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Are lesions on penis symptom of HSV1

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Posted on Wed, 16 Jul 2014
Question: I recently went to the doctor because I had two lesions on my penis. He said his clinical impression was that it is not herpes. He felt the lesions were abrasions. The dermatologist came in and took a swab test. Test came back negative. Out of concern for my wife (infidelity was involved, she is unaware) I went to get a std panel test done. I had a positive result for HSV 1. I have never had cold sores (at least that myself or my parents can remember). I am now concerned that I may have contracted HSV 1 on my penis. Is this a reasonable concern given the above mentioned? I am highly stressed about this situation. Is it uncommon for someone to have contracted HSV 1 and never had a cold sore? What are the HSV 1 genital to genital transmission rates? Please advise. What can I do to try and figure this out?
doctor
Answered by Dr. Sanjay Kumar Kanodia (17 minutes later)
Brief Answer:
Kindly elaborate query and send report

Detailed Answer:
Hello,

Welcome and thanks for posting your query to the forum.

I can understand your concern for recent episode of two lesions on penis and positive result for HSV 1 and therefore the related issues.

In view to help you better I request you to kindly tell me certain important points:

- Since how long back you have had these lesions on penis.

- How long these lesions (abrasions) persisted- for a 2-3 days or around a week.

- Do you still have anything related to the lesions or any abrasions or ulcers till now.

- Any history of unprotected sex. If yes then was it with known person or commercial sex worker.

- For HSV1 positive result- is it for IgM or IgG or both.

It view to help you best I request you to upload the report so that I can analyze it better. For uploading the report you have a facility on the right side of the page or can send on:

YYYY@YYYY

with "attention:Dr Sanjay Kumar Kanodia"

Hope to hear soon form your side.

With regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (34 minutes later)
I can understand your concern for recent episode of two lesions on penis and positive result for HSV 1 and therefore the related issues.

In view to help you better I request you to kindly tell me certain important points:

- Since how long back you have had these lesions on penis.
----------- Lesions have lasted for approx. 5-6 weeks. Very minor lesions on penis at this point. They surfaced a few days after sexual contact. There was another incident approximately 4 years ago where I was tested after sexual activity with a stripper at a strip club. Negative culture... however, I am concerned about false negative rate of cultures.

- How long these lesions (abrasions) persisted- for a 2-3 days or around a week.
----------- See above answer.

- Do you still have anything related to the lesions or any abrasions or ulcers till now.
----------- Yes, I saw my doctor and he said it looked like an abrasion, not herpes; however, I am still concerned.

- Any history of unprotected sex. If yes then was it with known person or commercial sex worker.
------------- I have a history of unprotected sex. Same partner for 9 years; however.... there was genital to genital contact with sex worker 4 years ago. She also kissed my penis and rubbed her lips in my genital area.

- For HSV1 positive result- is it for IgM or IgG or both.
------------ It is for IgG

It view to help you best I request you to upload the report so that I can analyze it better. For uploading the report you have a facility on the right side of the page or can send on: Don't have report with me; however, report shows the following.

Herpes Simplex Virus Type I 15.30 0.00-0.90 Positive 06/09/2014 06/10/2014

YYYY@YYYY

with "attention:Dr XXXXXXX XXXXXXX Kanodia"

Hope to hear soon form your side.

With regards,

Dr XXXXXXX XXXXXXX Kanodia
MD- Dermatology & Sexually transmitted diseases
doctor
Answered by Dr. Sanjay Kumar Kanodia (36 minutes later)
Brief Answer:
No herpes; IgG level shows good immunity

Detailed Answer:
Hello,

Welcome back and thanks for posting the details.

After reading your complete query, interpreting the reports and analyzing all the things with complete diligence I reassure you fully that you do not have herpes 1 or 2.

Let me tell you certain important facts related to herpes:

To tell you medically - Herpes lesions manifest itself as small vesicles (fluid filled blisters) which remains for just a day or two and then forms ulcers which are quite painful. These ulcers then heals in next 5-7 days.

To begin with also these vesicles are quite painful and itchy with discomfort and once the vesicles burst in a day or two then the ulcers which are formed are quite painful for next 4-5 days. So the symptoms can never go unnoticed and complete illness of herpes remains for 7-14 days only.

In my clinical experience as well as academically speaking herpes lesion manifest within 7 days of exposure or maximally by 2 weeks. It is only rarely seen that it manifest beyond 2 weeks. For that also we consider 4 weeks as maximum period.

In yourself I can make out that no such thing was present matching with the above symptoms. You can also notice that the lesion persisted for 4-5 weeks which is not a sign of herpes. Additionally to know that in herpes there are grouped vesicle or ulcers and not two individual lesions.

An important thing to know is that in herpes it is mainly type 2 which causes genital lesion and less commonly by type 1.

So you can rest assured regarding the rarest possibility of herpes on clinical grounds. You can make out that you do not have any of the symptoms which match with herpes or its symptoms or any other Sexually Transmitted Diseases.


Now for the part of reports:

To explain you elaborately - whenever we are exposed to any infection it is not possible that it will be clinically manifested. Sometimes clinically the disease is manifested in terms of signs and symptoms only where the immunity of the body is not able to contain or fight back the infection.

Even then the body produces antibodies against that infection. The first antibody produced is IgM which shows that the infection is currently going on. Later on IgG is produced as a part of good immunity or as sign of late infection in past.

In your test values you can see that it is IgG which is positive and not the IgM. IgM is the antibody which is expressed when there is an active or a recent infection is present. As soon as immunity towards that particular infection is acquired such as in your case towards herpes, then IgG is expressed. IgG positivity means either a good immunity or a very late infection in past which may or may not have had been expressed.

Your IgG is well above the cut off value meaning a very good antibody level for protection.

So for the herpes part you should not be worried at all.

The most important of all the point of support for your negative status is negative culture report too. These tests are conclusive evidence of your clear status. You do not require any further testing and just relax.

Hope the informations will relax you, if you have any further query I will be happy to help or if not then can close the discussion and rate the answer.

Wish you good health,

with regards,

Dr. Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (49 minutes later)
I want to follow up with a few more questions.

1) My understanding is that a positive HSV 1 indicates herpes. I assume you are referring to me not having HSV 1 genital herpes. Is that correct?

2) With the antibody levels shown from the test, approx. how long ago do you imagine my exposure to the virus was? Best guess? Several years ago? Within the last year? etc?

3) Clarification. The infection presented itself a few days after exposure. It also may have been 3 weeks as well. Two different partners.... Infections (the lesion, ulcer?) was under the tip of my penis head and one on the head of my penis. My physician referred to it likely being an abrasion. When the dermatologist came in... she took a culture and said that if it is negative it does not mean I don't have herpes and that I should come back if there is another outbreak. I had not had the labs done at that time... they were done afterwards.

Thanks for clarifying and I look forward to your response. You are very informative.

doctor
Answered by Dr. Sanjay Kumar Kanodia (19 hours later)
Brief Answer:
IgG positivity indicates past infection

Detailed Answer:
Hello young man,

welcome again to the forum and thanks for further follow up.

regarding your further queries:

1) My understanding is that a positive HSV 1 indicates herpes. I assume you are referring to me not having HSV 1 genital herpes. Is that correct?

@If you can see your reports then can get that it is your IgG which is positive and not IgM. As I told you before that IgG is a protective antibody and its positivity indicates past infection which may or may not be manifested. So do not get confused for any type of herpes including genital herpes in yourself. Based on your reports I very firmly reassure you that you do not have any type of herpes including genital herpes.

2) With the antibody levels shown from the test, approx. how long ago do you imagine my exposure to the virus was? Best guess? Several years ago? Within the last year? etc?

@ We can not guess or we can not predict from the IgG report that when had you got infected from chlamydia. We can not detect or estimate the exact time since you got infected. Therefore we can not predict whether it is from your current partner or from any other person in past and therefore the time period too.

Regarding rest of your doubts for herpes- As per your clinical presentation also it is not matching with herpes. As I told you before that Herpes lesions are multiple small vesicles (fluid filled blisters) which remains for just a day or two and then forms ulcers which heals in next 5-7 days.It never remains for 4-5 weeks.

So I agree with your treating doctor that it is not herpes.

So relax for any possibility of herpes and do not give any second thoughts about it.

Always use protection and follow safe sex practice.

My all best wishes for your good health.

I hope these informations will relax your mind. I will be glad to answer any further queries or if not then can close the discussion and rate the answer.

Dr. Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (37 minutes later)
I have also started to get burning sensation on my penile shaft recently... What should I do?
doctor
Answered by Dr. Sanjay Kumar Kanodia (3 hours later)
Brief Answer:
Kindly elaborate the burning sensation

Detailed Answer:
Hello young fellow,

Welcome again and thanks for swift follow up.

For your burning sensation on penile shaft-

- Do you feel all through the day or some of the time of the day only.

- Is it present on the shaft or the tip of penis or all along the penis.

-Is it pinprick like or sharp penetrating or continuous changing sensation different time of day.

Hope to hear soon form your side.

with regards,

Dr. Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (11 minutes later)
It is present from the mid to top portion of the penile shaft. It is a burning sensation... Almost like a rug burn. it comes and goes throughout the day. It was most noticeable after I got out of the pool but persists on other days as well.

Also you mentioned chlamydia in your note? Please clarify. It was 1-2 responses ago.

Lastly -- I did not have an IgM test. It was only an IgG test. Do the lab results still suggest an old infection? How old? More or less than 6 months? You kept referring to IgM previously... There was NO IgM lab done.

One more thing... Where are you from and where did you get your training done. Just curious.

Thx!
doctor
Answered by Dr. Sanjay Kumar Kanodia (35 minutes later)
Brief Answer:
IgM and IgG tests are done for HSV1 and 2 both

Detailed Answer:
Hello young fellow,

Thanks a lot for your swift reply.

I am from XXXXXXX and presently working as Associate Professor at National Institute of Medical sciences & Research; XXXXXXX XXXXXXX I am a Gold Medalist from University of XXXXXXX and did my MD from Prestigious SMS Medical College, XXXXXXX For the rest of the information about me & my academic carrier you can visit my web page at:

bit.ly/drsanjaykanodia

Now regarding your rest of the queries:

It is a dictum that for herpes that there is always IgM and IgG tests done for HSV1 and 2 is done in all cases. You go and check your report again and see it for clarification. That is why I also asked you to upload the report for guidance and clarification.

You can still send the report and check whether IgM and IgG for HSV1 and 2 was done or not. If it is not shown in the report then go ask your lab person and doctor for the same.


For the part chlamydia- it was for quoting an example as for all sexually transmitted diseases like chlamydia, herpes, gonorrhoea or any other sexually transmitted diseases. In may of these STDs we can not detect or estimate the exact time since you got infected by mere IgG value. So do not get confused with chlamydia alone -as it was used to quote an example only.

Now finally for your burning sensation- it appears to be due to healing of the two spots. Here the skin is quite sensitive so it is commonly observe d that during or after healing there is a feeling of burning or some times deep pain off and on. Do not worry about the same.

I hope these informations will relax your mind. I will be glad to answer any further queries.

Dr. Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (21 hours later)
I asked the lab. No IgM was done for any of the lab work. Please advise. Does this change your impression of my symptoms? I called several labs and none of them in CA that I called do IgM.
doctor
Answered by Dr. Sanjay Kumar Kanodia (40 minutes later)
Brief Answer:
Both IgM and IgG for herpes 1 & 2 should be done

Detailed Answer:
Hello young fellow,

It is really not only surprising but shocking too that labs at your local place are not performing IgM antibodies for Herpes.

It is not only mandatory but an essential requirement to perform both IgM and IgG for herpes 1 & 2.

Let me guide you again that it is both IgM and IgG for herpes 1 & 2 done in any of the suspected case of herpes

In any case based on our clinical findings it does not seems to be herpes. Even then I suggest you to take guidance of your treating doctor and ask for the IgM and IgG tests for herpes 1 & 2.

Let me know her view regarding the same and do inform me accordingly.

With regards,

Dr. Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (1 hour later)
I found a lab to test me with an IgM test as well. I am going in tomorrow and should have results soon. I will follow up with you after I get the results. Thanks for your advise.

Question: For IGM tests --- how recent does the infection need to be for the test to pick up the antibodies. Also, I have read that IgM tests sometimes show positive when someone is having an outbreak even if it is an old infection. Is that true? I look forward to following up with you soon. Thanks.
XXXX
doctor
Answered by Dr. Sanjay Kumar Kanodia (9 hours later)
Brief Answer:
Ig M is detectable up to 6 months period

Detailed Answer:
Hello young fellow,

Welcome again to the forum.

For your further queries-


For the detection of IgM - it can be detected in cases where the infection has manifested clinically. In all cases of clinical manifestation it can be picked from the day of clinical appearance to up to 6 months.

To tell you more elaborately and simply- If a person is exposed to herpes infection from the partner then the clinical manifestations generally appear within 7 days in most of cases. Rarely it may take 14 days also in other remaining cases. IgM is detectable from the day of the clinical manifestation- that is the formation of vesicles to up to 6 months period and after that it replaced by IgG.

Now for the part of other query of positive IgM in outbreak of old case- You are correct in the sense that herpes is a recurrent infection. So if there is a recent outbreak or recurrent infection then the IgM can come positive again.

This is good that IgM is done in one of the lab so you can go for the same to clear all the doubts. Do remember that you have to go for IgM for both HSV1 & 2.

Do follow me after the results.

With regards,

Dr. Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (4 days later)
I am curious about length of infection. I have had one IGG test (HSV 1 and 2) as well as a IgM/IgG test for HSV 1 and 2. They were approximately 2 weeks apart from one another.

Here are the following ranges for the tests.
Negative <0.91
Equivocal 0.91 - 1.09
Positive >1.09

My results were negative for HSV 2 on all tests.

The first test was taken after approximately 6 weeks of exposure.

My results on the first test (IgG only) was HSV 1 = 15.1 High. No IgM was taken.

I took a second test 2 weeks later.... approximately 8 weeks after exposure.

The second test I took was both an IgM and IgG test. I was NEGATIVE for IgM HSV1 and HSV2 and POSITIVE for IgG HSV1. The IgG HSV 1 value was 13.6 HIGH.

My IgG values are higher than I have seen on any of the forums I have looked at. Why are they so high? Does a higher IgG value mean the infection is relatively recent and immune system is highly active or does it indicate that I have built up a high level of antibodies and that it is an old infection? Why did the lab value change over the course of two weeks. Again, I have not seen values this high anywhere I have looked. Please share your clinical experience and understanding about lab values.

Lastly, I have read that IgM antibodies are often undetected after 4-8 weeks. Is this accurate or are they typically detectable for a longer period of time. I am trying to decipher approx how long ago this infection was. Basically, I want to get a sense whether it was >6-8 months ago or within the last 2-3 months.

Thank you for your time.

doctor
Answered by Dr. Sanjay Kumar Kanodia (8 hours later)
Brief Answer:
Difference of values are not important

Detailed Answer:
Hello young fellow,

Welcome to the forum again and thanks for detailed follow up regarding your tests.


After interpreting all the test values let me guide you again regarding the various results:

- You do not possess either HSV1 or HSV2. It is on the basis of the fact that HSV1 is negative for both IgM and IgG.

- For HSV2 also only IgG is positive which actually shows either a subclinical infection or exposure only and not clinical manifestation in yourself.

- Further regarding HSV2 - As per your interpretation IgG value shows higher value which you have never seen in any forum. Let me first reassure you that your values are totally normal and there is nothing abnormal in the same. IgG value of 15.1 and 13.6 are not that high and are very often observed in my clinical set up. I too often see your kind of values and even higher than these values. SO first and foremost do not be tensed about the same.

Now for the part of high values as you say are not related to any issue to immunity. It only shows that there had been exposure to the virus and tehn it resulted in immunity shown by IgG positivity. As I said previously we cannot interpret the time period by any test and nor by value of IgG too.

You should know that it only shows good immunity and nothing else!!!

Regarding the difference of values of 15.1 and 13.6 – If we test your blood on same day at two different times then also there can be difference in the values. You can see that there is difference of only 1.56 which is almost negligible. Even we see difference of plus or minus 5 or more in different tests. It can be due to multiple of the technical reasons which are beyond our discussion.

If there is any positive or negative test then there is an issue which is actually not!!

So, you should relax and should not think of any abnormality. Just relax!!!

I hope these informations will relax your mind. I will be glad to answer any further queries or if not then can close the discussion and rate the answer.

Dr. Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (10 hours later)
You said that hsv 1 was negative. That is not what I said!!! It is positive. You also referenced hsv2 as positive!! What are you talking about?! Please review my query more carefully and respond. Thanks.
doctor
Answered by Dr. Sanjay Kumar Kanodia (47 minutes later)
Brief Answer:
Kindly see the updated solutions

Detailed Answer:
Hello young fellow,

Welcome to the forum again and thanks for drawing my attention on HSV 1 & 2. I beg your pardon for the typological error. Kindly see the details below again and can find the solutions accordingly:


- It is fact that you do not possess either HSV1 or HSV2. It is on the basis of the fact that HSV2 is negative for both IgM and IgG. As well for HSV 1 too, it is only IgG which is positive.

- For HSV1 also only IgG is positive which actually shows either a subclinical infection or exposure only and not clinical manifestation in yourself.

- Further regarding HSV1 - As per your interpretation IgG value shows higher value which you have never seen in any forum. Let me first reassure you that your values are totally normal and there is nothing abnormal in the same. IgG value of 15.1 and 13.6 are not that high and are very often observed in my clinical set up. I too often see your kind of values and even higher than these values. SO first and foremost do not be tensed about the same.

For the part of high values IgG are not related to any bad issue of immunity. It only shows that there had been exposure to the HSV 1 virus and then it resulted in immunity shown by IgG positivity.

You should know that it only shows good immunity and nothing else!!!

Regarding the difference of values of 15.1 and 13.6 – If we test your blood on same day at two different times then also there can be difference in the values. You can see that there is difference of only 1.56 which is almost negligible. Even we see difference of plus or minus 5 or more in different tests. It can be due to multiple of the technical reasons which are beyond our discussion. If there is any conversion or values above or below positive or negative test then there is an issue which is actually not!!

It is only for the part of IgM which makes an issue. If Ig M is positive that actually tells us a recent infection. In herpes IgM is detectable from the day of the clinical manifestation (formation of vesicles) to up to 6 months period. It can be detectable by 4-8 weeks period or longer up to 6 months also but never beyond that. An important thing is that these are typically present only in cases of recent infection and not late infection.

Further to tell you the fact that at mouth region infection is mainly caused by herpes simplex virus 1 (HSV1) and at genital region it is caused by herpes simplex virus 2 (HSV2). We are basically concerned about possibility of infection by sexual mode where HSV2 is important as told above. In your case HSV2 is not in picture by any means so possibility of sexual mode of exposure is least likely. So this is also is a point of big relief for you.

I hope these informations will relax your mind. I will be glad to answer any further queries.

Dr. Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Are lesions on penis symptom of HSV1

Brief Answer: Kindly elaborate query and send report Detailed Answer: Hello, Welcome and thanks for posting your query to the forum. I can understand your concern for recent episode of two lesions on penis and positive result for HSV 1 and therefore the related issues. In view to help you better I request you to kindly tell me certain important points: - Since how long back you have had these lesions on penis. - How long these lesions (abrasions) persisted- for a 2-3 days or around a week. - Do you still have anything related to the lesions or any abrasions or ulcers till now. - Any history of unprotected sex. If yes then was it with known person or commercial sex worker. - For HSV1 positive result- is it for IgM or IgG or both. It view to help you best I request you to upload the report so that I can analyze it better. For uploading the report you have a facility on the right side of the page or can send on: YYYY@YYYY with "attention:Dr Sanjay Kumar Kanodia" Hope to hear soon form your side. With regards, Dr Sanjay Kumar Kanodia MD- Dermatology & Sexually transmitted diseases