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Conflicting Herpes Tests
On Jan 22, 23 and 24, I had sex with three different women (protected vaginal, unprotected oral). I haven't had any other sex since then. On Jan 26 I felt mild itchiness on my penis. On Jan 27 I noticed a sore towards the base of my penis. It was not painful. On Jan 29 I went to the county STD clinic. The doctor there took a swab of the sore, and started me on Valtrex suppressive therapy as a precaution. On Feb 6 or 7, I experienced an 18 hour "flu" -- chills, extreme fatigue, light-headedness. I slept from 5 pm until 9 am the next day. On Feb 9 (11 days after the culture was taken) the doctor called me with the results (this after they initially told me on the phone that they had no record of my test). The culture was POSITIVE for herpes type 2. By Feb 17, the sore had pretty much disappeared. I continued taking Valtrex. On April 24 I had a herpes blood test ("Herpeselect Type 1 and 2 Specific IgG-based") done by an online company to confirm the results of the culture test (I had an HIV test done at the same time). The result came back NEGATIVE for both herpes type 1 and type 2 (I was also negative for HIV). On August 21 – that’s almost 7 months post-exposure -- I had another herpes blood test done by a different online company ("Herpeselect Type 1 and 2 Type Specific IgG Immunoblot"). Again, it was NEGATIVE for both type 1 and 2. I stopped taking Valtrex on Aug 24. I have not had any symptoms since the original outbreak in January (and I had never experienced any symptoms before that time).
My questions:
1. Do I have herpes? What would explain the test discrepancies?
2. Could my taking Valtrex have "fooled" the two blood tests into giving false negatives?
3. What do you suggest I do now? More tests?
Thank you!
My questions:
1. Do I have herpes? What would explain the test discrepancies?
2. Could my taking Valtrex have "fooled" the two blood tests into giving false negatives?
3. What do you suggest I do now? More tests?
Thank you!
MEDICAL PROFESSIONAL
Yes, those obviously are possibilities.
Doctor, since this is an interesting scenario may I add a comment? Is this is a good example of how the Herpeselect can miss some cases? Or even better, could Astronoman be one of the rare people who never develop antibodies to HSV 1 or 2? Thanks.
MEDICAL PROFESSIONAL
In general, a culture is the gold standard; that positive result probably nailed the diagnosis. However, you are correct that you should have developed a positive blood test by now. And there are other atypical aspects of your situtation. Of all people with new, symptomatic HSV-2, the large majority have recurrent outbreaks within the next few months; that is, the lack of repeat episodes since January is atypical. Second, a single lesion at the base of the penis is not the most common initial symptom. But still, there are aspects that indeed suggest herpes, most importantly the STD clinician thought the lesion was typical enough to test it and start treatment. I don't know what to make of the flu-like symptoms; although common in initial herpes, it is peculiar that they started after you were on valacyclovir for almost a week.
All of which leaves uncertainty. On balance, my bet is that you are infected with HSV-2. However, I recommend you pursue the postive culture result, perhaps with direct communication with the laboratory. Conceivably there was an error, such as mixup of your test result with someone else's (which the clinic might not be aware of, but the lab could work out). Also, find out exactly what test they use. If it was a culture, the positive result almost certainly is accurate. If some other test was used, such as PCR, then questions might be raised (since PCR tests are not standardized, and errors may be more common in some labs than others).
So the direct answers are: 1) Uncertain, see above. 2) The common wisdom is that treatment never aborts HSV and probably your treatment did not affect the blood test result. However, the science in this arena isn't rock solid. Conceivably that could have happened, but I doubt it. 3) I suggest yet another blood test; maybe wait a little while and do it this fall, i.e. 9-10 months after onset. If still negative, have the specimen also sent to the University of Washington for a Western blot test--including the information of your positive culture for HSV-2. Also follow up with the clinic and/or lab about your culture result, as suggested above.
Sorry I cannot come up with a clear answer, but I hope this helps. Best wishes-- HHH, MD
All of which leaves uncertainty. On balance, my bet is that you are infected with HSV-2. However, I recommend you pursue the postive culture result, perhaps with direct communication with the laboratory. Conceivably there was an error, such as mixup of your test result with someone else's (which the clinic might not be aware of, but the lab could work out). Also, find out exactly what test they use. If it was a culture, the positive result almost certainly is accurate. If some other test was used, such as PCR, then questions might be raised (since PCR tests are not standardized, and errors may be more common in some labs than others).
So the direct answers are: 1) Uncertain, see above. 2) The common wisdom is that treatment never aborts HSV and probably your treatment did not affect the blood test result. However, the science in this arena isn't rock solid. Conceivably that could have happened, but I doubt it. 3) I suggest yet another blood test; maybe wait a little while and do it this fall, i.e. 9-10 months after onset. If still negative, have the specimen also sent to the University of Washington for a Western blot test--including the information of your positive culture for HSV-2. Also follow up with the clinic and/or lab about your culture result, as suggested above.
Sorry I cannot come up with a clear answer, but I hope this helps. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
