Genital Herpes Diagnosis and Patient Education in Urology

Regarding the diagnosis and education issues related to genital herpes?

1.
Doctor, I have phimosis and there are lesions and ulcerations on the inner side of my foreskin, but I have not observed any blisters.
A urologist diagnosed me with herpes virus.
After 15 days of treatment, I sought a consultation with an infectious disease specialist, who assessed that it did not appear to be herpes because there were no blisters (however, since he did not examine the lesions initially, he was hesitant to make a definitive conclusion and mentioned that it is possible to have herpes without blister formation).
Furthermore, the ulcerated area is quite extensive, and he suggested that aside from herpes, there could be other bacterial or viral infections causing the ulcerations.
I also underwent testing for sexually transmitted infections during the initial outbreak, and the results were as follows: (11/18, Herpes Simplex Virus Type 2 IgM: 3.66 (-); 12/10, Herpes Simplex Virus Type 2 IgM: 2.45 (-)).
Other tests for syphilis, HIV, and Chlamydia IgM antibodies were all negative.
Is it still possible that I have genital herpes? Should I also get tested for Herpes Simplex Virus "IgG"? (I am currently waiting for the ulcerated area to scab over.)
2.
If I do indeed have genital herpes, can I engage in unprotected sexual intercourse with my partner during asymptomatic periods (as I wish to conceive)?

Yang, 30~39 year old female. Ask Date: 2022/12/13

Dr. Chen Jiansheng reply Urology

Please seek medical attention.

Reply Date: 2022/12/13

More Info

Understanding genital herpes, particularly in the context of diagnosis and patient education, is crucial for both the affected individuals and their partners. Genital herpes is primarily caused by the herpes simplex virus (HSV), with two types: HSV-1 and HSV-2. While HSV-1 is often associated with oral herpes, it can also cause genital infections. HSV-2 is more commonly linked to genital herpes.

1. Diagnosis and Testing: In your case, the presence of skin lesions without vesicles (blisters) can complicate the diagnosis of genital herpes. The absence of vesicles does not rule out herpes, as some individuals may experience atypical presentations. The serological tests you underwent for HSV-2 (IgM) are useful, but they have limitations. IgM antibodies can sometimes yield false negatives, especially if the infection is recent or if the body has not yet produced detectable levels of these antibodies.
The IgG test is more reliable for diagnosing herpes infections, as it indicates past exposure to the virus. If you have not yet had an IgG test, it would be prudent to do so. This test can help determine if you have been exposed to HSV-2, even if you are not currently experiencing symptoms. Given your symptoms and the results of your IgM tests, it is advisable to consult with your healthcare provider about the possibility of an IgG test to clarify your status regarding genital herpes.

2. Transmission and Sexual Activity: If you are diagnosed with genital herpes, it is essential to understand how the virus is transmitted. Herpes can be spread even when there are no visible symptoms, a phenomenon known as asymptomatic shedding. Therefore, engaging in unprotected sexual intercourse with a partner could potentially transmit the virus, even if you are not experiencing an outbreak.

If you are considering trying to conceive, it is crucial to discuss this with your partner and healthcare provider. While it is possible to have a healthy pregnancy and delivery with herpes, precautions should be taken to minimize the risk of transmission to your partner and, if applicable, to the baby. This may include using antiviral medications during pregnancy and delivery, especially if there is an active outbreak at the time of delivery.

If you are not diagnosed with genital herpes, but are still concerned about your symptoms, it is essential to follow up with your healthcare provider. They may recommend further testing to rule out other infections or conditions that could cause similar symptoms, such as bacterial infections or other sexually transmitted infections (STIs).

In summary, it is vital to obtain a definitive diagnosis through appropriate testing, including the IgG test for herpes. Understanding the nature of herpes transmission is crucial for making informed decisions about sexual activity and family planning. Open communication with your partner and healthcare provider will help ensure that you take the necessary precautions to protect both your health and that of your partner.

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