Herpes - Primary Outbreak? Valid Test Results?

[hopingfalsepositive]

I am thirtysomething woman. On March 19th, I had one-time unprotected sex with an acquaintance that included vaginal intercourse and oral sex (both ways). Just a couple of weeks later, on April 7th, I got tested for herpes and my HSV-1 came back positive at 3.06 and my HSV-2 came back positive at 1.75.

A couple of days after I was tested, so around 3 weeks after the exposure incident, I started getting flu-like symptoms (chills, body aches), but also internal vaginal discomfort (but no pain while urinating), sore / tingly feet and ear aches / head pressure and even tingly lips. What I did NOT get, and am assuming I won't get because I'm feeling mostly better now, are any externally visible sores or lesions or blisters or bumps.

I'm assuming that it's highly possible to get all of these symptoms without lesions when you have Type 2, correct? Most people in my case just would have assumed that they got some weird flu-type thing with vaginal discomfort and never known they had herpes, right?

My assumption is that I just had a primary outbreak that just happened to not include external lesions.

So my questions are:

1) I don't want to be naive, and if I have all the symptoms except the blisters and sores then I should be realistic and assume that I am in fact positive for Type 2...would you agree?

2) If it’s true that I just had my primary outbreak and it did not include any lesions, what are the chances of me having blisters and lesions in future outbreaks?

3) All of the websites say that the first outbreak takes place 2 - 15 days after exposure. And if that's the case, then why would we have to wait a few months for accurate test results? If the outbreak occurs so soon after exposure, wouldn't the test results be conclusive once the outbreak occurs since the virus would obviously be in the blood and active?  

Thanks!!

[Edward W Hook, MD]

I doubt it.  This is a typical place for folliculitis.  At the same time, obviously I cannot examine you and HSV can be difficult to diagnose.  If you are conderned, a more definitive answer would be to get it cultured.  EWH

[hopingfalsepositive]

Hi again Dr. Hook,

The other day I saw a small red bump on my butt cheek but it didn't scare me because it looked like a little zit and was not sensitive at all. But just now when I looked again, there was another little bump close by, and then a little cut-looking thing there too. I read on lots of posts how herpes is often mistaken for pimples or insect bites when really they are herpes outbreaks. None of them are sensitive to the touch or have puss or juice or anything. Do you think this could be an outbreak?

Thanks!

[hopingfalsepositive]

Thanks Dr. Hook.

No, the doctor did not do a speculum exam, which is why I was looking for your feedback as to the likelihood of this happening.

I will wait for my sexual partner to get tested on Monday, and if he tests negative, then I will remain hopeful that I too will test negative when I go back in a couple of months for a retest.

[Edward W Hook, MD]

In medicine we never say never - you can't.  At the smae time, it would be very, very unusual for you to have an initial episode of HSV and not to have external lesions.  I presume the DR. you saw did a speculum examination and if so, if there were lesions limited to interanl locations, she/he should have seen them and then tested or acted accordingly.

I remain doubtful the you have genital HSV.  EWH

[hopingfalsepositive]

Quick additional comment - although there are no lesions or bumps or blisters or redness, there is a lingering vaginal stinging / burning feeling that comes and goes. I went to the doctor the other day (one of those out-patient walk-in clinics) and I tested negative for a UTI. That's why I'm wondering if I do have lesions but they're all in the vagina...

[hopingfalsepositive]

Thank you so much for the quick response - means the world to me! I have one more super quick questions, if I may.

It is possible that I do in fact that sores and lesions, but they are all inside the vagina, with no external visibility at all?

Before we had sex, my partner told me he had been tested for STDs very recently and that it all came out negative. When I told him that I tested positive, he called the clinic where he got tested and they told him that herpes was not included in his STD panel. He is out of the country now and will get tested this Monday when he returns.

Before him, I have been with only two sexual partners in the past 6 years.

Thanks again!

[Edward W Hook, MD]

The chances that you have HSV-2 are, in my opinion, rather small.  If you do, you have had it for a long time and are unlikely to have acquired it from your exposure on March 19.  Here are the reasons that I say this:

1.  As you note, most initial HSV outbreaks occur within 4-10 days of exposure.  Thus for your symptoms more than 3 weeks after your exposure to be an initial outbreak are slim.
2.  Your antibody (blood) test for HSV-1 is positive.  Thus you, like about 60% of Americans, have HSV-1.  This is most likely to be oral infection, whether or not you get cold sores.  
3.  Your antibody test for HSV-2 is in the "low positive range.  There is an ongoing debate in the expert community about what the cut-off for a positive HerpesSelect antibody test should be with many arguing that the current cut off is too low and that, in low risk persons (thus this may pertain to you), the cut off should be in the neighborhood of 3.5.  With a positive test for HSV-1 and a HSV-2 value of 1.75, there is about a 75% chance your HSV-2 result if false positive.
4.  If you have antibodies to HSV-2, they reflect an established infection and are unrelated to your symptoms.  Antibody production follows, not precedes initial HSV outbreaks.  It can take up to 4 months for antibodies to show up after an initial outbreak.
5.  The symptoms you describe are not consistent with HSV, with symptoms as prominent as what you describe, lesions should have been present.
6.  Do you even know if your partner has HSV??

If you wish to sort out your HSV antibody status, you should be tested with a second test for HSV-antibodies, unrelated to the first.  If your first test was a HerpeSelect, either a Western blot performed at the University of Washington or a BioKIt (Surevue) test will help.  If either of these tests are negative, your initial result was false positive.

The topic of herpes is a complex one.  The disease is common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans.  For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else.  I have done my best to answer your questions but in general, many of these questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).  

Hope this helps.  EWH

[hopingfalsepositive]

One more thing if I may...although a few of my symptoms are still lingering, I am feeling better on the whole. How likely is it at this point that I develop lesions and blisters? When you start to feel somewhat better, are you "in the clear"? Thanks!!