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conflicting culture and IgG results three years later
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conflicting culture and IgG results three years later

Hi,

Three years ago, my boyfriend gave me genital herpes. I had primary outbreak symptoms about a week after the first time we had intercourse. Symptoms included a couple of pimple-like sores that turned blistery, feeling fluish, swollen lymph nodes in the groin area. Early on, once I detected the first sore, I went to my gynecologist. She did a culture test on the sore, and also (I think) did an IgG blood test. My culture came back positive for herpes. When I asked my doctor what type I had, she replied "type doesn't matter, you have genital herpes." I had to ask her a second time to get a clear answer, and she briskly replied that I had type 2. Meanwhile, my blood tests were negative for both hsv-1 and hsv-2 indicating a recent infection.

Here is where it gets confusing, my sexual history definitely confirms that I got herpes from my boyfriend. After I had that outbreak after our first time having sex, he got tested as well. His IgG blood tests came back hsv-1 positive and hsv-2 negative indicating he has had hsv-1 for some time. We assumed, at the time, that he must have recently acquired hsv-2 (we had just started our relationship) and that he must be asymptomatic. What mattered then was that there really wasn't any risk of transmitting hsv-2 to one another.

Now, three years later we broke up and my mother and sister urged me to get retested to clarify the results. I got an IgG test done, and I came out hsv-1 positive, and hsv-2 negative. Over the past three years, I have had no outbreaks since the initial. I thought I was just one of those people who has hsv-2 and is really lucky. Now I am actually confused. I think my doctor hastily concluded I had hsv-2 without properly taking the time to read my results. She was so impatient, saying type didn't matter, genital is genital etc., and now I want to request my test results from three years ago.

In the meantime, is it possible to have hsv-2 but have a negative blood test three years later? Also, given my circumstance (# of outbreaks over three years is 0 after the first, boyfriend only had hsv-1 and now I test positive only for hsv-1), isn't it more likely that I have genital hsv-1?

Tags: conflicting hsv results years
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11 Comments Post a Comment
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101028_tn?1348750963
many providers unfortunately just assume if it's genital then it must be hsv2. at this point you can try to get a copy of your lesion culture results to see if they were actually typed or not or just + for herpes and assumed hsv2 since it was genital.  

at this point it's more likely it's hsv1 genitally you have, not hsv2.

grace
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Avatar_f_tn
sorry for posting two separate posts; I thought if they dealt with different issues then they should remain individual. but thanks for letting me know. so here is my second group of questions (since I am basically dealing with a whole new type of herpes):

if I have hsv-1 genital (female) and have had one primary outbreak three years ago:

1) how likely is it that I will give it genitally to male (hsv-1 and 2 negative) through regular sexual intercourse?
2) how likely am I to give him hsv-1 oral (again if he is hsv-1 and 2 negative) if he goes down on me?
3) how likely am I to give it genitally to male (hsv-1 pos) if we have regular sexual intercourse?
4) how likely am I to get hsv-1 orally from either auto-innoculation or a male who has oral hsv-1 now that I have it genitally?

think that's about it. I appreciate your response!
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101028_tn?1348750963
your partner would need tested to know their own status. you can't make educated decisions about what precautions to take until you know who has what. since if you have hsv1 you can still contract hsv2, knowing your partners status is important.

hsv1 genitally doesn't shed very much. you can transmit it to a partner but it's very low risk of doing so. typically we just recommend avoiding sex anytime you have anything going on genitally. if your partner has hsv1 too, it's really a non-issue in the relationship.

having hsv1 genitally means you aren't likely to contract it orally. what little info we have shows that about anywhere from 1/4-2/3's of folks who contract hsv1 genitally, also have it orally. Most people with oral herpes do not get obvious cold sores to know it. once you know your partners status, you can discuss if it's worthwhile to only have protected oral sex just in case you also have it orally too.
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Avatar_f_tn
thanks so much. I will definitely have my future partner get an IgG blood test to determine whether he has either or both types. I was trying to figure out the most likely scenarios I might encounter in the future.

to clarify, if my partner has hsv-1 orally, there is just a slim chance I'll give him hsv-1 genitally?

also, the only reason I wonder if I don't have hsv-1 oral is because three years ago when I had my primary genital outbreak, all blood tests were negative, meaning I had no instance of oral or genital herpes prior. since then I've developed hsv-1 antibodies. can I assume I just have genital hsv-1. or should I assume I have it orally too (even though I've never had a cold sore on my mouth) and should I worry about transmission when I just kiss a guy?

thanks again for your response.
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Avatar_f_tn
and one more question that relates more to my first post regarding conflicting test results:

I've read that among HerpeSelect 2 ELISA IgG type test for hsv-2, there is an accuracy of 98% meaning that among say 100 individuals who tested positive with culture tests for hsv-2, 2 of those people's IgG blood tests will report false negatives.

is that consistent with your own research?

thanks again.
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101028_tn?1348750963
that's the same stats we repeat here repeatedly.

30% of all newly acquired genital herpes infections are due to hsv1. it's fairly common so when providers assume if it's genital it's hsv2 is poor medicine :(

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Avatar_f_tn
wow. I can't believe how neglectful my first doctor seems to have been. and I can't believe I was basically misdiagnosed for three years until I went to a doctor who actually knew something about herpes.

I'm still going to get the info for my original culture test just to ease my mind.

Thanks again for all your responses!

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Avatar_f_tn
So I got all of my test results back to try and clarify my situation.

Almost three years ago (--Feb '09)
QuestDiagnostic Culture, HSV, Rapid with Type:
positive, HSV2
IgG Blood work:
HSV 1 negative (at 0.12) & HSV2 negative (at 0.26)

Last Week:
IgG Blood work:
HSV 1 positive (at 1.19) & HSV2 negative (at 0.11)

Now I am extremely baffled. As I mentioned in my first post, my boyfriend was positive for HSV1 and negative for HSV2 three years ago when I had my first and only outbreak  (over three years). My culture obviously tested positive, but I had not acquired any antibodies to HSV1 or HSV2. We assumed he had acquired a recent HSV2 infection because he had had unprotected sex with someone a couple of months before we got together. He is in the process of retesting so I will have his results hopefully in a week and if he tests positive for HSV2 antibodies then we will have an answer, but in the event that he, again, tests positive for HSV1 and negative for HSV2, I'm not sure what to make of my situation. I absolutely understand that viral cultures are the "gold standard" for detecting whether a patient is POSITIVE or NEGATIVE for herpes. In other words, I don't doubt that I tested positive for genital herpes three years ago, but I'm questioning the "typing" accuracy. I've spoken to three different physicians, and they have never seen a situation like mine. My questions:

a) what is the accuracy of "typing" for the HSV Rapid Culture Type Test I received from Quest?
b) really, what percentage of HSV2 positive patients never develop antibodies?
c) given my circumstance, assuming my boyfriend's and my bloodtests now line up after three years (during which I acquired antibodies to Type 1 that he had already and we both remain HSV2 negative), what should I make of that initial culture test typing?

Thanks so much again for your response. This has been mind-baffling, and extremely difficult for me to wrap my head around.

Also, I found one other post with an almost identical situation to mine:
http://forums.webmd.com/3/sexual-conditions-and-stds-exchange/forum/3297/4



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101028_tn?1348750963
the typing accuracy is pretty accurate.

a small percentage of folks won't test  + on the blood tests. this very well might be what is going on in your situation.

grace
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Avatar_f_tn
besides my boyfriend getting his blood work done again, is there anything else I could do at this point?

I haven't had symptoms since that first outbreak three years ago, so an additional culture test is out of the question. if my boyfriend comes back negative again for HSV2, but positive for HSV1, isn't the overall story conflicting with the culture "typing"?

do you know any articles that specifically address rapid HSV culture typing and accuracy?
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101028_tn?1348750963
at this point you can try getting a herpes WB to see if your hsv2 infection is reflected on there. otherwise best you can do is wait for a return of symptoms and get another lesion culture .    another option is to contact Terri Warren's westover heights clinic, become a phone consult patient and arrange for daily pcr swabbing for a few months. Terri can also arrange for the WB for you too. I think it's an initial consult fee of $75 then the cost of the WB as well as the cost of the daily swabbing. The folks at her clinic can better explain the costs to you when you call.
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