Genital Herpes and Balanitis: Symptoms and Diagnosis

Genital herpes? Balanitis?

Dear Director:
On March 8, I had my last sexual encounter.
On the morning of March 12, I experienced painful urination and noticed two or three red spots near the urethral opening of the glans.
I consulted a doctor on March 13 (no internal examination, only a urine test), and the doctor mentioned mild urethritis.
By March 18, the symptoms became more pronounced, and I had blood drawn that day, receiving a prescription for oral and topical tetracycline.

On March 20, I noticed an increasing number of wounds (ulcers) on the foreskin, resembling small holes.
I returned for a follow-up but did not receive any medication (only had the dressings changed).
On March 21-22, the situation peaked in the morning, with redness and swelling of the foreskin, itching and pain from the wounds, and worsening swelling of the glans.
During the follow-up, I reviewed the test results: syphilis was negative, and HSV-2 IgG was negative.
However, when I consulted the clinic physician, he suspected genital herpes and arranged for a referral (?).
Yet, he only changed the dressings and was still reluctant to prescribe antiviral medication for herpes.

On March 22, feeling uneasy, I went to another clinic.
After an internal examination, they also suspected herpes and prescribed both topical and oral antiviral medications.
I also paid out of pocket to retest for HSV-1 IgG and HSV-2 IgG, but the clinic said they did not have IgM testing available.

This summarizes my medical history.
I would like to ask you, Director, how accurate is the blood test from March 18? What possibilities could arise from the blood test results on March 22? Lastly, aside from genital herpes, what other potential conditions could I be facing? I feel like I have been completely overwhelmed this week.
🙏

zuò lì nán ān, 30~39 year old female. Ask Date: 2024/03/23

Dr. Li Minghui reply Urology

We recommend that you discuss the above situation further with your attending physician.
Wishing you good health.
Thank you!

Reply Date: 2024/03/23

More Info

Genital herpes is a common sexually transmitted infection caused primarily by the herpes simplex virus (HSV), which exists in two types: HSV-1 and HSV-2. While HSV-1 is typically associated with oral herpes, it can also cause genital infections, particularly through oral-genital contact. HSV-2 is more commonly linked to genital herpes. The symptoms of genital herpes can vary significantly among individuals, but they often include painful blisters or sores in the genital area, itching, and discomfort during urination.
In your case, the timeline of symptoms you provided suggests a progression that could be consistent with genital herpes. The initial symptoms of burning during urination and the appearance of red spots near the urethra could indicate an inflammatory response, possibly due to a viral infection. The worsening condition, with the development of sores and increased redness and swelling, aligns with the typical presentation of a herpes outbreak.

The diagnostic approach for genital herpes typically involves a combination of clinical evaluation and laboratory testing. In your situation, the blood tests for HSV-2 IgG were negative, which suggests that you may not have been previously infected with the virus. However, it is important to note that IgG antibodies can take time to develop after initial infection, and a negative result does not definitively rule out a recent infection. The IgM test is often used to detect recent infections, but it is not always reliable, and many clinicians prefer to rely on clinical symptoms and the presence of lesions for diagnosis.

The fact that your healthcare provider suspected genital herpes despite negative serology indicates that they were considering the clinical presentation as a significant factor. The presence of sores, especially if they are painful and recurrent, is a strong indicator of herpes. The recommendation for antiviral medication is standard practice for managing herpes outbreaks, as these medications can help reduce the severity and duration of symptoms.

Aside from genital herpes, other potential diagnoses for your symptoms could include balanitis (inflammation of the glans penis), which can be caused by infections, irritants, or allergic reactions. Other sexually transmitted infections (STIs) such as syphilis, gonorrhea, or chlamydia could also present with similar symptoms, although your negative syphilis test is reassuring.
It is crucial to follow up with your healthcare provider regarding your symptoms and the results of your tests. If the sores persist or worsen, further evaluation may be necessary, including a swab of the lesions for viral culture or PCR testing, which can provide more definitive results for herpes.
In conclusion, while your symptoms are suggestive of genital herpes, the negative serology requires careful interpretation. It is essential to maintain open communication with your healthcare provider, adhere to prescribed treatments, and consider follow-up testing to clarify your diagnosis. Additionally, practicing safe sex and informing partners about your health status is vital in managing STIs. If you continue to feel overwhelmed or anxious about your health, seeking support from a mental health professional may also be beneficial.

Similar Q&A

Understanding Genital Herpes: Symptoms, Diagnosis, and Treatment Options

On February 13 of this year, I visited the clinic due to frequent urination and discomfort in my bladder. After taking medication for five days, I only experienced slight improvement, but then I developed sharp pain in my left testicle. I was prescribed another five days of medic...

Dr. Du Shixi reply Urology
Hello: Your skin condition is likely balanitis. Genital herpes does not manifest unless there are symptoms (it may flare up if your immune system weakens). The tests at major hospitals are quite accurate. It is advised to avoid unsafe sexual practices, as both genital herpes and ...

Understanding Genital Symptoms: Herpes or Fungal Infections?

Hello, Doctor! I would like to ask whether my symptoms are indicative of genital herpes or candidal balanitis. I have been symptom-free for six months, but recently I have been feeling more stressed, depressed, and anxious. Occasionally, I experience a cramping sensation in the g...

Dr. Du Shixi reply Urology
Hello: Herpes is not something that can be completely cured; it tends to recur when the immune system is weakened. Medication and topical treatments only reduce the duration of the outbreak. Tests primarily confirm whether one has had the infection before. It is essential to obse...

Is Balanitis the Same as Herpes? Understanding the Differences

Hello Doctor, thank you for your response to my previous question. A few days ago, I had a blood test that confirmed my recent HSV1 IgG levels are elevated. The doctor mentioned that this might be due to oral sex leading to inflammation of the glans. However, based on my symptoms...

Dr. Du Shixi reply Urology
Hello: Balanitis is a broad diagnosis with various causes, used when the specific reason is not fully understood or when multiple factors may be involved. Wishing you good health.

Understanding Genital Herpes: Symptoms, Testing, and Transmission Concerns

Hello, Doctor: Recently, I visited a doctor due to itching of the glans, and the initial diagnosis was balanitis. Blood tests were conducted, and medication was prescribed. After four days of oral and topical treatment, I noticed improvement. During my follow-up appointment, I re...

Dr. Xu Weikai reply Urology
Hello, genital herpes. A blood test shows positive, and we need to determine which type of antibody is present. Some antibodies indicate a past infection, while others indicate an active infection. Herpes only presents with blisters during the initial outbreak; afterward, it rema...