Need More Testing?

[DracoWinters]

Hey there Dr.s-

First off, let me say how grateful I am. There is so much faceless, confusing and conflicting information on the internet, it's wonderful to see human and expert advice.

My situation (apologies for the length):

I had a one night stand with a man in which we had unprotected oral sex (giving and receiving) and a <1 minute of me receiving anal sex. Our penises did rub together without condoms, but not for a long period of time. My penis did touch his buttocks at some point without protection.

About a week after, I had a hard time peeing and painful ejaculation. I went to my doctor, they tested for gonorrhea and chlamydia which both came back negative. I also had a skin irritation under my testicles that a dermatologist easily saw was Lichen Simplex Chronicus, preexisting (I knew) and completely unrelated, no typical herpes symptoms. I scheduled an appointment with a urologist who determined rather quickly that I had prostatitis, and Cipro cleared it up.

8 weeks after the encounter, I thought it would be a good idea to get HIV/STD tested just to have peace of mind. My HSV tests came back

HIV neg
"positive" for HSV I
negative for HSV II (the HSV tests were IgM, I didn't know).

13 after the encounter, because of anxiety about the "window period" of HIV, I retested.
Test results:

HIV neg
HSVI IgM 1:120 (above reference)
HSVII IgM 1:40 (above reference)

The doctor's opinion was to get a HSVII Western Blot, but I've since moved away and don't have easy access to a lab which can get the test.

Right before the last test, I asked that partner and he said he had an STD test the week previous and was clean (I don't know if he was tested for herpes).

I've had no symptoms and no reason to believe I have HSVII other than that second IgM test, which I now know is useless.
Do I even need to be tested again? Why or why not? Why would the IgM results come back negative and then positive?

Thank you for your time and expertise!
Draco

[Edward W Hook, MD]

Both the structure of the IgM molecule and the nature of the test itself contrbute to the non-specificity of IgM tests for herpes viruses.  In addition, the IgM tests use non-specific antigens and not the gG antigens which are type specific as the basis of the tests.  More detailed response is beyond the scope of this forum.  EWH

[DracoWinters]

By "You apparently already know that you have HSV and this is also suggested by your test results" I assume you are talking about HSV1? I remember having one or two cold sores when I was a child, but nothing in my recent history, so an oral HSV1 infection would make sense. What is it about IgM tests that cause them to cross-react so easily?  I know it has something to do with the actual physicality of the test, but what does that mean?

Thanks for your time!

[Edward W Hook, MD]

Your HSV test results are useless.  You apparently already know that you have HSV and this is also suggested by your test results-

1.  As for HSV-2, the tests performed on you for herpes are of little value. You were tested with a non-specific test for HSV, in which antibodies for HSV-1 not uncommonly cause cross reactions with the HSV-2 test, causing cross reactions.  

There is nothing in your history to suggest to me that you have herpes or need re-testing for any STD.  If you are concerned about HSV-2, please get tested with a specific test such as the HerpeSelect.  If you choose to get tested however, please realize that if positive, that does not mean that you acquired HSV from the exposure you describe.  It could have been present and unapparent to you.

Hope this helps.  EWH