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Constant Tingling/Inconclusive HSV test/Asyptomatic Shedding
Hi Doctor,
I'm a gay man who practices safe sex. I had a rash on my lower abdomen/groin area this past July centered around hair follicles. It began with a lesion approx 5mm and after 10 days I applied Neosporin. Immediately, other lesions around other hair follicles appeared. The rash didn't itch, burn, crust, or blister. Severe symptoms cleared up with some Bactroban ointment immediately, though it took about 6 weeks for the lesions to disappear.
An IgG blood test performed at a clinic revealed a 2.4 index for HSV2. I saw my primary physician, who didn't think it consistent with HSV but gave me Valtrex which didn't have any effect. He performed a Western Blot about 4 weeks initial exposure, with atypical results. I had three other sores appear in virtually the exact same place, beginning the first week of October, another 2 weeks later, and another on Thanksgiving day, each healing more quickly, reduced from 2 weeks to about a week. I contacted all my partners who I had before and just after the initial rash appeared. None of them have had any symptoms and all say they've been tested and are negative for HSV2 via IgG blood culture.
My dermotologist examined a lesion that was 7 days old, but wouldn't give a diagnosis. He advised me that the only sure way to know if I have HSV was to take a culture from a lesion immediately after it appears, and that so long as I didn't have an open sore, I couldn't pass it to others.
So, what are the chances that I could have contracted HSV2 from a partner without symptoms, and what's the likelihood that if I do have HSV, that I could pass it to someone else without having symptoms myself? I have no symptoms now, save for the constant tingling sensation which covers the whole left side of my body though seems most concentrated on my left leg & lower back. Who should I be listening to through all of this?
I'm a gay man who practices safe sex. I had a rash on my lower abdomen/groin area this past July centered around hair follicles. It began with a lesion approx 5mm and after 10 days I applied Neosporin. Immediately, other lesions around other hair follicles appeared. The rash didn't itch, burn, crust, or blister. Severe symptoms cleared up with some Bactroban ointment immediately, though it took about 6 weeks for the lesions to disappear.
An IgG blood test performed at a clinic revealed a 2.4 index for HSV2. I saw my primary physician, who didn't think it consistent with HSV but gave me Valtrex which didn't have any effect. He performed a Western Blot about 4 weeks initial exposure, with atypical results. I had three other sores appear in virtually the exact same place, beginning the first week of October, another 2 weeks later, and another on Thanksgiving day, each healing more quickly, reduced from 2 weeks to about a week. I contacted all my partners who I had before and just after the initial rash appeared. None of them have had any symptoms and all say they've been tested and are negative for HSV2 via IgG blood culture.
My dermotologist examined a lesion that was 7 days old, but wouldn't give a diagnosis. He advised me that the only sure way to know if I have HSV was to take a culture from a lesion immediately after it appears, and that so long as I didn't have an open sore, I couldn't pass it to others.
So, what are the chances that I could have contracted HSV2 from a partner without symptoms, and what's the likelihood that if I do have HSV, that I could pass it to someone else without having symptoms myself? I have no symptoms now, save for the constant tingling sensation which covers the whole left side of my body though seems most concentrated on my left leg & lower back. Who should I be listening to through all of this?
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
I have skimmed your many posts in other threads on the herpes community forum. There's a lot of detail there and I'm not going to try to find and remember it all. Rather, I'll make some comments specifically on what you have said here, then will ask for some clarifications.
First, the initial outbreak you had doesn't seem much like herpes. It is rare for initial HSV-2 to primarily affect the lower abdomen. When first oubreaks cause symptoms, they usually are at the site where the virus is massaged into the body, i.e. the areas that receive maximum friction during sex. Generally that means the penis, anus, labia and vaginal opening in women, etc. And herpes doesn't involve hair follicles. So the first problem may be unrelated to your borderline/uncertain blood test results.
Also, folliculitis often is a recurrent problem, so the reappearance of new symptoms in the same area isn't a strong indicator of herpes.
You were also asked in one of the other threads, and I don't recall the answer: are you certain your other partners were in fact tested and negative for HSV antibodies? As you have learned, HSV testing usually is not routine in blood testing for STDs. (There is no such thing as "IgG blood culture"; IgG is an antibody test.)
As you already know, your dermatologist was mistaken in saying HSV-2 could only be passed to others during overt, visible outbreaks. If you have HSV-2, you can and should assume you are infectious for partners, primarily through genital or anal contact. (Among men who have sex with men, and who have HSV-2, roughly equal numbers of infection are genital and anal -- although of course this depends on the sites sexually exposed.)
For sure HSV is not a likely cause of "constant tingling sensation which covers the whole left side of my body though seems most concentrated on my left leg & lower back." Despite what you can find from personal testimony on the web, HSV infections are not known to cause such symptoms.
What do I think is going on? I am suspicious that you DO have HSV-2 (most people with ELISA ratios of 2.4 are infected); but that herpes is NOT the cause of any of the symptoms you have described, either the abdominal rash, the recurrent lesion seen by your dermatologist, or your lift-sided body tingling.
What to do now?
1) Describe in more detail the timing of your positive blood test (with the HSV-2 result of 2.4) in relation to the abdomen rash last summer; and the HSV-1 result on the same specimen.
2) If you have had any other HSV blood tests, also tell me the timing and precise numerical results for those tests.
3) If you are using any antiherpetic drug, stop stop taking it.
4) Have another HSV blood test. The lab should be asked to test for both HSV-1 and HSV-2; and if the HSV-2 result gives any value under 3.5, send off the same specimen to the Univ of Washington lab for another Western blod. If not on anti-HSV therapy, the repeat test can be done at any time. If you have been treated, it should wait until you have been off treatment for a few weeks or months.
5) If you have another genital area lesion, especially one that starts as a red bump that turns into a blister with clear fluid, follow your dermatologist's advice for immediate examination and testing, preferably within 1-2 days. The preferred test in that situation is a PCR test, not a culture.
I'll be interested in how all this shakes out. Thanks again for your question.
HHH, MD
I have skimmed your many posts in other threads on the herpes community forum. There's a lot of detail there and I'm not going to try to find and remember it all. Rather, I'll make some comments specifically on what you have said here, then will ask for some clarifications.
First, the initial outbreak you had doesn't seem much like herpes. It is rare for initial HSV-2 to primarily affect the lower abdomen. When first oubreaks cause symptoms, they usually are at the site where the virus is massaged into the body, i.e. the areas that receive maximum friction during sex. Generally that means the penis, anus, labia and vaginal opening in women, etc. And herpes doesn't involve hair follicles. So the first problem may be unrelated to your borderline/uncertain blood test results.
Also, folliculitis often is a recurrent problem, so the reappearance of new symptoms in the same area isn't a strong indicator of herpes.
You were also asked in one of the other threads, and I don't recall the answer: are you certain your other partners were in fact tested and negative for HSV antibodies? As you have learned, HSV testing usually is not routine in blood testing for STDs. (There is no such thing as "IgG blood culture"; IgG is an antibody test.)
As you already know, your dermatologist was mistaken in saying HSV-2 could only be passed to others during overt, visible outbreaks. If you have HSV-2, you can and should assume you are infectious for partners, primarily through genital or anal contact. (Among men who have sex with men, and who have HSV-2, roughly equal numbers of infection are genital and anal -- although of course this depends on the sites sexually exposed.)
For sure HSV is not a likely cause of "constant tingling sensation which covers the whole left side of my body though seems most concentrated on my left leg & lower back." Despite what you can find from personal testimony on the web, HSV infections are not known to cause such symptoms.
What do I think is going on? I am suspicious that you DO have HSV-2 (most people with ELISA ratios of 2.4 are infected); but that herpes is NOT the cause of any of the symptoms you have described, either the abdominal rash, the recurrent lesion seen by your dermatologist, or your lift-sided body tingling.
What to do now?
1) Describe in more detail the timing of your positive blood test (with the HSV-2 result of 2.4) in relation to the abdomen rash last summer; and the HSV-1 result on the same specimen.
2) If you have had any other HSV blood tests, also tell me the timing and precise numerical results for those tests.
3) If you are using any antiherpetic drug, stop stop taking it.
4) Have another HSV blood test. The lab should be asked to test for both HSV-1 and HSV-2; and if the HSV-2 result gives any value under 3.5, send off the same specimen to the Univ of Washington lab for another Western blod. If not on anti-HSV therapy, the repeat test can be done at any time. If you have been treated, it should wait until you have been off treatment for a few weeks or months.
5) If you have another genital area lesion, especially one that starts as a red bump that turns into a blister with clear fluid, follow your dermatologist's advice for immediate examination and testing, preferably within 1-2 days. The preferred test in that situation is a PCR test, not a culture.
I'll be interested in how all this shakes out. Thanks again for your question.
HHH, MD
Well I do...Thank you again doctor!
MEDICAL PROFESSIONAL
"PS--Any idea what could cause all the weird tingles?"
My term is genitally focused anxiety -- but "psychosomatic fear" also works. Just live with it; nothing harmful is going on. Once you come to understand and believe that, I'll bet the feelings diminish or disappear entirely.
That will end this thread. I won't have any further comments or advice.
My term is genitally focused anxiety -- but "psychosomatic fear" also works. Just live with it; nothing harmful is going on. Once you come to understand and believe that, I'll bet the feelings diminish or disappear entirely.
That will end this thread. I won't have any further comments or advice.
Oh God...thank you doctor. You'e sure?? It's been six months of absolute, constant fear. That it's finally over and I'm ok...I feel so lucky!
Thank you so much for your help, Dr. Handsfield. This has been horrible, and anyone else, if you're reading this, PLEASE be careful, talk to your partners, take precautions and do your research!
PS--Any idea what could cause all the weird tingles? Psychosomatic fear?
Thank you so much for your help, Dr. Handsfield. This has been horrible, and anyone else, if you're reading this, PLEASE be careful, talk to your partners, take precautions and do your research!
PS--Any idea what could cause all the weird tingles? Psychosomatic fear?
MEDICAL PROFESSIONAL
Yes, that's what it means; when there is a conflict between a low-level positive and a negative HSV blood test, the negative results always rule. You can put it to rest. Congratulations!
This is also a pretty good lesson for other persons anxious about herpes: the HSV blood tests are not perfect, and a lot of people who think they want to be tested end up with needless increased anxiety. The tests are to be used carefully in select circumstances, and testing isn't to be taken lightly.
This is also a pretty good lesson for other persons anxious about herpes: the HSV blood tests are not perfect, and a lot of people who think they want to be tested end up with needless increased anxiety. The tests are to be used carefully in select circumstances, and testing isn't to be taken lightly.
Morning Doctor,
I got my final results from my doctor's office this morning; everything came back "perfectly normal." I got a copy of the results, which I've not seen a HSV test quite like this before: "In Range" index score 1242 with a reference scale of 694-1618. I want to believe this means I'm out of the woods...but just please confirm it for me!
I got my final results from my doctor's office this morning; everything came back "perfectly normal." I got a copy of the results, which I've not seen a HSV test quite like this before: "In Range" index score 1242 with a reference scale of 694-1618. I want to believe this means I'm out of the woods...but just please confirm it for me!
MEDICAL PROFESSIONAL
Sorry, I can't interpret what the receptionist said or whether she even understands anything about the test.
Hello again Doctor,
So I don't have full results from my follow up test yet, though the results are in. My doctor is out of the office so I don't have comprehensive data yet, though apparently the test results have a different numeric indexing system from before (something like 650-10,000 is what the receptionist told me). She said she could only tell me that my results were "in range." I'm hoping to have a more detailed conversation with my doctor no later than tomorrow.
In the meantime, can you tell me what the heck "in range" means?
So I don't have full results from my follow up test yet, though the results are in. My doctor is out of the office so I don't have comprehensive data yet, though apparently the test results have a different numeric indexing system from before (something like 650-10,000 is what the receptionist told me). She said she could only tell me that my results were "in range." I'm hoping to have a more detailed conversation with my doctor no later than tomorrow.
In the meantime, can you tell me what the heck "in range" means?
MEDICAL PROFESSIONAL
The BiokitUSA test result is available in 20 minutes -- but it generally requires confirmation with WB. I advise you to go with standard testing. You've been dealing with this for 6 months; 1-2 more weeks shouldn't be a big deal.
That's my last comment until you report follow-up test results.
That's my last comment until you report follow-up test results.
Thank you again. Is there a rapid test available for HSV2, and if so, where might I find it? The thought of having to wait weeks, particularly with the approaching holidays doesn't exactly put me at ease.
MEDICAL PROFESSIONAL
OK, this confirmsmy thoughts above. Even though IgM testing is inherently unreliable, that positive result, in combination with the other test results, Is consistent with an infection acquired 2-4 weeks earlier. However, at this point we do not know for sure that you even have HSV-2, and I would suggest no further speculation about its origins until and unless the diagnosis is confirmed.
I did get a copy of the original clinic results for the ELISA testing as I wanted my doctor to review them since his initial examination found the symptoms inconsistent with HSV2 and he thought the likelihood of my exposure to be low. They performed both an IgM and IgG antibody test, with an IgM index of 2.6 and IgG of 2.4.
Even so, assuming one of my partners was HSV2 positive but not having an outbreak and that I was the penetrative partner in protected sex. What are the odds that I could have picked up the virus?
Even so, assuming one of my partners was HSV2 positive but not having an outbreak and that I was the penetrative partner in protected sex. What are the odds that I could have picked up the virus?
Thank you again doctor. Your point about serioconversion is one that had occurred to me, but with all the conflicting data and atypical symptoms I had hoped for something more concrete.
If somehow I did contract HSV2, I have no idea how or from who. Besides HSV1, is there any other infection with known cross reactivity to ELISA testing? If so, I will of course want to research the possibility of having contracted some other virus and seek treatment.
If somehow I did contract HSV2, I have no idea how or from who. Besides HSV1, is there any other infection with known cross reactivity to ELISA testing? If so, I will of course want to research the possibility of having contracted some other virus and seek treatment.
MEDICAL PROFESSIONAL
By the way, all this assumes that your IgG HSV-2 result was 2.4, as you said in one of the other threads. If the only positive HSV-2 result is the IgM of 2.6, then probably you do not have herpes at all. The HSV IgM antibody tests are useless; see the thread linked below. It's several years old, but still accurate:
http://www.medhelp.org/posts/STDs/Confusiion-over-other-IgM-Herpes-posts/show/248394
http://www.medhelp.org/posts/STDs/Confusiion-over-other-IgM-Herpes-posts/show/248394
MEDICAL PROFESSIONAL
Thanks for the additional information.
Most people with your HSV IgG results ARE infected with HSV-2. Specifically, the combination of HSV-2 ELISA ratio 2.4 and negative HSV-1 probably will sort out as being truly HSV-2 positive.
Also, your blood test results are quite typical for a new HSV-2 infection, i.e. within a few weeks. Specifically, an HSV-2 ELISA ratio of 2.4 at 3 weeks, and an "atypical" WB at 4 weeks, fits very well with a new infection in the process of seroconverting. Therefore, although my first thought was that your low abdominal rash probably wasn't herpetic, these results suggest this is at least a possibility.
All this reinforces my recommendation for another round of blood tests. Taking lysine shouldn't make any difference. (The data also suggest it makes no difference in herpes outbreaks either.) If the rash was herpes, I would predict a more definitely positive HSV-2 result, i.e. ELISA ratio 3.5 or higher; and a clearly positive WB result.
If cost is an important issue, have the IgG test only; if the HSV-2 result has risen to >3.5, that will settle it. If still below that level, then the follow-up WB will probably sort things out.
As this implies, I disagree with your doctor's advice to "drop it". As you surmise yourself, it is in your interest -- and that of your current and future sex partners -- to know whether or not you are infected with HSV-2. The additional tests I have recommended should sort it out. Feel free to print out this thread as a framework for further discussion with him.
Having said all that, your more detailed description of the rash doesn't sound like herpes. So we are still left with the possibility that you have HSV-2, but it isn't the cause of any symptoms you have described.
I see no point in azithromycin for similar outbreaks in the future, unless and until a bacterial infection is documented as the cause.
In any case, I'm not inclined to keep speculating. If you have the repeat tests, I will be very interested to hear the results and help interpret them for you. But there's not much more I can do until then.
Most people with your HSV IgG results ARE infected with HSV-2. Specifically, the combination of HSV-2 ELISA ratio 2.4 and negative HSV-1 probably will sort out as being truly HSV-2 positive.
Also, your blood test results are quite typical for a new HSV-2 infection, i.e. within a few weeks. Specifically, an HSV-2 ELISA ratio of 2.4 at 3 weeks, and an "atypical" WB at 4 weeks, fits very well with a new infection in the process of seroconverting. Therefore, although my first thought was that your low abdominal rash probably wasn't herpetic, these results suggest this is at least a possibility.
All this reinforces my recommendation for another round of blood tests. Taking lysine shouldn't make any difference. (The data also suggest it makes no difference in herpes outbreaks either.) If the rash was herpes, I would predict a more definitely positive HSV-2 result, i.e. ELISA ratio 3.5 or higher; and a clearly positive WB result.
If cost is an important issue, have the IgG test only; if the HSV-2 result has risen to >3.5, that will settle it. If still below that level, then the follow-up WB will probably sort things out.
As this implies, I disagree with your doctor's advice to "drop it". As you surmise yourself, it is in your interest -- and that of your current and future sex partners -- to know whether or not you are infected with HSV-2. The additional tests I have recommended should sort it out. Feel free to print out this thread as a framework for further discussion with him.
Having said all that, your more detailed description of the rash doesn't sound like herpes. So we are still left with the possibility that you have HSV-2, but it isn't the cause of any symptoms you have described.
I see no point in azithromycin for similar outbreaks in the future, unless and until a bacterial infection is documented as the cause.
In any case, I'm not inclined to keep speculating. If you have the repeat tests, I will be very interested to hear the results and help interpret them for you. But there's not much more I can do until then.
Also, I should mention that I am not on any kind of antiviral therapy. I do take 1500mg of L-Lysine a day as I find my overall health benefits from it. It also may be of note that my doctor prescribed Azithromyacin at the time of my second outbreak. The antibiotics were for a sinus infection, not the lesion which I'd already had for about a week. It seemed to clear much faster with the antibiotic.
As for further testing, my doctor is hesitant (he's told me to "drop it" more than once), and I'm just plain scared and concerned about the cost. I'm also worried about the tingling, since it sounds indicative of some kind of nerve damage. Could it all be related?
As for further testing, my doctor is hesitant (he's told me to "drop it" more than once), and I'm just plain scared and concerned about the cost. I'm also worried about the tingling, since it sounds indicative of some kind of nerve damage. Could it all be related?
Hey Doctor,
Thank you for your candid response. I'll address your questions, and hopefully you can provide an even more specific answer.
My positive blood test was performed July 21, approx. 3 weeks after exposure. IgM levels yielded a 2.6 index, and HSV1 IgG testing yielded .01--negative.
As I mentioned, I had Western Blot test approx. 4 weeks after exposure, with results atypical. My primary doctor, dermatologist and psychiatrist (I like a variety of opinions) saw no need for further testing.
I did contact all my partners that I had immediately before and after the initial outbreak and insisted they all get IgG antibody tests explaining that they would need to ask for the specific test and that even though we used condoms they were still at risk. They all say they tested negative and had no symptoms, and I've followed up with all of them multiple times. I suppose they could be lying, though the fact that my status is still undetermined and that they still want to "do it again" shall we say, suggests that they did get tested.
I have had NO SYMPTOMS anywhere on my genitals or anus, not even a tingling. All lesions appeared near my beltline or just below in my pubic area, and always around hair follicles. I've had folliculitus in the past, but I will say these abcesses don't look like any I've seen before.
To go into more detail about the lesions: they appear as very swollen ovular patches. At first the skin feels rough, and I can see white raised hair follicles on the skin, similar to goosebumps. They do NOT look like blisters I've seen anywhere, and are not visibly full of fluid. After a day or so, the skin peels off, usually with some orangish, plasma like discharge (as if from a broken scab), exposing the layer of skin underneath and the swelling reduces. They never hurt or itch. Eventually, a scab forms the way it would over a cut or pimple.
Thank you for your candid response. I'll address your questions, and hopefully you can provide an even more specific answer.
My positive blood test was performed July 21, approx. 3 weeks after exposure. IgM levels yielded a 2.6 index, and HSV1 IgG testing yielded .01--negative.
As I mentioned, I had Western Blot test approx. 4 weeks after exposure, with results atypical. My primary doctor, dermatologist and psychiatrist (I like a variety of opinions) saw no need for further testing.
I did contact all my partners that I had immediately before and after the initial outbreak and insisted they all get IgG antibody tests explaining that they would need to ask for the specific test and that even though we used condoms they were still at risk. They all say they tested negative and had no symptoms, and I've followed up with all of them multiple times. I suppose they could be lying, though the fact that my status is still undetermined and that they still want to "do it again" shall we say, suggests that they did get tested.
I have had NO SYMPTOMS anywhere on my genitals or anus, not even a tingling. All lesions appeared near my beltline or just below in my pubic area, and always around hair follicles. I've had folliculitus in the past, but I will say these abcesses don't look like any I've seen before.
To go into more detail about the lesions: they appear as very swollen ovular patches. At first the skin feels rough, and I can see white raised hair follicles on the skin, similar to goosebumps. They do NOT look like blisters I've seen anywhere, and are not visibly full of fluid. After a day or so, the skin peels off, usually with some orangish, plasma like discharge (as if from a broken scab), exposing the layer of skin underneath and the swelling reduces. They never hurt or itch. Eventually, a scab forms the way it would over a cut or pimple.
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.
