Do itching and discomfort in the genitals indicate herpes infection?

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Posted on Thu, 11 Jun 2015 in Sexually Transmitted Diseases
Question: Hi,
I'm a 50-year-old male and was diagnosed in October 2012 as being positive for HSV-1 and HSV-2. The clinic where I got tested had tested me 3 times. The first time was about 3 weeks after I thought I had been exposed to/contracted genital herpes. I remember I had requested a full panel for STD's, including HIV, syphilis, gonorrhea, chlamydia, and Herpes Simplex Type I and II. All tests were negative except for Type-1 HSV.

I got tested again a few weeks later, because the doctor at the clinic felt I had gotten a false positive. This time he ordered what he said was a more accurate test and the result for HSV-2 was negative. I was still unconvinced, because I was experiencing discomfort and itching in the genital areas.

The doctor thought maybe I had a fungal infection and prescribed Clotrimazol ointment for 1-2 weeks. I had done some online research and learned about the IgG and IgM blood tests and asked for a type-specific test for HSV-1 and 2. By now it had been about 10 weeks since I thought I was exposed. The test came back positive for both types. Shortly before I got my test results back I had developed what one doctor here and a general practitioner and dermatologist in my area all diagnosed as "contact dermatitis with secondary infection" on the shaft of my penis. The skin was red and raw on different parts and painful to the touch. The dermatologist prescribed oral antibiotics, as well as topical ointment containing hydrocortisone and a skin regeneration cream to be applied after healing had begun. The condition cleared up within 5 days.

In retrospect I wonder if this had been an initial outbreak; because in early September I had come down with an inner-ear infection called "vestibular neuritis".

I live and work in South Korea and most of the doctors here (along with most of the population) think of Herpes 1 and 2 as a skin condition rather than an STD... and they usually won't prescribe anti-viral suppressive thearapy unless an outbreak is in evidence.

For the past 2 years, then, I've simply been trying to live a healthy lifestyle and keep my immune system strong. I have not experienced any kind of blisters on my genitals in that time; although this past summer I developed what one dermatologist called a fungal infection in between both thighs and treated with anti-fungal ointment. I have been taking 1,000 to 2,000 mgs of L-Lysine supplement; because I had read that it can help to slow or inhibit the replication of virus particles.

In November 2014 I entered into a first-time monogamous relationship with a woman, who had never had sexual relations with anyone. The first time we were together I told her about my diagnosis and how I had been trying to manage the disease. Since that time we have had intercourse using condoms and never when I was having prodomal symptoms.

We plan to marry soon and recently my fiancee developed a small sore on her lower lip. She has been treating it with medicated lip ointment. I told her I thought it would be a good idea for both of us to visit an international clinic and get a type-specific blood test (IgG) for Type 1 and 2. We got the results back and they say both she and I have Type 1. She also tested positive for Type 2, but the doctor says her index is low; suggesting a false positive. I had gotten tested for HSV-1 and 2, as well as syphilis. The syphilis was negative this time and back in July 2012. I also tested positive for Type 1 Herpes but negative for Type 2.

Sorry for the long introduction; but I want to know how can this be? My last test for HIV-2 was positive and now it was negative? That makes no sense. Did the other clinic screw up the results?
doctor
Answered by Dr. Kakkar S. 37 minutes later
Brief Answer:
Would like to know the index value for Hsv type 2 tests. Low index value can be false positive

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your query in detail.

You have tested positive for type 1 Hsv, on each and every occasion, therefore you certainly have type 1 Hsv infection.
Regarding different results on different occasions for Hsv type 2, it is important to define index value (titres).
Low titres can be false positive and therefore a higher index value (titres) should considered to define positivity, specially in low prevalence populations.
Hsv type 2 usually causes genital herpes however Hsv type 1 can also cause genital herpes. Hsv type 1 genital herpes is less severe and there are fewer recurrences as compared to Hsv type 2 disease. Hsv type 1 usually causes oro-labial herpes.
A clinical episode of genital herpes usually presents with genital sores with pain and burning sensation. The episode that you had back in 2012 could have been a clinical episode of genital herpes.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Kakkar S. 8 hours later
I will have to contact the clinic where I had the previous HSV tests done. The timeline can be summed-up as follows:

July 8, 2012- the last time I had sexual activity before I started dating again last November. I was wearing a condom and the person who was with me performed oral sex on me and then we had intercourse. I was wearing a condom the entire time and then removed it carefully and took a shower with soap and water; taking time to wash my genitals.

About 2 weeks later I noticed tingling and burning in my penis, but no development of blisters. I had a feeling something was not right so I made an appointment with a skin clinic in Seoul that has English-speaking doctors and provides treatment to members of the US Armed Forces and their families.

I did the full STD panel (urine and blood tests) and the only thing to come up positive, if I remember correctly, was the HSV-2. I called the doctor to discuss this with him and told him I was not having any classic outbreak symptoms (developing fluid-filled vesicles that break and form open sores) anywhere in the genital area. He suggested I return in another 3-4 weeks to get re-tested, using what he called a more-accurate blood test. This would have been in August 2012, I believe...

When I got the test results back again this time they were negative. However, I had been doing research online while waiting for the results and I learned about the type-specific antigen tests IgG and IgM and I requested that both be done when I returned to the clinic in late September.

In early September I suffered the bout with Vestibular Neuritis and was placed on a 10-day course of antibiotics to treat it. At the end of 10 days I was fine and haven't had a recurrence.

In early October 2012 I developed the lesions on my genitals that I described in my first question and which cleared up when treated with hydro-cortisone and skin-regeneration cream. In late October I got back the results from the third HSV testing and was told I tested positive for both HSV 1 and 2. What was not clear from my conversation with the doctor over the phone was wheter he was looking at the IgM or IgG results. All he said was that "everybody has HSV-1" and that the tests revealed an "old" (past) infection; which I took to mean as I had contracted the HSV-2 earlier than July 2012.

I never did a follow-up consultation with the clinic where I was tested and I never got tested again during the past 2 years; until last Saturday when I went with my fiancee to the international clinic in Seoul. We got tested on Saturday, the blood samples were picked up on Wednesday and my fiancee received an e-mail yesterday with the results. When we got tested, I specifically requested that the IgG antibody test be done. I also asked that my fiancee be e-mailed the results but not me; because I'm trying to not let my employers know that I have (had) HSV-2.

My fiancee read the e-mail to me over the phone and said that my test for syphilis was negative and so was my test for HSV-2. Only the test for HSV-1 was positive. I'm thinking that I most likely contracted HSV-1 in childhood. I also had the chicken pox when I was 3 years old.

From July 2012 until February 2015 I had been completely abstinent from sexual activity. My fiancee and I began having protected vaginal sex in February. On two occasions I performed oral sex on her without a dental dam. I was not having any outbreaks at the time, nor any prodomal symptoms and I had washed out my mouth with antiseptic dental rinse beforehand and afterward.

My fiancee had never been with anyone before me. When she developed the one sore on her lower lip about 10 days ago it was just one single bump like a pimple, not a cluster of open weeping sores that crusted over. I remember that a couple of days before she developed it I had accidentally hit her in the mouth with my elbow when we were in bed together. I wasn't sure if that was the cause or not. She later revealed to me that about a year earlier, before we started dating, she had developed some small blisters on the corner of her mouth and she recalled having undergone a lot of stress at the time. I took that to mean that she already had contracted HSV-1 earlier in life and already had the antibodies when she met me.

If she already had HSV-1 when we met and I had it as well, is it possible I could have transmitted it to her genitally when I performed oral sex on her; even though I wasn't having any symptoms and had exercised good oral hygiene before doing it. So far as I know, I had no lesions, cuts, or anything unusual on my lips at the time. Also, she has not reported experiencing any sores in her genital region.

As I said, the lab report said she tested positive for Type-2 but that the index was low, suggesting a false positive. The report recommended re-testing in 3 months.

I'm wondering about my own timeline... The first two times I was tested for HSV-2 not enough time had elapsed for me to develop antibodies for it. When I got tested a third time, it had been about 3 months since the last time I had sex.

If I got tested last Saturday with the IgG antibody test, and it came up negative for HSV-2; does that mean that I only have HSV-1 (albeit orally and genitally)?
doctor
Answered by Dr. Kakkar S. 12 hours later
Brief Answer:
Only a high index value should be taken as postive

Detailed Answer:
Hi.

It seems that most likely you have only Hsv type 1 infection (oral Or genital).
Hsv type 2 test titres/ index value would be more conclusive of your status for Hsv type 2.
If it shows a high index value for type 2 Hsv, only then it should be taken as positive.
Normally an index value above 1.10 is considered positive ( between 0.90-1.10 is equivocal and less then 0.90 is definitely negative).
Therefore, a high index value for Hsv type 2 e.g 3 Or 5 is definitely positive.
Hsv type 1 can also cause genital herpes and can be passed on during unprotected oral sex and even protected vaginal sex.
Hsv type 1 causes a milder type of genital herpes i.e lesser severity and lesser frequency of recurrences
The risk of transmission for herpes is more during a clinical episode of oral herpes but the virus can still pass on during clinically silent phases as it is being shed from time to time asymptomatically.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 5 days later
OK, I was able to speak with the physician who tested me in 2012. He was looking at my chart during our recent phone conversation. He told me that the last test that was done was IgG and he read me the index values:

HSV-1 had an index value of 4.16

HSV-2 had an index value of 2.76

I don't know the index values for my most recent HSV-1 and HSV-2 tests from 2 weeks ago. I've asked my fiancee to call the clinic where the testing was done and give my index values from the 2012 test results to the doctor so he can compare them with the results he has on file. If the test for HSV-2 that was recently done was IgG an it was negative, then the index value would have to be lower than in the previous result. I'm keeping my fingers crossed that I have only HSV-1... even if it's both oral and genital it will be easier to manage.

I had read online in different health websites that the risk of asymptomatic shedding becomes less with each passing year after the first year of infection.

On occasion I experience strange, tickling, itching sensations that come and go in my face, forehead, and scalp. I'm not sure if they're prodomal symptoms or not; because I don't experience an outbreak afterward. Last month I developed what at first looked like an ingrown hair on the lower-left border of my lower lip. The area appeared slightly inflamed and puffy. A couple of days later I developed what appeared to be a couple of pimple-like bumps that wept a bit and then began healing. It took about 10-12 days to heal completely and then there appeared to be some slight redness remaining, like a scar. At present the area appears to have returned to normal. I'm guessing this may have been an HSV-1 outbreak. While the area was affected, I refrained from kissing my fiancee.

On two occasions I performed cunnilingus on my fiancee... but at the time I had no visible sores and I wasn't experiencing any prodomal symptoms. I realize, though, that there was still a slight risk of transmission.

As I said in my initial question, I have not been managing my condition with any kind of anti-viral medication. The doctors here won't prescribe them for me unless I'm having an actual outbreak. In the meantime I've been taking 1,000 to 2,000 mg daily of L-Lysine supplement to help slow the replication of the virus when it becomes active and to try and prevent outbreaks. I've been reading a lot of contradictory info in that regard: some sources say that L-Lysine does help reduce the re-occurrence of outbreaks and/or reduces the length of them. Others refute this claim, saying that the supplement does no good whatsoever.
doctor
Answered by Dr. Kakkar S. 15 hours later
Brief Answer:
Index value indicates that you are positive for both Hsv type 1 & 2

Detailed Answer:
Hi.

Index value above 1.1 is considered to be positive therefore going by this value means you have both Hsv type 1 as well as Hsv type 2.
Index value <0.90 is considered negative and between 0.90-1.10 is considered equivocal.

However, your recent test for Hsv type 2 was negative!
It is hard to explain the discordant findings and I suggest that you either clarify from the lab Or take up another test from a different lab.

Yes, herpes can be transmitted even during clinically asymptomatic phases though the risk is less.
Clinical episodes become progressively lesser in frequency with each passing year.

L-lysine is not a proven/ approved treatment for herpes and I don't advocate it in my patients.
However, it is available online and many herpes patients take it for its presumed benefits in herpes.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8898 Questions

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