HSV2 Incubation periods and changes in OD ratios

Question for Nurse Practioner Terri Warren:

I am a male, had protected vaginal sex in late March with female. Had sex twice in space of an hour and half, used a new condom both times and showered immediately after. Have not had any new partners since that time.

About a week after noticed a red bump in pubic hair at base of penis around a hair follicle. No ulceration or clusters or. Used zinc oxide based cream spot went away after three days. Then started to get small red blemishes on scrotum. Went to public GUM clinic and had viral swab which came back negative. Zinc oxide general antiseptic clearing spots in a few days. At exactly two weeks post exposure came down with bad cold (sweats, sore throat, upper respiratory) but one morning also noted stiff neck.

All through April and May noticed small bumps coming and going clearing up in a few days and also noted all over body intense and persistent muscle twitching and some discomfort but no swelling in inguinals.

At 8 week mark saw a dermatologist and during the consultation the GUM specialist came in and offered IgG testing. Said I would have developed antibodies by then. test results were HSV1 2.114 and HSV2 0.061. Test kit was a BioKit BioELISA test. Always had oral cold sores so results not surprising. Basically negative for HSV2 BioKIt reference rate is <0.9 is a negative for HSV2. Not concerned about HSV1. Old infection.

At 9 weeks itching and irritation became so intense visited a public GUM clinic and diagnosed with MCV and had about 5 frozen off which relieved itching temporarily-sores from cryo took a week to scab an go away.

At 10 weeks returned to GUM clinic of original blood work to retake test after developing sores around hair follicles in far RHS of pubic hair about 2.5 inches higher than base of penis. Blood work comes back HSV1 3.241 and HSV2      0.183. Doctor PCR swabbed sores at 4 days post outbreak and they also came back negative. Doctor prescribed Doxycycline said it was folliculitis.

Take same test kit again at 12 weeks after reading test is only really reliable between 12 -16 weeks post exposure. Bloods back HSV1 4.224 and HSV2 0.14. By now my Doctor thinks I am crazy says that I am 100% HSV2 negative and leave further testing. Just giving myself anxiety.

Continue to have itching patches in and around scrotum which change colour and come and go in similar places. Small single pimple like sores in pubic hair that take a few days to clear. Small skin breaks in scrotum where penis and scrotum meet that are mildly uncomfortable and red and take a a week to clear with anti-sepctic cream.

Finally take comfort test (same test kit as last three tests) at 18 weeks just to be sure. Results HSV1 3.143 but HSV2 now at 0.755. My doctor tells me I am worrying un-necessarily and that the change in OD ratio has no clinical significance and that any level below 1 is simply negative.  Reference rate for the BioKit ELISA test for HSV2 is <0.9 negative. Doctor also says plenty of time has passed and that I would have seroconverted by now after 18 weeks and that even 12 weeks was enough.

Q1. Does the change in Optical Density ratio with the same test kits between week 12 and week 18 show me as gradually sero-converting or would the results shown a higher number after 18 weeks if I was indeed positive. What is the normal pattern observed on tests where someone is sero-converting?

Q2. Can I take any comfort from the 18 week test-given the OD ratio has gone up so much from 12 weeks? Should I re-test again now at almost 6 months?

Q3. Given persisting symptoms (skin splits, itching, red patches, fissures that take 3-4 days to clear) should I re-test or is 18 weeks definitive? Should I stick with the same kit? I am reluctant to take Herpeselect given problems with false positives at low reference rates.

Q3. Is the Western blot test available outside the USA (Europe/UK) and if so where?

[gracefromHHP]

this isn't Terri's forum. you have to pay to post on her forum.

you don't need any more herpes testing. the changes in your hsv2 igg's are insignificant and enough time has passed to trust your results.

continue to follow up with the dermatologist as needed. Odds are your itching is from the folliculitis and/or a fungal infection from the antibiotics used to treat it.

this was protected sex. the risk of any std from it is very low. none of your symptoms even sound like herpes but sound far more like the 2 conditions you have already been treated for.

grace

[Katowicz]

Thanks Grace and apologies for not knowing Terri was a pay for in a different forum. Really appreciate the work you guys do.

Reason for my anxiety is that the pimple like spots keep occurring in roughly the same spots and since the exposure have been fairly much on and off every month. Additionally not always around a hair follicle either. Basically small one off pimples in the pubic hair sometimes accompanied by an itch or a burn- no swelling though.
I'm worried that I'm just taking longer than 18 weeks to seroconvert. Or I'm one of those unlucky few that never seroconvert at all. Definitely something not right going on since the exposure. When you sayy symptoms are not indicative of HSV 2 could you explain what you would most likely see in a new indection around 3-6 months?

[gracefromHHP]

not likely you are taking so long to seroconvert. also recurrences tend to be single lesions, not multiple like you are having. really no reason to suspect herpes as a cause based on the symptoms you described.

[Katowicz]

Ok so I get a fresh sore/spot at base of penis sp it's straight back to doctor this time as soon as it came up. Small ulceration that came up very sore like an open cut and have it PCR swabbed. Also one more IgG test at 5.6 months. Bloods come back HSV1 6.075 and HSV2 0.52. Negative swab comes back two days later. Driving me nuts. Can I put this aside now with a negative IgG at almost 6 months? What else could be causing these recurrent long lasting sores in my pubic hair so close to my genitals?

[Katowicz]

Ok so I get a fresh sore/spot at base of penis sp it's straight back to doctor this time as soon as it came up. Small ulceration that came up very sore like an open cut and have it PCR swabbed. Also one more IgG test at 5.6 months. Bloods come back HSV1 6.075 and HSV2 0.52. Negative swab comes back two days later. Driving me nuts. Can I put this aside now with a negative IgG at almost 6 months? What else could be causing these recurrent long lasting sores in my pubic hair so close to my genitals?

[gracefromHHP]

already told you you shouldn't be thinking herpes at this point :)

bacterial infections can keep coming back. sometimes not easy to get rid of them.