What's going on?

Only had 2 sex partners in life: #1 is my current bf (of 7 yrs); #2 was a one night stand, an old friend. MAR 09 (9 weeks after sex with #2 and 1.5 weeks after sex with #1), I had a flu/sore throat; spotted 6-7 purple sores in my vulva, bilateral. My GYN said the sores didn't look herpetic at all, said I had some nasty yeast infection and gave me antifungicals (powder, cream, oral). After 48h the sores eroded, looking like canker sores and urinating was painful. GYN then said it was probably herpes. Just to mention, a couple of weeks before all this I had had my pap smear and my GYN didn't mention any vulvar sores going on.
5 days after onset I had a PCR swab - negative for HSV (not on antivirals at the time, still had sores). Also had a combo HSV1+2 sorology that was positive. A month after onset I had a HerpeSelect - HSV1 3.4; HSV2 1.1. Then 5 weeks later I had another HerpeSelect - HSV1 1.3; HSV2 0.6.
Partner #1 tested HSV1+, HSV2-, no history of noticeble cold sores. Partner #2 showed me results of glycoprotein based test (not by Focus, but by R-Biopharm) 4 months after our encounter, IgG and IgM negative for HSV1 and HSV2. Claims never having symptoms.
So I moved on. But in June 2010, while having another bad sore throat (and during sex with #1), I again felt two sores in my vagina, plus two weird pimples in upper buttock. GYN refused to swab it, said vulvar sores can only be HSV. Me and Partner #1 had another sorology test - still HSV1+, HSV2-. Partner #2 still claims having no symptoms at all, neither his current girlfriend. He's willing to get tested again, but I'm not sure if it's a good idea after 2 years - might confuse us even more. What do I make of all this? Do I have HSV2? I don't have access to WB.

[Terri Warren, RN, Adult Nurse Practitioner]

Well, you could have HSV 1 genitally and orally.  I cannot imagine why your doc didn't swab the lesions, that is just not acceptable.  I would ask again for a swab test kit to take home with you so you can gather a swab from any unusual skin area.  If you can't get that done, you can call my office, become a phone patient, and we can send you swabs to gather at home and send back to us.  You need to figure this out, and at this point, I think swab testing is the only way to get more clarity.

Terri

[atlost000]

Just to clarify: my boyfriend (partner #1) and I had our latest sorology tests in June 2010 and December 2010, all with the same results: HSV1+, HSV2-.

[atlost000]

Thanks, Terri. Yes, I am aware that genital HSV1 is a possibility, but my GYN said that the fact that my boyfriend does not experience cold sores is against such possibility; besides, she said that a positive combo sorology during the "initial episode" is also against genital HSV1; she was expecting a seroconversion for HSV2, which never happened.

Any truth in such statements? Besides, why was my PCR swab negative during initial episode for both HSV, isn't that odd?

I don't live in the US so I'm afraid I won't be able to call your office and arrange the swabs. But my dermatologist is fully aware of my case and is willing to see me (and swab the lesions) if such sores reccur again. I've been checking myself daily in the last 8 months and no similar episodes have caught my attention.

Do you personally believe that HSV2 is a possibility in my case? Thanks, Terri.

[Terri Warren, RN, Adult Nurse Practitioner]

People shed virus from the mouth without symptoms, just as people do from the genitals.  About 30-40% of new genital herpes is HSV 1 now, I'm not in sync with what your doc said about that.  A positive combo should never be done, and the fact that neither was positive individually points to why.  So I'm not in agreement there either.  I don't think we have any idea what to make of the combined positive test at this point.  

Five days into an outbreak it doesn't surprise me that the swab test was negative.  

I think at this point the two options are to get a western blot and rule out HSV 1 more certainly and swabbing any lesions that come up right away.

Terri

[atlost000]

I thought a PCR swab while having open sores during a initial infection would hardly be false-negative.

"I think at this point the two options are to get a western blot and rule out HSV 1 more certainly and swabbing any lesions that come up right away." - as I said in my first post, I don't have access to WB, I don't live in the US. And you mean ruling out HSV2, correct? 'Cause all my sorology tests confirm that I have HSV1, I just don't know where exactly.

I'm just trying to understand if there's any possibility of me having genital HSV2 considering my partners results and my own results, 'cause my doctor was expecting me to seroconvert to HSV2, which never happened. I don't stress much about having contracted genital HSV1 from my boyfriend, I just want to understand if it's more likely for me to have contracted HSV1 genitally (with a positive combo sorology just a couple of days after the initial outbreak, probably indicating that I had a preexisting oral infection) or me having contracted HSV2 from that one night stand (while never having a positive sorology).

Thanks.

[Terri Warren, RN, Adult Nurse Practitioner]

PCR and culture can be negative even if a person has been infected with virus, yes.  Our daily home swabbing studies show not infrequent outbreaks that are accompanied by very low shedding at the time.

I realize that you don't live in the US, but anyone can write to the University of Washington and have a kit sent to their health care provider who can draw the blood and send it back to UW.  This information is on their website, and I think it might be a realistic option for you.

As I read your post, you have a low positive HSV 1 result, that needs to be confirmed with another test, so I think that's a reasonable place to start. I'm not a big believer at all in the combined test - have seen many false positives on that test - people having neither HSV 1 nor HSV 2 in the long run.   I am wondering more if you have HSV 1 genitally.  If you aren't concerned about having contracted HSV 1 genitally from your boyfriend, then perhaps you don't need further testing for HSV 1.  If you are concerned about HSV 2 only, then it seems like you have your answer about that - both partners tested negative for HSV 2, and you've had no other partners, right?  I know I must be missing something here, the disadvantages of communicating in this way.  Sorry if I'm not being as helpful with this as you might need me to be.

Terri

[atlost000]

No Terri, you are being very helpful. And yes, Internet consulting has its disadvantages - one of them being communication mishaps. Besides, English is not my first language so I might be giving you a hard time trying to understand my doubts.

As for the WB, I'll check it out. But I imagine it must be a pain in the neck to ship blood material overseas.

I also tend to believe that HSV2 is out of the question since both my partners (yes, my only partners in life, I'm 25 y/o) tested negative, but my doctor said after reading the combo sorology result: "Well, this means you probably had oral HSV1 before all this, so this gotta be genital HSV2". So I couldn't get the HSV2 hypothesis out of my head.

So I keep wondering if I'm one of those few who doesn't seroconvert in HerpeSelect. As for my partners, I wonder if Partner #2 (one night stand) blood test was not too soon (4 months after our encounter) or if the blood test he used was as quick and as sensitive to detect seroconversion as HerpeSelect (the kit was by german R-Biopharm, gG based), etc.

My initial infection symptoms started almost 10 weeks after that encounter, which would be most unusual for HSV incubation period. But I still think about that my doctor said, despite all negative results.

Anyway, I just wanted to know what you think about this HSV2 hypothesis. From your experience, is there a realistic chance that I might find out that I have it? Thanks a lot, that would be my final question.

[Terri Warren, RN, Adult Nurse Practitioner]

I think your provider made a huge leap in thinking that this blood test result is due to HSV 2.  If both of your partners have tested negative for HSV 2, and yes, your second partner waited long enough to be tested, I would rule out herpes type 2 for you.

Terri

[atlost000]

Hey Terri. Just to let you know: partner #2 (one-night stand) got tested again and showed me his results - again negative for HSV2, at 0.6, two years after our encounter. The lab allegedly used HerpeSelect this time.
So I guess the chance of both of us testing false-negative or being infected with a gG deficient strain is like...less then 1%?

Anyway, I'll certainly see my dermatologist again in case a similar case of vulvar ulceration happens again, just to make sure what's going on afterall. She believes I suffered from some sort of drug allergy (I was taking a certain NSAID in both episodes), but I'm skeptic. Thank you very much.

[Terri Warren, RN, Adult Nurse Practitioner]

Glad to hear he tested negative.  
Ask your dermatologist for a PCR swab to take home and gather youself at the first sign of an outbreak - that way you can capture it early in any outbreak.

Terri

[atlost000]

Thanks, Terri. Just to clearify: the PCR swab would be useful to confirm genital herpes, correct? Or you think that it would be mostly useful to distinguish between HSV1 and HSV2?

I keep reading posts about people who never tested positive in HerpeSelect and end up having a positive culture/PCR for HSV2. I'm afraid that might be my case (and my one night stand partner's case...) and I might be putting by boyfriend at risk. Is that realistic at all?

[Terri Warren, RN, Adult Nurse Practitioner]

The PCR is good both at picking up virus to make a diagnosis AND differentiating between HSV 1 and HSV 2.

There are people who test swab test positive and antibody test negative, that is true.  I wouldn't say there are a lot of them around - I probably have 5 or 6 in my practice right now that we have accumulated over the years, but that's 30 years of practice and 5 or 6 patients, that we know about.  At some point, you just have to rely on something - negative swab tests, negative blood tests.
If you have never had sex with a person who is HSV 2 positive, you can't have it.

Terri

[atlost000]

"If you have never had sex with a person who is HSV 2 positive, you can't have it."

Well, what concerns me is the possibility of both me and that one-night stand partner having false-negative results. Is that plausible at all? I read that less than 1% of isolated strains were actually gG deficient, which probably means that they have some sort of limitation when it comes to transmission, but people in MedHelp keep talking about gG deficient strain, how HerpeSelect does not recognize it, etc. I'm going crazy!

Can you bring me some peace of mind? How likely it is that all my two partners and myself are testing false-negative due to a bizarre virus mutation? Should I even bother considering such scenario?

That's my last question. Thanks.