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Trying to move forward - vaginal sores
Hi. Please help me to shed some rationality to my thoughts. No similar ulceration episodes have occurred in the last 7 months; still, I check myself daily, trying to find something that would be suitable for a PCR.
I got tested for the 5th time, using a different test (by R-Biopharm - http://www.alka.com.br/site/files/rbiopharm/artigo_herpes.pdf). Partner B (7 year bf) also got tested. We were both negative for HSV2. I also learned that Partner A used the same test 4 months after our encounter, not a crude antigen based one like I said in my last post; he was negative for HSV.
My GYN insists that vaginal sores cannot be anything other than herpes and I feel bad about having sex with Partner B. However, I tested positive with a high titer on a combo HSV sorology just 2 days after my “initial ob” – which probably indicates a previous oral HSV1 - and my tests are still negative for HSV2.
1. What is statistically more likely – me having genital HSV1 with a positive sorology just 2 days after symptoms (therefore coexisting with a previous oral HSV1 infection) or me having (recurrent) HSV2 and not testing positive after almost 2 years?
2.Getting tested with a test that uses purified gG instead of recombinant gG (like Focus) is a valid attempt of increasing the sensitivity of my results?
3.Not having had sores for 7 months makes it less likely for be HSV?
I got tested for the 5th time, using a different test (by R-Biopharm - http://www.alka.com.br/site/files/rbiopharm/artigo_herpes.pdf). Partner B (7 year bf) also got tested. We were both negative for HSV2. I also learned that Partner A used the same test 4 months after our encounter, not a crude antigen based one like I said in my last post; he was negative for HSV.
My GYN insists that vaginal sores cannot be anything other than herpes and I feel bad about having sex with Partner B. However, I tested positive with a high titer on a combo HSV sorology just 2 days after my “initial ob” – which probably indicates a previous oral HSV1 - and my tests are still negative for HSV2.
1. What is statistically more likely – me having genital HSV1 with a positive sorology just 2 days after symptoms (therefore coexisting with a previous oral HSV1 infection) or me having (recurrent) HSV2 and not testing positive after almost 2 years?
2.Getting tested with a test that uses purified gG instead of recombinant gG (like Focus) is a valid attempt of increasing the sensitivity of my results?
3.Not having had sores for 7 months makes it less likely for be HSV?
MEDICAL PROFESSIONAL
It is true that not all type-specific HSV tests convert to positive as fast as HerpeSelect, but that difference is seen only at 3-6 weeks. As far as known, all tests reach maximum positivity by 4 months. If you or a partner turns out to have a positive test for HSV-2 someday, feel free to post it here. But there isn't any need to post additional negative results. My advice is that you just let it go, secure in the knowledge you don't have genital herpes.
Thanks, Dr. HHH. Just to correct my previous information, Partner A has done some sort of STD screening and was considered "clean" by his doctor, but I'm trying to gather some aditional information. I suspect HSV was not included, as usual.
Yes, Partner A (one night stand) and Partner B (longtime bf) were my only sexual partners in life. And as I said before, Partner A got tested with the R-Biopharm test 4 months after our encounter, being negative for HSV1 and HSV2, IgG and IgM. I would tend to accept such result considering that 4 months is allegedly enough for seroconversion, but I've read some data about other glycoprotein based tests taking much longer to show seroconversion than HerpeSelect, which makes me wonder about the validity of such results.
Anyway, I'll wait for his test's details and let you know. Would it be possible not to close this thread for now? Thanks.
Yes, Partner A (one night stand) and Partner B (longtime bf) were my only sexual partners in life. And as I said before, Partner A got tested with the R-Biopharm test 4 months after our encounter, being negative for HSV1 and HSV2, IgG and IgM. I would tend to accept such result considering that 4 months is allegedly enough for seroconversion, but I've read some data about other glycoprotein based tests taking much longer to show seroconversion than HerpeSelect, which makes me wonder about the validity of such results.
Anyway, I'll wait for his test's details and let you know. Would it be possible not to close this thread for now? Thanks.
MEDICAL PROFESSIONAL
I was unaware you have had only 2 lifetime sex partners; if you said it earlier, I missed it. That neither of them has HSV-2 is is not just an "element"; it is crucial. All by itself, if you had told me nothing else, it rules out HSV-2 as an explanation for your symptoms. important. Adding that fact to all the other information, I now consider it impossible you had HSV-2.
I agree that multiple, bilateral genital lesions strongly suggests a primary infection. For the reasons above, it couldn't be HSV-2, and the positive blood test for HSV-1 at only 2 days is also incompatible with a primary infection beginning only 2 days earlier. The only slimp possibility for herpes remains an atypical non-primary HSV-1 infection. People are immune, or at least highly resistant, to new infections with the same HSV type with which they are already infected. If you had HSV-1 before the symptomatic genital ulcer event, that is strong evidence HSV-1 wasn't the cause.
About 5% of people with HSV-2 do not develop measurable antibody. PCR performance for HPV says nothing about HSV diagnosis. But your doctor nevertheless is correct that a negative PCR or culture can never definitively rule out herpes.
Considering all the evidence, my advice is that you go forward with great confidence you don't have it and therefore cannot infect your current or future partners. In the off chance you have another episode of genital ulceration, of course get it checked out as promptly as you can. But I doubt it will ever happen.
I agree that multiple, bilateral genital lesions strongly suggests a primary infection. For the reasons above, it couldn't be HSV-2, and the positive blood test for HSV-1 at only 2 days is also incompatible with a primary infection beginning only 2 days earlier. The only slimp possibility for herpes remains an atypical non-primary HSV-1 infection. People are immune, or at least highly resistant, to new infections with the same HSV type with which they are already infected. If you had HSV-1 before the symptomatic genital ulcer event, that is strong evidence HSV-1 wasn't the cause.
About 5% of people with HSV-2 do not develop measurable antibody. PCR performance for HPV says nothing about HSV diagnosis. But your doctor nevertheless is correct that a negative PCR or culture can never definitively rule out herpes.
Considering all the evidence, my advice is that you go forward with great confidence you don't have it and therefore cannot infect your current or future partners. In the off chance you have another episode of genital ulceration, of course get it checked out as promptly as you can. But I doubt it will ever happen.
By one of those *major* coincidences, Partner A has just contacted me to say that he re-tested for HSV (by request) and other STDs and again was negative. So my only two sexual partners in life are testing negative for HSV2. Just to add that element to your analysis, thanks.
Thanks for your answer, Dr. HHH. I just feel very bad about the possibility of exposing my current partner to an infection that I caught outside our relationship (HSV2) - he knows all about it and is fine with it, but I feel bad about the whole thing.
My appointment with the vulva expert was very disappointing. She sounded very misinformed about HSV sorology tests, saying that is currently impossible to distinguish HSV1 from HSV2 through a blood test (a statement also made by my bf urologist), which I know is not longer true. As for my PCR swab results, she said that she has had cases where such exam showed negative for HPV while the patient was clearly suffering from a HPV infection. She said that we could try another swab, but in her opinion vaginal sores cannot be anything else other than HSV and it doesn't matter what type it is.
As for question 1, do you know the percentage of people that have HSV2 (with recurrences) and show negative results with HerpeSelect?
As for the possibility of the first episode being a recurrence after an asymptomatic initial infection - which would explain the positive combo sorology test -, I thought that having had 6-7 sores, spread bilaterally in my vulva, was enough to confirm that it was a true initial infection. Did I get it wrong?
Anyway, I just asked about the meaning of the positive combo sorology test because I don't understand whether is possible or not for someone to have oral HSV1 acquired in childhood and many years later catch genital HSV1. I suspect I`ve had cold sores as a child because my whole family suffers from it (my mom still suffers from it, for instance), but mainly because I had that positive combo sorology days after symptoms. But I don`t know exactly how sorology tests behave in such cases. Could the positive combo sorology be indicating a pre existing HSV1 infection?
Sorry for the length of my questions. Thanks again.
My appointment with the vulva expert was very disappointing. She sounded very misinformed about HSV sorology tests, saying that is currently impossible to distinguish HSV1 from HSV2 through a blood test (a statement also made by my bf urologist), which I know is not longer true. As for my PCR swab results, she said that she has had cases where such exam showed negative for HPV while the patient was clearly suffering from a HPV infection. She said that we could try another swab, but in her opinion vaginal sores cannot be anything else other than HSV and it doesn't matter what type it is.
As for question 1, do you know the percentage of people that have HSV2 (with recurrences) and show negative results with HerpeSelect?
As for the possibility of the first episode being a recurrence after an asymptomatic initial infection - which would explain the positive combo sorology test -, I thought that having had 6-7 sores, spread bilaterally in my vulva, was enough to confirm that it was a true initial infection. Did I get it wrong?
Anyway, I just asked about the meaning of the positive combo sorology test because I don't understand whether is possible or not for someone to have oral HSV1 acquired in childhood and many years later catch genital HSV1. I suspect I`ve had cold sores as a child because my whole family suffers from it (my mom still suffers from it, for instance), but mainly because I had that positive combo sorology days after symptoms. But I don`t know exactly how sorology tests behave in such cases. Could the positive combo sorology be indicating a pre existing HSV1 infection?
Sorry for the length of my questions. Thanks again.
MEDICAL PROFESSIONAL
Welcome back to the forum.
It's good to hear you haven't had any further recurrences of your genital ulcerations. As we discussed last fall, the evidence is very strong that you don't have genital herpes, notwithstanding your gynecologist's opinion. (Her insitance that herpes is the only possible cause of vaginal ulceration is demonstrably wrong.) We discussed that evidence in your other thread and there really isn't much to add, except that the additional negative test(s) for HSV-2 since then make the evidence even stronger. Although I wasn't personally familiar with the latest test method, a glance at the URL you provided shows it to be a reliable type-specific test, which uses a somewhat different technology than most HSV blood tests. That makes it doubly reassuring: when several kinds of HSV-2 blood test all are negative, using different technologies, the evidence against HSV-2 infection is elevated. Having a slightly higher numerical result on one test to the next is normal. Even with the same brand of test (and even with the same production batch of that test), the numbers never are identical on repeat testing; any value below the positive cut-off value is equally negative.
Can I prove you don't have herpes? No. As we discussed before, it remains conceivable you had an atypical course of genital HSV-1, or that you are one of the few people with HSV-2 who simply doesn't develop measurable antibody to the virus. But I still doubt it. Also, I believe your last thread closed with your plan to see a specialist in vulvar conditons. What did s/he have to say about all this?
To your current questions:
1) It is impossible to develop measurable antibody to HSV within 2 days of onset of infection. However, it IS possible to have an initial asymptomatic infection, followed in a few weeks or months by a first recurrence -- which seems like the first infection. Beyond that, I cannot say whether either of these two unlikely scenarios is more likely than the other. I continue to believe your problem wasn't herpes at all.
2) To my knowledge, there is no difference in test performance based on recombinant versus non-recombinent purified IgG as the test antigen -- except as I said above, having the same results on multiple kinds of tests reinforces the truth of the negative outcomes.
3) The absence of outbreaks for 7 months is another argument against HSV-2, although only a soft one. It doesn't help distinguish between HSV-1 versus a non-herpetic cause.
So I still think the best bet is that you didn't have herpes at all; and I am even more certain you do not have HSV-2. If you had HSV-1, there probably is little risk of transmission. Both recurrent outbreaks and asymptomatic viral shedding are uncommon for genital HSV-1, and therefore genital-to-genital HSV-1 transmission is uncommon. So even if genital HSV-1 is the explanation, your partner may not be at risk.
At this point, it is unlikely you're ever going to have any more definite answers -- unless of course the problem recurs (which I hope doesn't happen) and you have a PCR test. Even then, a negative result wouldn't be proof.
I hope this helps. Happy new year-- HHH, MD
It's good to hear you haven't had any further recurrences of your genital ulcerations. As we discussed last fall, the evidence is very strong that you don't have genital herpes, notwithstanding your gynecologist's opinion. (Her insitance that herpes is the only possible cause of vaginal ulceration is demonstrably wrong.) We discussed that evidence in your other thread and there really isn't much to add, except that the additional negative test(s) for HSV-2 since then make the evidence even stronger. Although I wasn't personally familiar with the latest test method, a glance at the URL you provided shows it to be a reliable type-specific test, which uses a somewhat different technology than most HSV blood tests. That makes it doubly reassuring: when several kinds of HSV-2 blood test all are negative, using different technologies, the evidence against HSV-2 infection is elevated. Having a slightly higher numerical result on one test to the next is normal. Even with the same brand of test (and even with the same production batch of that test), the numbers never are identical on repeat testing; any value below the positive cut-off value is equally negative.
Can I prove you don't have herpes? No. As we discussed before, it remains conceivable you had an atypical course of genital HSV-1, or that you are one of the few people with HSV-2 who simply doesn't develop measurable antibody to the virus. But I still doubt it. Also, I believe your last thread closed with your plan to see a specialist in vulvar conditons. What did s/he have to say about all this?
To your current questions:
1) It is impossible to develop measurable antibody to HSV within 2 days of onset of infection. However, it IS possible to have an initial asymptomatic infection, followed in a few weeks or months by a first recurrence -- which seems like the first infection. Beyond that, I cannot say whether either of these two unlikely scenarios is more likely than the other. I continue to believe your problem wasn't herpes at all.
2) To my knowledge, there is no difference in test performance based on recombinant versus non-recombinent purified IgG as the test antigen -- except as I said above, having the same results on multiple kinds of tests reinforces the truth of the negative outcomes.
3) The absence of outbreaks for 7 months is another argument against HSV-2, although only a soft one. It doesn't help distinguish between HSV-1 versus a non-herpetic cause.
So I still think the best bet is that you didn't have herpes at all; and I am even more certain you do not have HSV-2. If you had HSV-1, there probably is little risk of transmission. Both recurrent outbreaks and asymptomatic viral shedding are uncommon for genital HSV-1, and therefore genital-to-genital HSV-1 transmission is uncommon. So even if genital HSV-1 is the explanation, your partner may not be at risk.
At this point, it is unlikely you're ever going to have any more definite answers -- unless of course the problem recurs (which I hope doesn't happen) and you have a PCR test. Even then, a negative result wouldn't be proof.
I hope this helps. Happy new year-- HHH, MD
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.
