asking the wrong questions

[larry123456]

I posted this question on here before, but I focused on the wrong thing, so I thought I'd re-ask.

Oct 31 - Unprotected vaginal intercourse with partner with HSV (didn't tell me)

12d - Very raw irritation on genitals

17d - genitals flush red, several 1-2mm dark red raised bumps with a tiny dark center on red irritated skin appear in two places on shaft, each area has about 3-4 bumps.  Tender groin lymph nodes, sore lower back, diarrhea, maybe testicle pain

18d - pos for chlamydia, 1G Zithromax, 2-3 more of the same 1-2mm dark red raised bumps with tiny dark center appear on glans

28ishd - red bumps disappear on their own after not changing for 1.5 weeks, leaving very raw irritation and skin redness

3m later still having sensitive genital skin with a slight blotchy rash on the glans, but don't want to focus on that

Meds:
500mg Levaquin 2x day 5 days
Z-Pack Azithromycin
Fluconazole
2G Metronadizole (only thing that seemed to help a little)

13w post exp - Captia 12 - <0.90 (no # )
14w post exp - HerpeSelect 12 - <0.90 (no #)

The 1-2mm dark red raised bumps with a tiny dark center that hung around for 1.5 weeks are what concern me.  Over 1.5 weeks they never really changed in appearance until they disappeared.  I can find nothing online that looks like them.

1) I've been told online this doesn't sound like herpes, don't even bother testing.  What are your thoughts?

2) Would PCR-DNA swabbing be effective in this case where testing is not?

3) What factors affect seroconversion?  Would a mild outbreak mean antibodies were made quickly and that's why it was mild, or would a mild outbreak possibly just not make enough to be recognized by testing?  Would large amounts of antibiotics impact my immune system and delay seroconversion?

4) I'm considering the WB thru your clinic, is 4 m post-exp enough?  Can a HerpeSelect be done at the same time?  What does it cost to add HS to the $120 for WB?  I'm looking at best possible detection.

[larry123456]

A related discussion, Update to our other discussion was started.

[Terri Warren, RN, Adult Nurse Practitioner]

Welcome

Terri

[larry123456]

Thanks for the call Terri!

So 5 months ELISA type specific negative and 4 month Western Blot negative, that is awesome!

Goes to show that clustered red bumps, teeth gnashing genital pain, and swollen groin lymph nodes doesn't have to be herpes!  Who knows what it was...

Thank you!

[Terri Warren, RN, Adult Nurse Practitioner]

3.5 weeks is too long - there's some problem somewhere, either on your lab end or UW or our end.  Please call my office tomorrow and ask them to have me call you on Tuesday.  

Your results look really terrific now, I think you have no worries at all, but let me find that blot.

Terri

[larry123456]

Good morning Terri,

Still waiting for the Western Blot from your clinic, that's 3.5 weeks now, they must be really running behind.

Anyway, since it was cheap enough, for my sanity I did another $39 IgG specific HSV 1 and 2 test at AnyLabTestNow.

You'll remember at 18 weeks post-exposure, 15-16 weeks post-symptoms:

IgG Type 1 - 0.47
IgG Type 2 - 0.19

Now I'm 21 weeks post-exposure, 19 weeks post-teeth gnashing genital discomfort, 18 weeks post red bumps.  This time I was:

IgG Type 1 - 0.49
IgG Type 2 - 0.08

Clearly within the negative range on both counts.  HSV2 is very low.  Interesting, and concerning at least to me, that the HSV1 is still lingering around the exact number though.

With the absence of that terrible discomfort, red bumps, sore lower back, and tender lymph nodes I think I'd put this to rest.  Those symptoms and that number lingering at the same amount makes me hesitant.

[larry123456]

Thanks for responding, that's encouraging news on the biopsy you mention.  I'll wait out the results of the Western Blot from your clinic.

I wish I could get more definitive info on the optical density ratios of the ELISA test.  Some people show .01 and .02, which is clearly negative.  The .47 is still negative as well, but why higher?  I wish I knew the numbers of my tests over the last 4 months. I've read through the HerpeSelect protocol and understand the variations with washing, etc, but it still makes me wonder why some people show consistently low while others show consistenly around a different negative number.

[Terri Warren, RN, Adult Nurse Practitioner]

If the irritation was from HSV 1, it would likely have been seen on the biopsy as multinucleate giant cells, it wasn't.  

I would not expect CT or Trich to cause irritation of the type that you describe.

No, biopsy would not likely show up gadnereallal.

Terri

[larry123456]

Thanks Terri,

More data.  Results from skin biopsy show nothing infectious, but contact dermatitis/contact irriation.

Assumptions and questions on my part:
1) HSV1, if present in my system, may not show up on biopsy even if I have present irritation/symptoms?

2) I had chlamydia for sure, and maybe trich as 2g metranadizole really helped symptoms, could those have contributed to contact irritation that is only slowly waning months later?

3) Could contact irritation have caused red spots?  The pictures for that don't look like what I had either.

4) Would biopsy show the other possible agents like gardnerella?  With how much the one-time 2g metradinzole seemed to help, I can't help but to think it only lessened an irritating bacteria and maybe a week of it would kill if off for good.

I'm getting off track now, sorry...

[Terri Warren, RN, Adult Nurse Practitioner]

No, it doesn't really worry me.  But I will be eager to see the western blot.  As you know, the ELISA just isn't as good as the western blot for HSV 1.  I am certainly reassured greatly by your HSV 2 result.  

Patience, my friend.  You could still have a week or two to wait on those results, or it could come back this week.  Sometimes it is sooner.

Terri

[larry123456]

Hi Terri,

I've been watching your advice in http://www.medhelp.org/posts/Herpes/Been-tested-5-timesmany-questions-remain/show/1680368 closely as we have similiar symptoms.

I took a Western Blot and HerpeSelect through your clinic last week.  Not knowing the HerpeSelect results wouldn't come for 3 weeks, I decided to go to AnyLabTestNow and do the IgG specific for $39 since I needed instant gratification for my sanity.

My results at 18 weeks post-exposure, 15-16 weeks post-symptoms:

IgG Type 1 - 0.47

IgG Type 2 - 0.19

It's obvious I'm negative on both and 18 weeks post-exposure that would look very favorable, but the higher number on the Type 1 does concern me given the other thread I mentioned where a higher number eventually showed a positive and the fact that the ELISA tests are less sensitive to Type 1.

My symptoms were:

- Red bumps

- Headache

- Swollen groin lymph nodes

- Sore lower back

Does the Type 1 number at this point worry you at all?

[Terri Warren, RN, Adult Nurse Practitioner]

Well, many things could cause the genital area to be itchy and sensitive, for example.  And many things could make you feel tired, too.  Herpes doesn't cause diarrhea or low back.  It could cause groin lymph node swelling, but so could an ingrown toenail.  My point is that herpes is a  skin condition, and the things that you describe could just fit so many other conditions.  The key is the skin presentation.  

I hope the western blot will help clear up your concerns.

Terri

[larry123456]

Went to see the dermatologist, I think I'm going to request a skin biopsy.

Terri, I have a specific question, when you said my symptoms were vague and didn't sound like herpes I wanted to clarify.

10 days out I got super sensitive and itchy.  Was also sort of tired.  17 days out I got 1-2mm red bumps that were accompanied by diarrhea, sore lower back and groin lymph node pain.  About a week and a half later those red bumps seemed to just disappear.

From what I read about presentations of herpes the symptoms all seemed to fit, minus never blistering.  What about it makes you think it doesn't sound like it?  I'm glad to hear that, but confused.

I'll call your clinic in a week for a 4 month WB, I'm just at 16 weeks today.

[Terri Warren, RN, Adult Nurse Practitioner]

OK, sounds good.

terri

[larry123456]

I appreciate all of your insight and information.  I'll post more only when I've talked to the dermatologist, taken the 4 month test, or have any factual information.  Thanks Terri!

[Terri Warren, RN, Adult Nurse Practitioner]

Candida can be severe or not severe, the pictures always are the worst possible scenario I think.  

I honestly can't address what might have been going on with someone else and their symptoms.  Also, why would people have sex during an outbreak?
I don't think your theory about an auto-immune response leaving the body irritated doesn't make a lot of sense to me.

This will be my last post on this thread.

Terri

[larry123456]

Thank you Terri,

I did look at pics of candida balanitis, it didn't look that severe.  Imagine everything turning red, like sitting in a hot bath, but then 3-4 1-2mm dark red bumps occuring together in 3 places.  I would say it was very raw too, maybe itching, but mostly just very raw.  3 months later it still has blotchy redness, I'm seeing dermatologist #2 today.

The thing that concerns me is the partner said her last boyfriend never caught it until they had sex during an outbreak, and then he "only got little red bumps" and never had another outbreak.  The correlation seems too much for coincidence.

It leaves me to think that:

1) he and I both had the very same atypical symptoms?  Unlikely or HSV1?

2) or his red bumps were not the same as mine

3) she was misdiagnosed and it's something else, but what?

Nonetheless, when she said didn't catch it until having an outbreak, then only red bumps it concerns me.

I see a lot of forum posts with exposure to herpes, negative tests for everything, but this very same irritation months later.  Could it be an auto-immune response where the virus didn't take, but left the body irritated?

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, I agree that testing at 4 months would be a good idea.  It is true that not every single person who has herpes isolated in a swab test serconverts, even by western blot.  I have eight patients over 30 years who did not seroconvert, and those are people we have followed for that purpose.  However, these are people who had positive swab tests from lesions in the genital area.  You are having some very vague symptoms that aren't really consistent with herpes.  I think we are talking apples and oranges here, in terms of people who do or do not seroconvert.

At some point you have to go with what is most likely, and take it for the best you can do, right?

Did you look at pictures of candida balanitis?

Terri

[larry123456]

You are right, it's tough to tell from the study the real timeframes.

"Nine of 113 subjects-3 infected with HSV-1, 3 with HSV-2, and 3 with nonprimary HSV-2-did not seroconvert by either test (median follow-up time, 38 days; range, 15-167)."

Median follow-up time was only 38 days, but there is definitely one person at 167 there.  And that is post-symptoms, which in my case were 2-3 weeks after exposure depending on what could be considered the start of them.

The bummer part of that study is that there is no mention of anti-virals, which were shown later to extend seroconversion time in some instances.

I think my best option is to do both the Western Blot and HerpeSelect at 4 months (17 weeks) and hope for the best.

[RogerSams]

If we are thinking of the same study, I am familiar with it...  Many of the participants in the study did not continue testing past sixty days, so the figures for six months are skewed, as a portion of that 10% actually were not tested at six months..

[larry123456]

Thank you Terri!  Is there any STD at all that has 1-2mm dark red raised spots with a very tiny dark center which are preceded by skin so raw you just want to cut it off?  I always hear of these "atypical" herpes cases.

The only thing I can think of, besides herpes, is the chlamydia irritated my skin so badly that bumps broke out, but I find no other evidence of this on the internet... they did seem to sort of go away with the meds, although the next day they did increase..

The sandpaper irritation persisted, but I have to think part of that was me putting everything I could think of on it to try and make it stop..

Can I do HerpeSelect through your clinic at the same time as the Western Blot?  If so, how much extra is it and will it give me an index value vs just <0.90?  My concern is the study where 10% of the people were not caught by either test within 6 months.

[Terri Warren, RN, Adult Nurse Practitioner]

The use of a general CBC is of no use whatsoever in diagnosing an STD of any kind.  The only exception would be if someone developed a systemic version of an STD, which is not common and isn't at all what you are describing.  

1) I would agree that your symptoms don't sound typically like herpes, no.
2) PCR swabbing is most effective when you have symptoms.  PCR swabbing is sometimes used when people who are infected want to know how often they are shedding virus.  It might also be used to determine the location of infection.  But in your case, when your antibody tests are negative, I don't think swabbing would be useful.
3) Seroconversion timing varies, but we don't know the exact factors involved with how quickly that happens.  We do know if you take antiviral therapy and decrease the amount of virus that is present for the immune system to see, that seroconversion can take longer.
4) 4 months is long enough to wait for serconversion by western blot, yes.

Terri

[larry123456]

15 weeks out, my normal blood work shows:

WBC - 5.4 x10E3/uL - Good range 4.0-10.5
Neutrophils - 54% - Good range 40-74
Lymphs - 32% - Good range 14-46

Neutrophils (absolute) - 2.9 x10E3/uL - Good range 1.8-7.8
Lymphs (absolute) - 1.7 x10E3/uL - Good range 0.7-4.5

I had read online:
"As a very generalized rule-of-thumb, your white blood cell count usually responds to acute bacterial infections very quickly; less quickly with viral infections like herpes. But not necessarily. If you have an active herpes outbreak, and you had it before, than yes, I would expect the WBC count to be elevated. There would also be a preponderance of a subtype of white cells known as "lymphocytes" and a relative lesser number of "neutrophils" which are more commonly seen with bacterial infections."