Dr Hook, HSV 2 question

[anxis]

Dr Hook,

I’ve been trying to interpret various papers and studies on HSV 2 but have just got more anxious and worried, and would appreciate your advice.

My last partner had had HSV 2 for several years. We were together for 6 months but never ever had unprotected sex, I’ve heard that use of condoms is preventative but not 100%?

About 7/8 weeks after we last had sex I developed small white spots on the head of my penis. They were painless and went after about 4 days, seemed superficial and didn’t ulcerate, they cleared up before I could get to the sexual heath clinic. It was suggested that it was thrush, possibly from a recent sexual encounter. I was given cream which I used and there has been no recurrence since.

I have had IgG specific HSV 1& 2 tests at : 9 ½ weeks, 13 weeks, 16 weeks, 20 weeks. They have been negative for both HSV 1 & 2.

I’m extremely worried, and am trying to move on, but have recurrent urethral itching, that feels like it sometimes radiates into my abdomen and perhaps occasionally down my leg. This started in late March and comes and goes, it has no pattern over 24hrs, sometimes I have a day without noticing it. I'm not sure if it's psychosomatic, it certainly seems worse if I worry on it. There is no dysuria.

Please let me know what you think of my symptoms,  I am worried about this itching, and have tested for –ve for GU and Chlamydia, one physician suggested it may be a manifestation of my anxiety, but I’m not sure. Is recurrent urethral itching a good indicator of HSV 2?

How reliant can I be on these tests? I fully intend to have a test at the 6 month mark, but am unsure of whether this is 24 or 26 weeks as papers just say ‘6 months’. Also, is there a chance I could be carrying HSV 2 and not seroconvert? If so would a Western Blot test be better? I am extermely anxious, please advise me.

Thanks

[Edward W Hook, MD]

1.  Sorry, I cannot explain the itching.  If the itching were due to HSVm your blood test would be positive.
2.  Yes, over 93% of persons will have developed antibody by this time.  A small proportion of person do not develop antibody.  The significance of this phenomenon is unknown.  The Western blot picks up a few of these persons but not many.
3.  See 2 above.
4.  Seems to cocur n both groups.,  Numbers are quite small however.
5.  I would suggest checking the American Social Health Association web-site (disclosure, Dr. Handsfield and I are both on the Board of ASHA).  they also have a hot line

Hope this helps.  Please remember, you have not had lesions, your tests are negqtive and you have taken precautions.  There is no evidence thaqt you have HSV.  Try not to let this concern eat at you.  There is little raaason for you to worry.  EWH

[Edward W Hook, MD]

Let me try to alleviate your anxiety.  there is little in your history to be concerned about herpes and much evidence to suggest that you do not have it.  I understand that having a partner might raise concerns but there is more evidence that you did not get it than there is that you did.  Let's review:

1. Your partner.  You did the right things- disclosure and condoms both reduce the risk of herpes transmission significantly.  The fact is, most exposures to persons with herpes do not led to transmission.
2.  The tests.  The test are good.  In your case, without evidence of HSV-1, over 90% (93% in one study) of persons who are going to develop antibody have by 3 months.  A small additional proportion become positive later but very few.  Your results make it very, very unlikely that you got HSV from your partner.  The yield of further testing for you beyond three  months will be very low.
3. Symptoms.  You symptoms are not compatible with HSV or, for that matter, any other STD.  When combined with negative tests you have nothing to worry about.

My advice- relax.  I understand the anxiety but you are doing things right and have no evidence of infection.  I hope my comments help.  EWH

[anxis]

Thank you for your comments Dr Hook, I have a few questions, sorry to be persistent but I want to make sure I dont have HSV2 to potentially pass on to another partner. After what I'm going through I wouldn't want someone else to experience it.

1) My Urethral itching has not abated, it comes and goes. What do you think of the link?

http://www.medhelp.org/forums/neuro/messages/30846.html

which I found concerning.

2) If the 6 month test is clear is this fairly definative?

3)I have read that some people do not seroconvert - is this due to the ELISA sensitivity? i.e. would a western blot detect where an ELISA wouldn't or do some people simply NOT seroconvert.

4) If some people do NOT serocnvert, do they generally belong to the HSV1 negative group, or is this not specified.

5) Could you post a link to the most up to date and , in your oppinion, reliable research if at all possible.

Thank you again.