HSV Antibodies affected by stress?

[JustPuzzled]

I have been having recurring ulcers in my genital area. I assumed right away it must be HSV. I even had negative HerpeSelect tests at 4 months(NEG for both types of HSV).However, since the first ulcers appeared I was worried constantly and stressed about it being Herpes nonstop. It was a never ending stress issue for me. My question is being that I was under a great deal of stress for a long period of time(4 months), would that stress have weakened my immune system causing my body not to develope Antibodies? Is it possible? Should I retest?

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum. Responding only to the title you selected for your question, before reading anything else:  HSV antibody test results are not affected by stress.

Now I have read the question.  It doesn't change my first impression.  The negative HSV-2 antibody result is strong evidence that herpes is not the cause of your genital area ulcers.  However, up to 10% of people with HSV-2 do not develop positive antibody tests.  If a health care provider has examined your genital lesions and believes they are compatible with herpes, you might have it.  If in doubt, the provider can test a lesion for the virus by culture or PCR during your next outbreak.

Finally, the pattern of your genital ulcers could make a big difference in judging whether or not you have herpes.  If you're having diffuse ulcers, i.e. all over the genital area, or if lesions come and go frequently, herpes is unlikely.  Recurrent genital herpes causes lesions that start as red bumps, turn into blisters, then get scabs and heal over a total period no longer than 2 weeks.  Each such outbreak occurs in more or less the same spot every time, give or take and inch; and always on the same side of the body's midline (recurrent herpes on both sides of the genitals is rare).  Such outbreaks never occur no more often than once a month (usually every 2-3 months) and between outbreaks there are no symptoms of any kind.  If this description fits your symptoms, herpes might be likely despite the negative blood test.  If it does not, then probably herpes is not the problem.

I hope this helps. Best wishes--  HHH, MD

[JustPuzzled]

My 1st outbreak was in Jan. on my labia minora(upper) 2 single red bumps a few days after my last  sexual encounter. The pimple looking bumps became open oozy ulcers. had them for about 5 days after they were open. One doctor suggested maybe folliculitis(no swab was performed) Then 2 days later just a single ulcer across from where the others were.Another Dr. said maybe herpes and just sent me on my way.(I had it for a few days by the time i got to the doctor's so she figured a swab would be useless.

March I had got a scratch on my perineum went to the Dr. and this one said it did not look like herpes. Few days later it became a puss leakin sore then i got a 2nd sore on my perineum a few days later and had them for a week and a few days.

I currently have a sore in the same spot as the third one i got in January. It was like a pimple and it seemed like there was a lump under it. The skin seemed firm. I hurt from friction so i popped it to relieve the pressure. Now its an open sore.


NOTE: I took two Igg blood tests and both were Neg. I never had the flu like symptoms or the painful urination.

1.You think this fits Hsv?
2.So some people NEVER develope HSV antibodies? 10%? really?
3. Could I be one of them?

[H. Hunter Handsfield, M.D.]

1) This doesn't sound like herpes, but I cannot say for sure.
2) I'm not going to repeat myself.  Why would I have said it if I weren't sure?
3) Sure you could be one of them.  But I don't think you are.  

See my advice above about seeing a provider if/when another sore appears.  You also could have another blood test; sometimes it takes 6 months to become positive.  Finally, you could arrange for testing of your sex partner(s), especially anyone you had sex with in the 2-3 weeks before the first lesion began.  If that person has a negative blood test, it will confirm you were not exposed and that herpes is unlikely.

[JustPuzzled]

Dr. thanks for all of your help. I wasn't questioning you by the 2nd question. It was more of a surprised response question.(I never knew that until now)

Also, does folliculitis seem likely for these lesions?

[H. Hunter Handsfield, M.D.]

If the lesions were in areas with hair, folliculitis would be a good bet.