Question QUESTION: Male 23yrs old. Live in California.
I had protected and unprotected sex with a woman. Also condom was pre-lubricated kind. Day or so later my foreskin started to swell and I had 2 or 3 red fluid-filled bumps near tip of penis on the frenulum, if I recall correctly. Anyways I went to see the doctor a day or so later and the red bumps were gone. Anyways I got urine tested and said I was fine but the doctor said I have genital herpes and referred me to my primary doctor to get blood tests to confirm. So I saw my primary doctor and he examined me and said I have yeast infection and gave me that athletes foot creme and I got blood tests done to test for stds. Eventually the swelling went away and I was told the tests came back positive for hsv1. I had cold sores before so I'm not sure how to know if it is genital or oral only. However my penis ocassionaly stings like for a single second randomly can be when I'm sitting or when I'm walking. I see no craters or anything like that on my penis that's why I did not put a photo. I also had those blood tests like 1 or 2 weeks after sex, so can it be another std or something? I am in between health insurance or I'd go to a doctor, in 2 weeks I should have insurance again. Any help appreciated and if requested I will upload photos although I don't think they will be helpful as nothing is visible.
ANSWER: Hello Carlos,
It sounds like you did have balanitis caused by yeast, a skin fungus. This may or may not occur with herpes. The definitive test for herpes is a test to identify the virus, a DNA-based test test abbreviated NAAT. Antibody tests from your blood are pretty non-specific, and cannot say with absolute certainty whether a single episode of blisters is due to herpes type 1 or type 2. There are a multitude of antibody tests that detect immediate antibody (IgM) or long term (IgG) for both herpes type 1 and herpes type 2. So the question is which tests were positive for herpes type 1? If you had the IgG test, it would be positive from a long time ago fever blister as a child, even though the recent penile outbreak from something new would have had caused an elevated IgM.
Whether it is positive or not does not explain the presence of acute stinging, which might be something benign, or something else.
Sorry I can't be more definitive! Let me know exactly what all the tests were, and maybe I can put the clues together.
QUESTION: I tried to reply asap but you were maxed out. I talked with the nurse and she told me it was IgG test. However I should note that the weeks prior to the sexual activity, we would kiss and I ended up getting cold sore outbreaks regularly and my neck stiffened up and hurt by moving it a tiny amount(guessing lympth nodes swelled?); tylenol fixed my neck problem but I'm not sure which came first the neck hurting or cold sores and if the prior then I think I never had cold sores before (although I thought I did). I only mention this because I am thinking maybe I contracted the hsv1 orally with her and now I ask would that be enough time to show up on IgG test and if not then maybe I got something else that the tests didn't catch this time? Also I added a picture which shows little bumps I did not notice before and they are around the urethral orifice but they do not hurt or anything. Any information is appreciated, thank you for your time.
Answer Hello Again, Carlos,
Sometimes I have days without questions, and sometimes I am quickly "maxed out". Sorry about your inconvenience.
So your IgG blood test for HSV 1 was positive. HSV 1 is usually responsible for the cold sores and fever blisters associated with lip infections. You may have acquired this as an infant or child, and may have had it for decades, or you may have had the first episode as an adult, acquired during your recent episode of vigorous kissing.
As mentioned earlier, the appropriate test would be a NAAT for actual identification of virus during a suspected outbreak. Having serum (blood) antibody tests for immediate (IgM) and long term (IgG) for HSV 1 would have been more appropriate, but when the IgG is actually detected depends upon the manufacturer of the test. And the actual number given does NOT correlate with the length since first infection.
The photo does not show any current herpes outbreak.
Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc.
There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything.
Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!).
There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!
Family Practice PA since 1981;
Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site.
Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.
Organizations Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.;
American Academy of Physician Assistants;
Wisconsin Academy of Physician Assistants;
National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)
Publications Journal of the American Academy of Physician Assistants (JAPA)
Q Visions, Quarterly Newsletter of the NABWMT
Education/Credentials Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI)
Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA)
Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC);
Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)
Awards and Honors Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology;
Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants;
Fellow, Wisconsin Academy of Physician Assistants
Past/Present Clients Brady East STD Clinic, Milwaukee, WI
Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons