What are the tests available to differentiate between a herpes simplex infection and penile cancer?

Question

Hi doctor,

I had unprotected sex with my partner, and she had eczema on her hands. Now, I have body aches, tingling sensations all over my body, and frequent urination. I also have bumps on my penis, but it is not painful, and there is no discharge. Before this sexual activity, I had consulted a urologist because my PSA levels were high. The urologist said it could be due to prostatitis as malignancy was ruled out via an MRI and DRE. I suspect this to be an HSV infection. Can an HSV infection cause frequent urination and raise my PSA levels? Do I need antiviral drugs? Can I do nothing since it is not causing much disruption to my daily life? Should I check if it is HSV1 or 2? Are these bumps a sign of penile cancer? I have attached the pictures for your reference. Kindly suggest.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern. The clinical diagnosis of genital herpes should always be confirmed by laboratory testing, including serotyping antibodies, IgG (immunoglobulin G), and IgM (immunoglobulin M). The definitive diagnosis of genital herpes relies on demonstrating the presence of HSV in the genital area either by virus isolation or antigen testing. Though various tests can identify HSV (herpes simplex virus) antibodies, few tests can differentiate between HSV-1 and HSV-2. IgM antibodies become detectable 10 to 21 days post-infection, with IgG-class antibodies developing around the same time. Also, IgM antibodies may persist for months following the resolution of the initial infection and may or may not develop during recurrent infection, whereas IgG will persist indefinitely. IgG assays are type-specific, meaning that they can differentiate between HSV type 1 and HSV type 2. HSV IgM assays are not and have not been recommended for diagnosis by recent guidelines. From the reports attached (attachment removed to protect the patient's identity), your IgG levels are positive but have not been reported for HSV-1 or 2. I suggest you repeat the HSV test.

An increase in prostate-specific antigen (PSA) is not only seen in prostate cancers, but also in prostate inflammation and urinary infections. However, a continuous rise beyond 4 unit values in about two or more tests might suggest prostate cancer. I suggest you consult an oncologist for the increase in PSA.

I hope this helps you.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern. Although it appears more like herpes lesions than penile cancer blisters, I suggest you perform the recommended tests because visual inspection cannot be used to distinguish between an HSV infection and penile cancer. For penile cancer, radiographic studies such as an MRI (magnetic resonance imaging) and ultrasonography can detect it and the lymph nodes. Additionally, a penile cancer lesion biopsy can help confirm the diagnosis and its staging.

I hope this helps you.

Thank you.