advice on testing timeline and asymp. shedding

[monkeychamp]

Dr. Handsfield,
I had protected oral sex abt 3.5 months ago which caused recurrent mild clear discharge from the penis without erection.
http://www.medhelp.org/posts/show/442774?post_id=post_2648464

While I'm being evaluated by that for a urologist I need some info regarding testing:

1. all my std tests at 3 months hsv1/2 igg, herpes, syphilis were negative. When is the last time i should go get tested? 4 months, 6months? just want to put my mind at ease. what tests in particulr should i repeat? i tried to look around for data on the website but didn't see anything firm.

2. while i'm hsv1 negative since the last results, i would like to know if you hv any data on how often asymptomatic shedding occurs for oral herpes? is a simple peck on the cheek or lips enough to transmit oral herpes?

3. what kind of things to they look for in semen analysis and semen culture? my urologist saw wbc's in my prostatic secretions put me on levaquin for 3 weeks but still saw the wbcs the next time i saw him. does presence of wbc's always mean infection?
my discharge is absolutely clear in nature not like the milky secretion you see after a prostrate massage.

thank you for again for this great service!

[Edward W Hook, MD]

Straight to your questions:

1.  93% of antibody tests for HSV will be positive at 3 months.  You can be slightly "surer" at 6 months but at this time, without lesions or antibodies, you can be confident that you did not acquire herpes.  The 3 month syphilis test can clearly be counted on.
2.  I'm going to answer your question in a slightly different way than you asked.  Most exposures to herpes do not lead to infection.  Your chances of getting HSV-1 from a "peck on the cheek" from someone who is asymptomatically shedding the virus are essentially zero.  It is not something to worry about.
3.  The presence of WBCs in semen or prostatic massage suggest inflammation. It does not necessarily mean infection (there are other reasons for inflammation).   Furthermore and relevant to your question on this site, most prostatitis is not due to STD.  Levofloxacin is a broad spectrum antibiotic effective against many different bacteria

Hope these comments are helpful. EWH

[monkeychamp]

thanks and given that if you have no prior exposure to hsv do you almost always see lesions? also are you aware of any number of days the virus is asymptomatically shed?

[Edward W Hook, MD]

There is asymptomatic shedding from genital sites in persons with genital herpes about 10% of the time.  The figure is likely to be similar for persons with oral HSV-1.  As said before, most exposures do not lead to infection.

Lesions are the rule but there are exceptions.

Please do not let the two facts stated above worry you.  when your exposure and results are considered , the chance that you ahve gotten herpes is tiny and should not be a cause for concern.  EWH

[monkeychamp]

thanks doc. quick ques. on trich. can it be caused by oral sex? and how do doctors test for it?

also my semen analysis report says "few colonies of coagulase negative staphylococcus". thats all it says- what do you make of this?

thanks!

[Edward W Hook, MD]

No, trich is not transmitted by oral sex.  Testing for Trich is not as good as testing for other STDs.  In women it is diagnosed most often by a wet mount microscopic examination of genital secretions.  In men, occasionally cultures are performed or, in research studies PCR but to be honest, few physicians look for trich in men.

The cultures for coagulase negative staph are irrelevant. These bacteria live on the skin normally
EWH

[monkeychamp]

Dr Hook, I just saw the results for my semen analysis. The results hv everything in normal rangle except ph which is 8.3 (7.2 -8 is normal). Any thoughts on this?

[Edward W Hook, MD]

Sorry, this is beyond the scope of my knowledge.  There is no known association between a (slightly) elevated ejaculate pH and herpes.  It is something you should discuss with the person who performed the test.  EWH

[monkeychamp]

Apologies, this was concerning the symptoms of clear discharge i have.

http://www.medhelp.org/posts/show/442774?post_id=post_2648464

[monkeychamp]

so basically what i'm trying to get at is beacause its > 8 is it it means there is an infection. if you see the link below i have discussed my clear discharge issue with you.

http://www.medhelp.org/posts/show/442774?post_id=post_2648464


thanks.

[Edward W Hook, MD]

Read my response please. Ejaculate pH is not within my field of expertise.  As I said, "There is no known association between a (slightly) elevated ejaculate pH and herpes.  It is something you should discuss with the person who performed the test. "  In general infection make the pH of body fluids go down, not up.  EWH ,

[monkeychamp]

Dr. Hook/HHH,
I went to my derm for just a regular checkup and mentioned to her abt the protective oral sex encounter i had 5 mths ago. As a precaution she did the hsv 1/2 igg and igm tests on me.

Plz note that i have had hsv 1/2 IGG tests at week 5, 14, 18 and they have ALL been negative. This is the FIRST time she did an igm also.

the results for the tests she did(week 22) were
hsv1 igg - negative
hsv2 igg- negative
hsv1/2 igm - positive(high)

she said this might be beacuse of seroconversion. she doesnt beleive igm result can be a false positive.

a few questions:
1. igm is usually high due to recent infection( i hvnt been sexually active in 5 months). how recent is recent? i kissed a girl 1 month ago but she had no lesions that i 'm aware of nor have i had ANY outbreak at all in the past month since i kissed her or last 5 months since the protective sex encounter.

2. if i do need to get tested again, when shud i get tested? how soon does igg turn positive if igm is positive( and lets assume its a true positive)

3. if this igm is infact a false positive( as dr hhh hs mentioned in numnerious posts that it can be), does it mean/imply anything else? all my IGG tests so FAR have been NEG. why do still docs do this test?

Thanks much for your help!

[Edward W Hook, MD]

Sorry, if you search this site you will see that we both have repeatedly stated that IgM tests are a waste of time, are nonspecific and should not be done.  They pick up antibodies from many other infections in non-specific fashion and are misleading.  the reason they and other non-gG, non-type specific tests are still available is because the manufacturers claim they are specific and they were brought to market before the current generation of improved test became available.  The FDA has a method for clearing tests so that they can be tested before they are brought to market but no means for taking them off when better tests become available or when earlier claims are found to be incorrect.  EWH