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is it really HSV1?
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is it really HSV1?

Hello Dr! I have some questions with regard to my herpes (GHSV1) diagnosis last month.

Roughly around mid december last year I had intercourse with my bf (oral, vaginal), before him I was a virgin and have not engaged in sexual activity of any kind with anyone. Around the 20th of December I felt extremely itchy down below with thick yellow discharge and realised 3 small pimple like bumps around my labia (white head, not in a cluster) that appeared 2-3 days later. I immediately went to see my GP on the 24th who did a visual inspection and a swab of my lesions. Initially I thought it was a bad yeast infection or that it could've been the rubbing/latex during intercourse that I was not used to, or an allergy from a new soap that I had started using. Whilst waiting for my results to come back my doctor prescribed me with Valtrex and Diflucan which I took both on the day and all the symptoms were gone the next day. Unfortunately on the 26th the the PCR test from the lesion swab came back positive for HSV1. As you can imagine I was in tremendous shock. I didn't expect to catch an STD from the first and only man I've slept with.

The doctor explained the nature of the disease and that it is the same strain of the virus that causes oral cold sores, which most people in the population already have. I asked my bf if he has ever had a cold sore and he said he might've had one years ago but weren't sure if they were even cold sores. He definitely did not have a sore on his mouth when he performed oral sex on me so I didn't understand how the transmission could've happened. Although  I've read up alot about HSV and understand that transmission can still take place asymtomatically through viral shedding even though it is less likely.

Three weeks later I experienced some itchiness again coupled with some pain in passing urine so I went to see another doctor as I was overseas. There were no bumps this time. After inspection the doctor said the itchiness is obviously due a yeast infection and my urine sample revealed a UTI. She gave me some medicine which alleviated all the symptoms the next day. There, I also I took a IgG blood test for HSV1 to confirm my previous herpes diagnosis (even though a positive PCR result is pretty conclusive but just to make sure). The results came back >200ru/ml, which is considered a fairly high positive as the normal range lies between 16-20. Upon reading on some info I realized that IgG antibodies typically take months to generate after the initial infection and that its level should be best measured after 3-4months.

My questions here are:
1. Is my IgG blood test reliable since it was taken relative soon since my initial suspected outbreak? and can the high value be due to the UTI (not sure if it is correlated). Is there any chance that it could be false positive and therefore, should get myself retested after a few months?

2. Before, during and after my suspected outbreak I did not experience any flu like symptoms or swollen glands. Also my lesions did not crust over, everything healed up within 4 days. Not to sound like I'm in denial and I understand that PCR is highly sensitive at detecting the virus, but I want to ask if there is ANY chance of it being a misdiagnoses? My reason being that my symptoms did not exactly match a typical first herpes infection as it usually lasts for 2 to 3 weeks, and that skin pain can last for 1 to 6 weeks?

I realise that is two diagnostic methods leading me to a herpes positive outcome. I guess I'm just trying to be hopeful here and if theres any chance of it being a mistake I would want to do another test so I can be fully convinced and slowly accept the reality.

Thank you so much for your time Dr, and I hope to hear from you soon :)

4 Comments Post a Comment
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101028_tn?1348750963
this is not the doctor's forum - you have to pay to post there.

the 2nd blood test you had done isn't one that we recommend and I really can't comment on the results very much.  For most herpes igg blood tests, about half of folks will test accurately within 2-3 weeks of being infected.

You had a + lesion culture to know that you have hsv1 genitally. you don't need any further blood testing for herpes with this partner. If your partner hasn't had herpes blood testing, make sure that he seek out type specific herpes igg blood testing to know his own status for hsv2. we know your hsv1 came from receiving oral sex from him. The odds of transmission without obvious oral symptoms are actually just as high when an obvious cold sore isn't present as when it is if he was having asymptomatic shedding of the virus.  Having an uti wouldn't affect hsv igg blood testing either.

keep asking questions!

grace


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oops sorry my mistake, I'm just glad there is a forum like this for people to ask questions :) Thank you so much for your response.

My partner tested negative for both HSV1 and HSV2. This is why it has led me to think that perhaps there was a mistake in the PCR test. I heard due to its sensitivity, it is also prone to contamination, although chances are low.

May I ask why the second test that I took is not a recommended test to take?    

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101028_tn?1348750963
well even the best blood tests still miss 1out of every 10 hsv1 infections. no reason to doubt a + lesion culture, it's the negative cultures we doubt.  you've had no other partners so you know you contracted hsv1 from this partner.

the 2nd test you had is one that has a very high false positive rate and a decent false negative rate too.
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Avatar_f_tn
Thank you Grace for your helpful response to my post :)

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