lab results

[jj925000]

I have been having irritation around my penis, that comes and goes.  Primary doctor looked at in was not sure what it was.   I have done alot of testing mostly Herpeselect Igg here are my values.

Had std test 8 weeks after possible risk of herpes.
Hsv1 value =0.1
Hsv2 value<0.1
Herpes 1/2 Igm= 0.61

Repeated at  3 months values
Hsv1 value =0.11
Hsv2 value<0.1

Repeated at 21 weeks Herpeselect Elisa Igg
Hsv1 value =0.01
Hsv2 value=0.08
Herpes 1/2 Igm= not detected

Then At 30 weeks since i was still having irritation went back asked for a Western Blot, gave him doctor correct quest code for it, but instead they ran a
HSV AB IGM  and again it said not detected.

Since i am still having irritation and have not been able to get the WB done what is the likelihood i have hsv2 or hsv1 based on the test results.  Should i follow up with Hsv Wb, I am trying to have a baby and need to know accurately.

[H. Hunter Handsfield, M.D.]

Such persons are rare.  If an infected person without antibody has a genital outbreak which is tested and positve for HSV-2, the diagnosis can be made that way.  But if there are no outbreaks, there is no way for such people to know they have HSV-2.

And why does herpes enter your mind as a possibility?  Any of the innumerable causes of skin rash anywhere on the body can involve the genitals, and therefore the large majority of genital area rashes are not herpes.  Have you been sexually exposed to someone known to have genital herpes?  Since your primary care doc was uncertain about your penile rash/irritation, the next logical step is to see a dermatologist.  My bet is that s/he will confirm that your symptoms don't suggest herpes.  In the meantime, you really shouldn't be worried about it.

If you want to report back the results of a visit to a dermatologist, I'll be happy to hear what s/he says.  Otherwise that will have to end this thread.  Take care.

[jj925000]

Thanks for the follow.  One question related to people who don't produce antibodies to hsv-2 or hsv-2.  How would you know if you fall in this group, is there testing for people who don't produce antibodies?  If so can you recommend a testing method.  

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  Bottom line:  For sure you don't have genital herpes; you don't need a Western blot test.

You don't describe your penile "irritation" in sufficient detail for me to judge whether your symptoms are consistent with herpes.  But probably not, if you are not having recurrent clusters of blisters that turn into sores then scabs, healing over 1-2 weeks.  If "irritation" just means a little redness, itching, etc then herpes is very unlikely, regardless of the blood test results.

Your blood test results are unequivocally negative, showing you are not infected with HSV-1 or HSV-2.  The Western blot is actually less sensitive than the HerpeSelect IgG test -- i.e. more people have false negative WB than false negative type-specific IgG test.  Therefore, WB is rarely useful to confirm a negative test result.  The main use of WB is to confirm a suspicious but uncertain positive IgG result.

So your and your partner's intent to conceive can go foward without fear of herpes.  (Even if you had genital herpes, that would not prevent you from safely fathering a child.)

If your penile "irritation" continues, see a health care provider when it is most bothersome.  Probably there is a simple, non-herpes, non-STD explanation.  Any of the innumerable causes of skin rash anywhere on the body sometimes can involve the genitals.

Happy new year and best wishes for healthy and happy family--  HHH, MD