Is it really HSV1?

[curiousone123]

Hello Dr HHH :)

Roughly around mid December last year I had intercourse with my bf (oral, vaginal), before him I was a virgin. 5 days later I felt extremely itchy and noticed thick yellow discharge and 3 small bumps around my labia (white head, not in a cluster) that appeared 2-3 days later. I immediately went to see my GP on the 24th who did a swab of my lesions. Initially I thought it was a bad yeast infection or rubbing/latex during intercourse that I wasn't used to, or an allergy from a new soap that I had started using. I was prescribed Valtrex and Diflucan, both I took on the day and all the symptoms were gone the next day. Unfortunately on the 26th the PCR results came back positive for HSV1 (negative for all other STDs).

Three weeks later I experienced similar itchiness again coupled with some pain in passing urine. The doctor said the itchiness is obviously due a yeast infection and my urine sample revealed a UTI. I was given medicine for the yeast infection and UTI and it alleviated all the symptoms the next day. There, I also I took a IgG blood test for HSV1 to confirm my previous herpes diagnosis. The results came back >200ru/ml.

My questions here are:
1. Is my IgG blood test reliable since it was taken relative soon since my initial suspected outbreak? would you recommend that I get retested after 3-4 months?

2. Before, during and after my suspected outbreak I did not experience any flu like symptoms or swollen glands. Also  my lesions did not crust over, everything healed up within 4 days. My partner definitely did not have a sore on his mouth when he performed oral sex (could it be asymptomatic viral shedding?). I know I may sound a little in denial  but I want to ask if there is ANY chance of it being a misdiagnoses?

I'm just trying to be hopeful here but also prepared for the worst.

Thank you so much for your time Dr, I hope to hear from you soon :)

[Edward W Hook, MD]

Welcome to the Forum.  Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

You were well served by your first doctor who tested and treated you quite appropriately, something that all too many doctors do not do.  You have genital HSV-1.  A positive PCR or culture test trumps all other diagnostic tests and should be believed.  While I am not familiar with the test you had, it is reasonable the you would have an antibody response to your infection about a month after your initial outbreak.  While it may take some people up to 6 months to develop antibodies to HSV and a small proportion of infected persons do not develop antibodies detected by current tests, about half of recently infected people will have positive tests 3-4 weeks after their initial outbreak.  

I suspect that your BF, like about 60% of Americans has HSV-1, most likely acquired in childhood and that despite the absence orf regular cold sores, he was asymptomatically shedding the virus at the time it was transmitted to you.  

In answer to your specific questions:
1. Is my IgG blood test reliable since it was taken relative soon since my initial suspected outbreak? would you recommend that I get retested after 3-4 months?

See above. I see no need for further antibody testing - your results are all pefectly consistent with your history of recently acquired genital HSV-1.

2. Before, during and after my suspected outbreak I did not experience any flu like symptoms or swollen glands. Also  my lesions did not crust over, everything healed up within 4 days. My partner definitely did not have a sore on his mouth when he performed oral sex (could it be asymptomatic viral shedding?). I know I may sound a little in denial  but I want to ask if there is ANY chance of it being a misdiagnoses?

You have two unrelated tests for HSV-1 and a consistent, although not classically typical illness at the time of your initial tests.  There is very, very little chance that this is a misdiagnosis.   I suggest that you search our site for more information about genital HSV-1.  Compared to HSV-2, you are far less likely to experience recurrences,  and if you do have recurrences, they will likely be milder than average for HSV-2.  You are also far less likely to transmit infection to others than if you had HSV-2.

I hope these comments are helpful.

EWH

[Edward W Hook, MD]

You really don't need to worry.   While in medicine one can never say never, there is rally no realistic chance that you will infect your BF again. The immunity he has developed from his infection will keep you from trans tilting to him.  Please don't worry.  EWH

[curiousone123]

Dear Dr Hook :) first of all my apologies, I addressed my question in response to a post by somebody else answered by Dr Handsfield, I didn't realise the forum was shared!

Thank you very much for your detailed response, indeed it was very helpful. I will take on your advice to not take further antibody testing.

The reason why I was so concerned about the diagnoses is because I'm very scared to transmit the infection to my boyfriend, even though HSV1 is far less likely to transmit than HSV2 and he already carries HSV1 antibodies due to his oral infection, I suppose there is still a small risk.

May I ask, in your years of professional experience, do you know of any couples, one being a HSV1 carrier, who has never transmitted the infection to their partner whether with/without suppressive medication and/or with/without the use of a condom?

To my understanding, since the frequency and severity of the recurrences (if any) will decrease over time, and the virus will shed less and less, does that mean that the risk of transmission will be lower over time also?

Thank you for your time Dr Hook.