Recurring Ulcers: Herpes Diagnosis and Testing Accuracy

Q: Recurring Ulcers: Herpes Diagnosis and Testing Accuracy

Based on your description, the sexually transmitted infection (STI) tests are mostly negative. <br>If there are deeper ulcers, the primary concern is likely a bacterial infection (which may also be accompanied by a viral infection). <br>If there is also dampness, such as in the c

A ulcer-like lesion appeared beneath the glans, diagnosed as herpes. There has been one recurrence. Blood tests showed no herpes infection. Inquire about the accuracy of the test?

Previously, frequent masturbation led to a skin tear below the coronal sulcus (without ulceration).
On February 5th, after confirming that the skin tear had healed with no wounds, I engaged in unprotected sexual intercourse and noticed that the previously injured area had torn again during cleaning.
On February 7th, I discovered ulcer symptoms (very painful).
On February 10th, I consulted a urologist, who visually diagnosed it as herpes.
I was prescribed pain relief, antibiotics, and antiviral medication for herpes.
By February 25th, the ulcer had mostly healed, leaving red marks.
On March 1st, the wound recurred, and I returned for consultation.
I was prescribed pain relief, antibiotics, and antiviral medication for herpes again.
On March 3rd, I visited a clinic for blood tests to conduct a "serological immune test" for HSV-I and HSV-II.
On March 6th, I received the test results.
Serological immune test: HSV-I IgG Herpes Simplex Virus Type I IgG - Test value: 0.02, Normal reference value: <0.6; HSV-II IgG Herpes Simplex Virus Type II IgG - Test value: 0.2, Normal reference value: <0.5.
Additionally, tests for TPPA, VDRL (RPR), and HIV were all negative.
Molecular testing: Gonorrhea DNA (PCR) and Chlamydia DNA (PCR) were both negative.
By April 1st, the wound had nearly completely healed, but there were still red marks, and the healed area occasionally ached.

Question: The test results were negative, but since the occurrence of sexual intercourse, I have indeed experienced ulcerative herpes symptoms, and the physician diagnosed it as herpes.
Could it be that the testing was too close to the infection date, with nearly a month having passed, and that the antibody levels had not increased sufficiently, leading to inaccurate test results? As of April 2nd, nearly two months have passed since the first ulcer was discovered; would retesting now yield higher accuracy? Given that there was already a wound before the ulcer was discovered, is it possible that during intercourse, the healing area ruptured, leading to other bacterial infections causing the ulcer, rather than being caused by the herpes virus? Or could other sexually transmitted infections be responsible for the ulcer?

Alex, 20~29 year old female. Ask Date: 2023/04/02

Dr. Li Xinyi reply Urology

Based on your description, the sexually transmitted infection (STI) tests are mostly negative.
If there are deeper ulcers, the primary concern is likely a bacterial infection (which may also be accompanied by a viral infection).
If there is also dampness, such as in the case of not having a circumcision, there may be a fungal infection as well.
Treatment should primarily consider oral and topical antibiotics.
If the wound has not yet healed, it is important to rest adequately; without proper rest for about ten days, healing may be difficult.

Reply Date: 2023/04/02

More Info

When it comes to recurring ulcers, particularly in the context of herpes simplex virus (HSV) infections, it is essential to understand both the diagnostic process and the factors that may contribute to the symptoms you are experiencing. Based on your timeline and the medical evaluations you've undergone, let's delve into your concerns.

Firstly, the symptoms you described—painful ulcers in the genital area—are indeed consistent with herpes simplex virus infection. The fact that your healthcare provider diagnosed you with herpes based on visual inspection supports this. However, the subsequent serological tests for HSV-1 and HSV-2 returned negative results, which raises questions about the timing of the tests and the potential for false negatives.

Serological tests for HSV typically measure the presence of antibodies (IgG) against the virus. It is important to note that antibodies take time to develop following an initial infection. In many cases, it can take several weeks to months for detectable levels of IgG antibodies to appear in the bloodstream. Given that your first symptoms appeared shortly after engaging in unprotected sexual intercourse, it is possible that the timing of your blood test (approximately one month post-exposure) was too early to detect antibodies, leading to the negative results.
As for your question regarding the accuracy of the tests, it is generally recommended to wait at least 4 to 6 weeks after potential exposure to allow for sufficient antibody development before testing for HSV. Since you are now approaching two months since the onset of your symptoms, retesting may yield more accurate results.
Additionally, it is crucial to consider that other factors could contribute to the ulceration you experienced. The initial skin breakdown in the area could have created a portal of entry for other pathogens, leading to secondary infections or ulcers that are not directly related to HSV. Other sexually transmitted infections (STIs), such as syphilis or chancroid, can also present with ulcerative lesions. The negative results for gonorrhea and chlamydia are reassuring, but they do not rule out other STIs.
Given that your symptoms have persisted and you have experienced recurrent ulcers, it would be prudent to follow up with your healthcare provider. They may recommend additional testing, including a swab of the ulcerated area for viral culture or PCR testing, which can provide more definitive evidence of an active HSV infection.
In summary, while your initial serological tests returned negative, the timing of those tests may have influenced the results. Given the persistence of your symptoms, retesting after a sufficient interval and considering other potential causes for your ulcers is advisable. Always communicate openly with your healthcare provider about your symptoms and concerns, as they can guide you through the appropriate diagnostic and treatment pathways.

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