line here is that you should re-visit your doctor for personal evaluation of all these issues -- the genital area "outbreaks", the intermittend urethral discharge, and the potential anatomic site and duration of your HSV-1 infection.  After you have done that, I will be happy to address one or two brief follow-up questions.

Best wishes--  HHH, MD