Unsure if Herpes, awaiting swabs, need help

[JackThrowAway]

Hey all, 37M here - some background, I was a little promiscuous and slept with one person (unprotected) on Jan 15 and then another (protected but unprotected oral) on Jan 27. They don’t have any symptoms and are awaiting test results.
 

On Feb 15 (4 weeks and 2.5 weeks after potential exposures) I went for a routine std checkup and the HSV2 result came back as equivocal for 0.95H. I am going for a second test next week (which will be 4.5 weeks after last exposure). I suspect if I’m infected then the equivocal is showing an early infection.
 

Since that result I’ve gone downhill and effectively been reading a lot online about symptoms etc. I haven’t had any symptoms at all except for some tingling around my anus, and groin area and in the past 2 days I have had some burning in my urethra and the tip of my penis looks a little red and inflamed. I’ve also just noticed three white spots on my penis glans (1 on my inflamed tip and 2 around the head). I was swabbed yesterday and will get results next week. The doctor preemptively put me on Valocyclovir in the meantime too. 

This morning I noticed possibly an outbreak in my lower groin area (however it’s not really itchy and not painful at all). I also just noticed what could be a herpetic whitlow on my finger. 

The main thing is the burning in my urethra and inflammation of the tip of my penis with the white spots that is unusual. 
 

Any advice would be amazing while I await the results of the swab and secondary IGg test.

 

Photos can be accessed here:

https://picallow.com/jackthrowaway-photo/

Edited February 25 by JackThrowAway

[CHT]

59 minutes ago, JackThrowAway said:

Hey all, 37M here - some background, I was a little promiscuous and slept with one person (unprotected) on Jan 15 and then another (protected but unprotected oral) on Jan 27. They don’t have any symptoms and are awaiting test results.
 

On Feb 15 (4 weeks and 2.5 weeks after potential exposures) I went for a routine std checkup and the HSV2 result came back as equivocal for 0.95H. I am going for a second test next week (which will be 4.5 weeks after last exposure). I suspect if I’m infected then the equivocal is showing an early infection.
 

Since that result I’ve gone downhill and effectively been reading a lot online about symptoms etc. I haven’t had any symptoms at all except for some tingling around my anus, and groin area and in the past 2 days I have had some burning in my urethra and the tip of my penis looks a little red and inflamed. I’ve also just noticed three white spots on my penis glans (1 on my inflamed tip and 2 around the head). I was swabbed yesterday and will get results next week. The doctor preemptively put me on Valocyclovir in the meantime too. 

This morning I noticed possibly an outbreak in my lower groin area (however it’s not really itchy and not painful at all). I also just noticed what could be a herpetic whitlow on my finger. 

The main thing is the burning in my urethra and inflammation of the tip of my penis with the white spots that is unusual. 
 

Any advice would be amazing while I await the results of the swab and secondary IGg test.

 

Photos can be accessed here:

https://picallow.com/jackthrowaway-photo/

Hello "Jack"..... it's always tough to tell from pictures what might be going on.... some of your pics are possibly HSV-related but, several are not.  You did the right thing by having a PCR swab test.... the IgG test however, is being done too soon to be of much value.....if your possible exposure was no more than 4.5 weeks ago, any possible antibodies to HSV would not be fully formed at this stage.... you must wait at least 12 weeks from exposure for the IgG test to be accurate.  Your "equivocal" result simply says there is no way to tell yet if you have the antibodies to the virus at this stage.... a repeat test will be needed.  I know it's tough but, you need to wait at least another 8 weeks to repeat that test for it to be of any value.  Did you get a result for HSV1 and a separate one for HSV2?  Your equivocal result of .95 may simply be the result a cross-over interference of an old HSV1 infection you may have had as a child (the majority of people -70% were exposed to HSV1 as children so, it's quite common).   

You will want to know if your partners' results show any STI infections.... so, follow up on those if you can.  Until then, see what the swab test shows but, again, you should wait until week 12 after your most recent sexual encounter to get that next IgG test for HSV2.   Do your best not to jump to any hard conclusions yet.... let's see what the results show.... I wish you the best and please come back and ask any questions you might have as you move forward.  

[JackThrowAway]

Thanks for the response. A full panel std test was performed and the HSV1 came back as negative, only the HSV2 was the abnormal or equivocal result. 
 

Am aware of the 12 weeks for a fully formed accurate IGg test, will await those results too. 
 

Understand it’s hard to tell what’s going on from a few photos, but is it possible this could be a primary outbreak? I’m wondering if my penis is more affected from a bacterial issue and I have foliculitis on my groin as it seems very mild. But the equivocal test has been messing with my mind quite a bit.

[CHT]

On 2/25/2023 at 11:24 AM, JackThrowAway said:

Thanks for the response. A full panel std test was performed and the HSV1 came back as negative, only the HSV2 was the abnormal or equivocal result. 
 

Am aware of the 12 weeks for a fully formed accurate IGg test, will await those results too. 
 

Understand it’s hard to tell what’s going on from a few photos, but is it possible this could be a primary outbreak? I’m wondering if my penis is more affected from a bacterial issue and I have foliculitis on my groin as it seems very mild. But the equivocal test has been messing with my mind quite a bit.

Hello again, "Jack".... it's possible those photos show a primary infection but, I'm not seeing precisely what is typically seen during a primary outbreak of HSV.... the sores more typically are clustered together and fluid filled.... later transitioning to a scabbing stage before disappearing.  Some of your non-penis pics look possibly to be healed HSV sores but, as you point out, could just as easily be foliculitis.  The pic of the sore at your urethra is possibly suspect but, this too could be bacterial in nature (again, it does not present in the my typical initial HSV outbreak pattern)..... the swab results will hopefully give you a more definitive answer.  I assume your HSV1 test was an IgG test?  If so, just like your HSV2 IgG test, it's possible you tested too soon after exposure.... most of us were exposed to HSV1 as children but, it's still possible to contract HSV1 in the genital tract as an adult.... it's just too soon to make any assumptions about the equivocal results for the HSV2 test.... I know how tough it is to wait the full 12-16 weeks to get the definitive test but, do your best not to let your mind run amuck on you at this stage (easier said then done, right!)

So, are you still having symptoms at week 5?  Have all previous suspect areas fully healed?  Any further problems?  Are you taking 1 gram of valacyclovir daily?

[JackThrowAway]

Hi CHT, thanks for the response. The HSV1 was also an IgG test. 

I am still currently on 1000mg twice daily of Valacyclovir. I haven’t had any worsening of symptoms so far although I have a rash on the other side of my groin now too. The rashes aren’t painful to touch but slightly itchy here and there but nothing too noticeable. I didn’t notice any fluid filled blisters or pain before I noticed redness in that picture I took. 

I started using anti-fungal cream on the penis and groin and the groin area looks like it’s healing (it’s a mild pinkish color now). I still have the three white spots on my penis but they haven’t gotten any worse, however I still feel the occasional pinching at the tip here and there, although it does look less inflamed.

I take it that Herpes could present itself as a primary outbreak in any shape or form, but usually it should be more pronounced? 

Thanks again,

[JackThrowAway]

As an update, the swab came back negative for HSV1 and HSV2. Urine analysis was negative for the usual chlamydia and gonorrhea. 
 

So I’m feeling a little bit more relieved, however has anyone had similar symptoms etc to mine and had it turned around later? 

[CHT]

On 2/28/2023 at 12:03 PM, JackThrowAway said:

As an update, the swab came back negative for HSV1 and HSV2. Urine analysis was negative for the usual chlamydia and gonorrhea. 
 

So I’m feeling a little bit more relieved, however has anyone had similar symptoms etc to mine and had it turned around later? 

Very good news.... for added peace of mind, I'd suggest getting that IgG retest at week 12.... I think you are just fine, you've mostly likely been dealing with a bacterial infection of some sort.... best of luck.

[JackThrowAway]

So still in the era of being confused, and I know that I need to wait a few more weeks till week 12 to get a more accurate IgG test, however:

Went to see the doctor who examined everything, he confirmed that these were not Herpes symptoms at all and suggested I go to see a urologist. I took another IgG test there (4.5 weeks after last exposure) and I just got another equivocal result. First result was 0.95 and second was 1.0. HSV1 was negative in both tests. 

The two tests apart are two weeks, also I was on antivirals for my 2nd result (which I'm unsure if it would increase or decrease the test result). 

Anyone care to chime in if they have knowledge or experience? I have been doing my head in the past two weeks reading anything and everything online.

[JackThrowAway]

Hi all, as an update. My IgG test result from the urologist came back as 1.41 within the positive range. 

I feel there's no doubt that I have it now given some of the symptoms and this recent test.

Any advice on next steps?

[WilsoInAus]

Hey @JackThrowAway you mentioned a few weeks back this partner was being tested… what were their results?

[JackThrowAway]

@WilsoInAus I am still awaiting the result of the person who I slept with unprotected, the other person who I was protected with had a negative test recently, however I'm not sure if she's really telling me the truth. 

As much as I'd like to hope it's a false positive, the urologist I spoke to said that the fact I had two equivicol test results followed by the positive pretty much makes it positive. He said that I didn't have any usual symptoms for herpes however and just thought the redness on my penis and groin pain was a result of the stress of overworrying from it. I guess I can always test again in another 6 weeks or so, but I'm not positive of a changed result.

He advised against me taking any valtrex for suppressive therapy give he said I appear asymptomatic. I'm not sure if that's true from reading the forums?

[CHT]

2 hours ago, JackThrowAway said:

@WilsoInAus I am still awaiting the result of the person who I slept with unprotected, the other person who I was protected with had a negative test recently, however I'm not sure if she's really telling me the truth. 

As much as I'd like to hope it's a false positive, the urologist I spoke to said that the fact I had two equivicol test results followed by the positive pretty much makes it positive. He said that I didn't have any usual symptoms for herpes however and just thought the redness on my penis and groin pain was a result of the stress of overworrying from it. I guess I can always test again in another 6 weeks or so, but I'm not positive of a changed result.

He advised against me taking any valtrex for suppressive therapy give he said I appear asymptomatic. I'm not sure if that's true from reading the forums?

was your HSV IgG result specific to HSV2?  What week was this following your exposure (did you wait full 12+ weeks?)?  Did you also get an HSV1 result?  I think you mentioned you had a PCR swab test earlier that came back negative....correct?  

Edited March 8 by CHT

[JackThrowAway]

 

@CHT Yes, I was tested for both HSV1 and HSV2 and HSV1 came back negative all three times (0.33 on the last result). 

I have not yet waited the full 12 weeks - need another 6-8 or so I think. The PCR swab test from the swab of the redness on my penis and on the foreskin came back negative.

[WilsoInAus]

Hey @JackThrowAway rest assured if either of these partners was positive for HSV-2 you’d know! They’d blame you for their infection.

Even if one of them was positive, whether you were infected or not is a further question to resolve.

Your urologist is wrong in the sense that bloods can never confirm positive unless they exceed 3.5 or so. It matters not how many low positives you have, some people just have other stuff in their blood that results in false low positives - often for a long time at a stretch!

Your next steps are an IgG at 12 weeks. If that’s low positive I’d consider the Westernblot.

Suppression is an important option that positive people could consider discussing with sexual partners. At this stage you are not confirmed so it’s not yet relevant - it’s up to you whether you do or do not take antivirals. Personally, I’d wait until you have confirmation to consider the topic further.

[JackThrowAway]

Thanks @WilsoInAus for the response, I've noticed that you are highly active in the community and have done an immense task of answering anxious people's questions such as mine, thanks for all your time!

I'd like to entertain the idea that perhaps its a continued false positive however I am still a little suspicious about the "non-herpes symptoms" I have such as some redness, some itching around the thighs, some groin pain too (it feels like I've overstretched the groin), and then I have some random tingling in areas around the anus, thighs and also the lips (I'm not sure why). I've never really felt this before, except for a small bout of prostatitis years ago, so I'm not sure the stress brought about that condition too. But I doubt that it's all a coincidence given the testing and unusual symptoms and timeline.

But yeah, I've kind of resigned myself to just trying to accept it rather than over-analyze every itch and scratch as I have been the past 3 weeks. Having said that I will wait for the 12 weeks to get another IgG and possibly WesternBlot.

[JackThrowAway]

As an update - the person who I was with unprotected just got her test back and it was positive. 

So, I think unfortunately all signs point to me being infected. I haven't had any blisters but just the inflammation and redness on the tip of the penis, slight redness around the groin (that anti-fungal cream has helped clear up) and some tingling / burning in the anus area.

At this stage I'm just hoping I don't have a rectal infection of herpes.

[WilsoInAus]

Hey @JackThrowAway yes most of your partners you've ever had will test positive for HSV-1. Even if they test positive for HSV that doesn't mean a transmission occurred.

If you haven't had a blistery lesion, then there are not really any signs that point explicitly to a herpes infection.

How would you have a rectal outbreak? Did one of these "she" have some equipment and flip you?

[JackThrowAway]

She tested positive for HSV2. No, there was nothing of that sort in that area.
 

However I also have ulcerative colitis so I’m on medication that makes me immunosuppressed. I have been bleeding a bit when I pass stools during the time of redness, so I’m unsure if I’m getting a flare from the colitis (from all the stress of everything) or if it’s due to the virus making it’s way to an already inflamed area and popping up as blisters that I can’t see and hence the bleeding. 
 

I had two equivocal results (at 4 weeks and 6 weeks) that then went to a positive result (7 weeks after exposure). Combine that with some flu symptoms, redness, tingling etc. makes me feel it’s conclusive that this points to a hsv2 infection.

[WilsoInAus]

Hey @JackThrowAway herpes causes an outbreak where it enters the body first and maybe a progressive spread. If it doesn't cause an outbreak at the entry site then it won't cause one elsewhere, it also won't 'jump' upon infection - it would be more likely that the lesions are continuous from the penis to the anus.

Nevertheless, testing trumps symptoms or any interpretation of symptoms. The correct conclusive result arises when:

• you have a positive swab; or
• An IgG HSV-2 level over 3.5 (Herpeselect test).

[JackThrowAway]

Thanks @WilsoInAus for the info. Just to update, I’ve been waiting to take my 12 week test which was done yesterday. I still have what seems like a fungal infection in the groin and recital region and treating with anti-fungals.
 

I just got the result back and it’s another equivocal of 1.07. I guess it’s time for a WesternBlot.

[JackThrowAway]

Just for a further update - performed the supplemental test via QuestLabs which is the Inhibition Assay.

The test came back negative:
"The HSV-2 IgG screening assay was repeated on a different platform as part of the inhibition test, and the result was negative; thus the Inhibition result could not be determined. Most samples exhibiting this type of discrepancy have initial HSV-2 IgG index values of 1.10-3.00. If early HSV-2 infection is suspected, submission of another sample collected 2-3 weeks after this sample is recommended."

I'm going to still go ahead with the WesternBlot for confirmation. Will update once received the result.

[WilsoInAus]

Hey @JackThrowAway that is the news the we’re hoping for and expected in these circumstances. The Westernblot is just a sleep easy and will also be negative.

[JackThrowAway]

Thanks @WilsoInAus. I read a previous post of yours on the Inhibition Assay test and how it's performed, but is there a possibility that it could be a false negative? I also ready on Terri's forums that she has never seen a negative IA test turn positive on the WB (although sample size was only 23 or something). 

It's hard to believe given everything and the symptoms (are they just psychosomatic?!)

[WilsoInAus]

Hey @JackThrowAway that’s correct, the inhibition tests are based on the full viral proteins and have the same sensitivity as the Westernblot. There is negligible to zero chance of a false negative here and the Westernblot will not come up with a different result.

[JackThrowAway]

@WilsoInAus and to everyone else following this thread - I went for the WesternBlot for confirmation on the Inhibition test and it also came back negative.

I encourage everyone with low positives or equivocal results to go for it, the current system is hopeless and most doctors do not understand how it could be a false positive. The urologist I went for said without a doubt given I had a positive of 1.41 that I was definitely positive and didn't need a confirmation result.