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Timeline and probability
Thanks in advance for your reply.
3.5 months ago I had a severe, unusual headache with nausea which lasted 3 hours. Within a couple of days I developed a swollen, itchy, tingling lower lip. The lip swelling subsided after 2 hours.
2 weeks after that, I had another severe headache and vomiting which lasted 4 hours. The next day my lower lip swelled again and within an hour, the swelling shifted from one part of my lip to the other side. (all lower lip) Again, the inside felt tender, itchy and tingly. The lip swelling subsided after 8 hours.
Another 2 weeks later, during protected sex with a guy with genital HSV2, the condom slipped off. He wasn't having an outbreak and said he hadn't had one in over a year.
5 days later I had a blood test, which came back IgM positive (2.1)and IgG negative. I don't know what type of test. I was told I had HSV1 and HSV2. After reading about the blood tests, I plan on retesting 4 months after the condom 'malfunction.'
I've not had any genital symptoms and no further oral symptoms. However, I have had several welt/hive? outbreaks in my groin/bikini area. They itch like crazy, but if I don't scratch, they go away quickly. I've never had cold sores.
Here are my questions:
(1)Considering the test results, does is seem more likely that I have oral herpes, based on headaches, swollen lips and lack of genital symptoms? (I do intend to retest.)
(2)Can a person have both oral and genital HSV2, or only one or the other?
(3)Does oral HSV2 shed asymptomatically? If not, is oral HSV2 something that should be discussed before kissing? What about oral HSV1? Does it shed and should it be discussed before kissing?
(4)I read that sun exposure (UVB rays) can spur an outbreak. Is that likelihood reduced by vigilant use of sunscreen on my face and lips? Even during intense fitness for hours outdoors?
(5)Are the welts/hives related to the virus? If so, is there a greater correlation to HSV1 or 2?
(6)Can a person have the antibody, but not the virus?
(7)Is it possible to be IgM positive, but never test IgG positive, or will the IgG eventually turn positive? For example, after 6 months, the IgG is still negative, do I keep testing or forget it? Do I have an obligation to tell prospective partners that I 'may' have HSV2 herpes, but haven't yet tested positive?
3.5 months ago I had a severe, unusual headache with nausea which lasted 3 hours. Within a couple of days I developed a swollen, itchy, tingling lower lip. The lip swelling subsided after 2 hours.
2 weeks after that, I had another severe headache and vomiting which lasted 4 hours. The next day my lower lip swelled again and within an hour, the swelling shifted from one part of my lip to the other side. (all lower lip) Again, the inside felt tender, itchy and tingly. The lip swelling subsided after 8 hours.
Another 2 weeks later, during protected sex with a guy with genital HSV2, the condom slipped off. He wasn't having an outbreak and said he hadn't had one in over a year.
5 days later I had a blood test, which came back IgM positive (2.1)and IgG negative. I don't know what type of test. I was told I had HSV1 and HSV2. After reading about the blood tests, I plan on retesting 4 months after the condom 'malfunction.'
I've not had any genital symptoms and no further oral symptoms. However, I have had several welt/hive? outbreaks in my groin/bikini area. They itch like crazy, but if I don't scratch, they go away quickly. I've never had cold sores.
Here are my questions:
(1)Considering the test results, does is seem more likely that I have oral herpes, based on headaches, swollen lips and lack of genital symptoms? (I do intend to retest.)
(2)Can a person have both oral and genital HSV2, or only one or the other?
(3)Does oral HSV2 shed asymptomatically? If not, is oral HSV2 something that should be discussed before kissing? What about oral HSV1? Does it shed and should it be discussed before kissing?
(4)I read that sun exposure (UVB rays) can spur an outbreak. Is that likelihood reduced by vigilant use of sunscreen on my face and lips? Even during intense fitness for hours outdoors?
(5)Are the welts/hives related to the virus? If so, is there a greater correlation to HSV1 or 2?
(6)Can a person have the antibody, but not the virus?
(7)Is it possible to be IgM positive, but never test IgG positive, or will the IgG eventually turn positive? For example, after 6 months, the IgG is still negative, do I keep testing or forget it? Do I have an obligation to tell prospective partners that I 'may' have HSV2 herpes, but haven't yet tested positive?
MEDICAL PROFESSIONAL
I don't normally look back at threads this old, but I'm glad I did this time.
You are exactly right about the problem of people being told they have herpes when they don't, based on faulty lab tests. In one respect, though, it's getting better. This was a major problem with the older, non-type-specific IgG tests; it's one of the main reasons HerpeSelect and the other type-specific tests are a such an important development. With luck, the IgM problem also will soon be a thing of the past. As I said in another thread, soon Quest Diagnostics will stop doing routine IgM testing when HSV blood tests are requested for adult patients.
Thanks for your kind comments about the STD Forum. Take care--
HHH, MD
You are exactly right about the problem of people being told they have herpes when they don't, based on faulty lab tests. In one respect, though, it's getting better. This was a major problem with the older, non-type-specific IgG tests; it's one of the main reasons HerpeSelect and the other type-specific tests are a such an important development. With luck, the IgM problem also will soon be a thing of the past. As I said in another thread, soon Quest Diagnostics will stop doing routine IgM testing when HSV blood tests are requested for adult patients.
Thanks for your kind comments about the STD Forum. Take care--
HHH, MD
I've been glued to this website since I discovered it. It's by far the best one out there. Thanks for the service you provide to the STD community.
After testing IgM positive/IgG negative twice (ordered by my gyn - the 2nd test wasn't mentioned in my original email above), I just received results from the HerpeSelect test -
negative for both HSV-1 and HSV-2. Sadly, my gyn knows very little about herpes and corresponding blood tests. She had me do the first two within 3 weeks of my exposure and immediately put me on Valtrex. Never mentioned that the test was outdated and unreliable. I did my own research, found a Quest lab, requested another referral for a 3rd test (HerpeSelect) as recommended by Dr. Hansfield.
Anyhow, I just wanted to state an observation. I was told both times after the first two (unreliable) tests that I had HSV-1 and HSV-2, this was based on the IgM results. If I had not continued my personal research, I would have fallen into the category of 'having herpes' without symptoms. This is a rhetorical question, but I wonder how many people fall into this category??? The percentage that I see quoted regularly is 90% of those with herpes don't know they have it because they have no symptoms. If that number is extrapolated from those who do have it with no symptoms, but a large % of those people were diagnosed by an unreliable test...well, you get the point...
Needless to say, maybe I'm one of those who takes several months to seroconvert (I hope not), but I'll test again in a few months to be sure.
Thanks again for a great website.
After testing IgM positive/IgG negative twice (ordered by my gyn - the 2nd test wasn't mentioned in my original email above), I just received results from the HerpeSelect test -
negative for both HSV-1 and HSV-2. Sadly, my gyn knows very little about herpes and corresponding blood tests. She had me do the first two within 3 weeks of my exposure and immediately put me on Valtrex. Never mentioned that the test was outdated and unreliable. I did my own research, found a Quest lab, requested another referral for a 3rd test (HerpeSelect) as recommended by Dr. Hansfield.
Anyhow, I just wanted to state an observation. I was told both times after the first two (unreliable) tests that I had HSV-1 and HSV-2, this was based on the IgM results. If I had not continued my personal research, I would have fallen into the category of 'having herpes' without symptoms. This is a rhetorical question, but I wonder how many people fall into this category??? The percentage that I see quoted regularly is 90% of those with herpes don't know they have it because they have no symptoms. If that number is extrapolated from those who do have it with no symptoms, but a large % of those people were diagnosed by an unreliable test...well, you get the point...
Needless to say, maybe I'm one of those who takes several months to seroconvert (I hope not), but I'll test again in a few months to be sure.
Thanks again for a great website.
Thank you very much for your quick reply. I hope it's ok to further clarify a few questions and make sure I understand your response.
On question (2), I was asking about someone having both oral and genital HSV2. I thought the malaise/flu-like symptoms were odd at the time, but didn
On question (2), I was asking about someone having both oral and genital HSV2. I thought the malaise/flu-like symptoms were odd at the time, but didn
MEDICAL PROFESSIONAL
As I said, the chance herpes explains your symptoms is low. I suggest waiting until more definitive testing, then dealing with the herpes questions and uncertainties in the unlikely event the diagnosis is confirmed by proper testing.
I didn't examine you and your doctor did. Depending on the details of what s/he saw on examination or on more detailed history, I might agree with his or her assessment. But in general, most people the symptoms you described are having a primary allergic reaction, not an infection.
IgM antibody testing has 2 main problems: 1) false positivity, i.e. a positive not indicating HSV infection at all; and 2) even if truly positive, such testing cannot distinguish HSV-1 from HSV-2. In all likelihood, your result is just plain false positive. Otherwise, the IgG test would have been positive.
HHH, MD
I didn't examine you and your doctor did. Depending on the details of what s/he saw on examination or on more detailed history, I might agree with his or her assessment. But in general, most people the symptoms you described are having a primary allergic reaction, not an infection.
IgM antibody testing has 2 main problems: 1) false positivity, i.e. a positive not indicating HSV infection at all; and 2) even if truly positive, such testing cannot distinguish HSV-1 from HSV-2. In all likelihood, your result is just plain false positive. Otherwise, the IgG test would have been positive.
HHH, MD
MEDICAL PROFESSIONAL
Your symptoms strongly suggest an allergic reaction of some kind. Severe headache followed by nausea also is classic for migraine, but to my knowledge migraine is not associated with the lip swelling etc.
None of your symptoms suggests herpes at all and you probably are not infected with HSV of either type. See many other comments on this forum about the uselessnes of HSV IgM testing. In the slight chance the result is true, i.e. that you have an early infection and will later develop a positive IgG test, the IgM result simply cannot tell that someone is positive for both HSV-1 and 2.
I would not have recommended HSV testing at all on the basis of your symptoms; but now that you have the confusing IgM result, follow up with a repeat type-specific IgG test ~3 months after the first symptomatic event. To your specific questions.
1) The IgG results are the reliable ones and indicate that you have neither HSV-1 nor HSV-2.
2) People can be infected with both viruses.
3) Oral HSV-2 is rare. Search the threads about genital herpes (e.g., search term "oral herpes" or "oral HSV-2") for more information.
4) Sunburn can trigger oral herpes outbreaks in some people.
5) Your welts/hives are unlikely to be due to herpes.
6) No. Everybody who gets HSV-1 or -2 is infected for life, and the presence of antibody indicates such an infection. There is no such thing as antibody without infection.
7) See above. I predict your IgG results will not be positive on repeat testing. In that case, you absolutely can and must ignore the IgM result. Search the threads for "herpes diagnosis", "HerpeSelect test", and "IgM".
And discuss your apparent allergic symptoms with your doctor. It could indicate a fairly serious allergy. When facial swelling occurs as a result of allergy, there is increased risk that a future reaction could involve the throat
None of your symptoms suggests herpes at all and you probably are not infected with HSV of either type. See many other comments on this forum about the uselessnes of HSV IgM testing. In the slight chance the result is true, i.e. that you have an early infection and will later develop a positive IgG test, the IgM result simply cannot tell that someone is positive for both HSV-1 and 2.
I would not have recommended HSV testing at all on the basis of your symptoms; but now that you have the confusing IgM result, follow up with a repeat type-specific IgG test ~3 months after the first symptomatic event. To your specific questions.
1) The IgG results are the reliable ones and indicate that you have neither HSV-1 nor HSV-2.
2) People can be infected with both viruses.
3) Oral HSV-2 is rare. Search the threads about genital herpes (e.g., search term "oral herpes" or "oral HSV-2") for more information.
4) Sunburn can trigger oral herpes outbreaks in some people.
5) Your welts/hives are unlikely to be due to herpes.
6) No. Everybody who gets HSV-1 or -2 is infected for life, and the presence of antibody indicates such an infection. There is no such thing as antibody without infection.
7) See above. I predict your IgG results will not be positive on repeat testing. In that case, you absolutely can and must ignore the IgM result. Search the threads for "herpes diagnosis", "HerpeSelect test", and "IgM".
And discuss your apparent allergic symptoms with your doctor. It could indicate a fairly serious allergy. When facial swelling occurs as a result of allergy, there is increased risk that a future reaction could involve the throat
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
