HSV-2 initial blood testing

[Jerod]

Hello. I recently had unprotected sex with a woman who told me she was HSV2 +, but was asymptomatic for 2 yrs. However, she had just finished her period and had small abrasions on her arms due to a bike accident. I've been with only one other woman in the last few years. I became anxious 3-4 days after this recent experience when I started feeling brief 'prickly/burning' and 'muscle ache' in my penis, as well as low-grade 'burning' around my anus (this during that initial time, not since). I also experienced a few muscle aches in my inner thigh and my gluts. I have had these ongoing symptoms for two weeks and seem to be subsiding. I have, however, had none of the stereotypical prodromal symptoms of itching or burning, tingling while urinating or deficating, no fever, and from what I can tell no swollen lymph-nodes in my groin nor flu-like symptoms.  Most importantly, I have not had any lesions around my genitals.  

I saw my dr. 5 days after the encounter and I got the entire STI blood panel done the next day. I tested negative on HIV, chlam, gon, syph. I tested positive for HSV 1, which I knew I had but had never been blood tested for. I haven't had an outbreak for years. For HSV2, I tested negative on the IgM, but borderline negative on IgG with a .91 reading.  My dr. suggested a re-test at the 2-wk mark to see if the IgG reading goes up - which may indicate that I have the hsv-2 virus.  

My questions are:

1) Is it possible that I took the initial IgM/IgG tests too soon to detect any antibodies? I understand that a more accurate IgG test would be done at the 3-month mark...
2) What does the IgG .91 reading mean if I ultimately don't have any HSV-2 antibodies?
3) How quickly/rapidly would an IgG antibody count increase if one is infected?
4) What impact, if any, would my + HSV1 IgG have on my HSV2 IgG blood reading? i.e. would my + hsv1 confuse the IgG reading, making it either false positive or false negative?
Thank you.

[Terri Warren, RN, Adult Nurse Practitioner]

1)Yes, you took it way too soon.  Your test for HSV 2 is basically only a baseline test at  that point to tell if you were infected prior to having sex with her, which you were not.  I would wait at least 6 weeks for a second test, and even then, only 70% of people are positive by then, if you want to be really sure, you need to test again at 4 months post exposure.
2) It means nothing if you don't become positive.  Really, no meaning at all.
3) I would expect to see some increase by 6 weeks, but don't take antivirals during that time or it could screw up your test results
4) Your positive HSV 1 will mean that you will seroconvert more slowly to HSV 2, if you do become infected.  It could contribute to the high negative value of .91.  

The abrasions on her arms have nothing to do with transmission at all.  And the chance that you would get HSV 2 after one encounter with her is very low.  I would suggest that you try to keep your worry down and just retest.  Most likely, things will be fine.  Let me know if you have other questions.

Terri

[Jerod]

Thank you, Terri.  Given that my test results are in limbo - and I may or may not have contracted HSV2 - does it mean that I'm more or less likely transmittable right now without any usual prodromal signs or lesions? Or is that just too difficult to answer?  Not that I'm looking to infect others, but I'd like a sense.

I mentioned that I had one encounter, true, but we had sex a few times within an hour, so does that count as multiple encounters and if so, increasing the chances of contracting HSV2?  And finally, given that she just ended her period, does that increase chances at all?  I know that these are all hypotheticals and are hard to answer firmly, but your expert feedback is appreciated.  

[Terri Warren, RN, Adult Nurse Practitioner]

If I were in your situation, I would probably restrict new sexual activity until I had a better idea about what was going on, just to be on the safe side.
Yes, each time you had sex counts as an encounter, I would say.
I'm not clear that her having her period has any influence either way on transmission.


Terri