HSV-2 Rapid Test result

[SSS10001]

Hello and thank you so much for this forum.  I had an HSV 1 and 2 - specific Ab, IgG by Labcorp in the last 10 days.  20 years married and monogamous. Did a full work up with new gyno and requested comprehensive work up due to intermittent dyspareunia.  Evidence of lichen planus on exam.  Every test normal except HSV as follows: HSV 1 IgG, Type Spec <0.91 negative and HSV 2 IgG, Type Spec 1.61.  Specimen sent through Labcorb to Univ of Wash this week.  HSV-2 Rapid Test showed extremely faint pink next to bright right control spot.  It was a very faint pink and indistinct. I have a variety of autoimmune issues - Hashimotos Thyroiditis, +ANA on previous labs, Lichen Planus (oral and vulva).  So....questions are: Is an HSV - 2 Rapid test ONLY negative with completely white next to control spot or is mine possibly negative?  Also, can autoimmune issues affect HSV IgG results and or HSV-2 Rapid Test?  Just interested in your thoughts on these questions as I am impatient on waiting on the WB result lol.  Asymptomatic HSVwise and shocked when got results at work up. Thanks in advance!!

[Terri Warren, RN, Adult Nurse Practitioner]

You're welcome

Terri

[SSS10001]

Thanks so much

[Terri Warren, RN, Adult Nurse Practitioner]

No, Bactrim doesn't cause an outbreak but very frequently, women can present with UTI symptoms that are actually herpes lesions in the urethra.  Herpes lesions in the urethra can present with white cells (small amounts) in the urine and pain with urination.  The way you describe the labial symptoms, I'm thinking you've nailed an outbreak presentation in yourself.  

I didn't know that UW was offering daily home swabbing, that's great.

Terri

[SSS10001]

Hi Terri, your answers have been very helpful as have two phone consultations with Dr. Toulbe (sp?).   Although  I would consider myself asymptomatic over the years, I have seen you refer to people recognizing subtle symptoms post diagnosis.  I tested for HSV 1/2 because after receiving cortisone injections, oral prednisone for lichen planus and using Singulair for other issues (all concurrently) I had rashes develop on vulva and in my mouth.  The rash on vulva biopsied for lichenous eczema.  My recent result for + WB HSV 2 (neg HSV 1) was unexpected.  My hubby (20 years married and monogamous) Is negative HSV 2.  I have been searching the dusty corners of my mind for possible episodes that might have been HSV 2 symptoms.  A few years ago I took one Bactrim DS for sinusitis and within 2 hours suffered significant tingling (nerve pain) on left labia majora/minora followed by severe swelling, redness which took several days to a week to improve. (only took one Bactrim DS tablet).  Diflucan didn't expedite resolution; it just took time.  If I had to identify possible mild HSV 2 symptoms in the past it would be in that exact area.  Can Bactrim DS cause an OB?  Obviously it could have been an allergic reaction, but the location makes me wonder if it was OB due to the Bactrim DS....thanks Terri.  
PS I'm doing a month of swabs to send back to U of W for shedding analysis.  I greatly appreciate the opportunities for analysis....

[Terri Warren, RN, Adult Nurse Practitioner]

You're welcome.

Terri

[SSS10001]

Thank you very much for your feedback.  

[Terri Warren, RN, Adult Nurse Practitioner]

I'm not aware of any cases of a false positive HSV 2 western blot.  The structure of the test really doesn't allow for this.

If you've had HSV 2 for 20 years and your husband is uninfected and you've had no other partners, the chances that he will get it at some future time are really quite low.  We know that partners of people with HSV 2 who are themselves negative develop an immune response detectable in the CD8 cells that appears to be protective, over time, though we don't know that this is 100% protective.  Needless to say, there are explorations of how this might work in a prophylactic vaccine.  

Is your husband worried about this?  My experience is that the uninfected partner is far less worried about getting herpes in this situation of long term relationships than is the person who has herpes.

Hope my office was able to provide you some good counsel.

Terri

[SSS10001]

Thanks so much, Terri. My WB was positive which is disappointing but I'll manage. This forum is so reassuring. Problem for me is that hubby of 20 years is negative on rapid test. He has not had Elisa igg specific lab. We are monogamous and I'm amazed he's not positive as I was clueless of my status. Now researching suppression....am on valtrex already. Have phone consult with your clinic later today. I don't want to transmit this to him!!!  I'm still in denial a little bit and was hoping for cases of false positive WB lol ;)

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, we have definitely seen pale pink dot people be negative by western blot.  No question, yes.  I don't have any indication at all about what might cause a pale pink dot, none, and I don't believe anyone does, quite honestly.  It would have been so great if this little test didn't have this little problem, but it does and that makes me leary about using it.  A complete white area where the dot should be is great and reassuring, but too often we got the pale pink dot.

Terri

[SSS10001]

Thanks for your reply....I am a health care provider myself and ordered it using my upin #...I have an account with labcorp as provider.  I had this lab call the phone number on the paperwork in the kit and it was a smooth process.  They were overly accommodating.  Have there been cases where there was a very pale pink dot that followed up with a negative WB?  Thoughts on autoimmune antibody contribution - generally speaking?  I know it's speculation at this point in my particular case, but your expertise provides very good information...

[Terri Warren, RN, Adult Nurse Practitioner]

The reason we don't use the rapid test kits any more is because I had trouble with the very pale pink dots, not knowing if they are positive or negative.  Very frustrating.  You were wise to get the western blot.  I'm quite surprised that LabCorp could do that for you/  How did you manage that?  I've been completely stonewalled with them, trying to get that sent to UW.

Terri