weak hsv-2 positive?

[kubrick1]

July of last year I gave oral sex to a girl, no other sexual contact. Within a few days small bumps appeared inside my mouth and have remained there ever since. I was told by 3 ENT doctors these were normal and oral swabs, biopsy plus blood work seemed to confirm this. About six months later small painless bumps appeared on my penis head and rectal itching started about a month after this. Rectal itching was thought to be a hemroidal issue and bumps on the penis were said not to be HPV on visual exam only.Burning in mouth began around March and more blood work was done. I was told I was HSV-1 positive and HSV-2 negative. I’ve never had a cold sore so I wasn’t sure if I had just gotten exposed and that’s what was causing all of this. I was sent to an infectious disease doctor and she said I was exposed to HSV-2. My igg showed a weak positive at .8 for HSV-2. I called back to my original doctor and he said no that is just the strong HSV-1 results showing up in the HSV-2 results. I was retested and the nurse told me I was weak positive for both. What does this mean? I’ve never had an outbreak and the burning mouth sensations is not really episodic it’s more of a persistent state with no visual changes.

[H. Hunter Handsfield, M.D.]

You describe no symptoms that suggest either oral or genital herpes. The blood test results apparently show that, like half of all people, you have been infected with HSV-1.  That infection probably was oral and acquired in childhood.  Most such persons are asymptomatic and never develop cold sores or other herpes manifestations.   From your description, there was no reason to suspect herpes as the cause, and that was confirmed by the 3 ENT docs.  Further, oral HSV-1 rarely if ever is acquired by performing oral sex, and your oral bumps probably had nothing to do with the sexual event you describe, despite the timing.

And most likely you are not infected with HSV-2.  You say that at least one blood test result was clearly negative, maybe two of them.  From the wording, I cannot tell whether the IgG test with the ELISA ratio of 0.8 is the first test or a repeat.  That number suggests it was the HerpeSelect test, for which 0.8 is entirely negative, not 'weak positive'.  A person with no HSV antibody can have repeated tests whose ELISA ratios vary from 0.1 to 0.9; variation in that range relates to variations in the biochemistry of the test, not small amounts of HSV antibody.

Further, even if there is an HSV-2 result higher than that, say an ELISA ratio over 1.0, probably it was false positive.  In people with HSV-1 antibody, a low-positive HSV-2 result often is false.  Your 'original doctor' seems to understand this and s/he is the provider you should listen to.  The ID specialist and the nurse you spoke with apparently do not understand the complexities of HSV antibody testing.

So most likely you have no HSV-2 infection.  (By the way, no blood test measures 'exposure' without infection.  A positive result means a person has been infected with the virus and still carries it.  A negative result means there has been no infection, even if a person has been exposed to the virus.)

At this point, I suggest you drop the whole thing, confident you have an asymptomatic oral HSV-1 infection that will never cause you any harm and that you probably will never transmit to anyone else, sexually or otherwise; and confident that you do not have HSV-2 or genital herpes.  But if you want to nail it down with even greater certainty, ask to have a blood specimen sent to the University of Washington clinical laboratory for a Western blot test, the gold standard tie-breaker for uncertain HSV antibody testing.  You can be confident it will show HSV-1 but not HSV-2.

Good luck--  HHH, MD

[kubrick1]

Thanks for the feedback. Oral swabs were done within a few days of possible exposure and then again in November or December. The HSV bloods test were done in May and last week. Both showed a .8 igg for HSV-2. I was never told I had “weak positive” for HSV-2 until I saw the infectious disease doctor last week. My original doctor told me a definitely had a strong positive for HSV-1 but the ID nurse told me when I called in I had a weak positive for both on these new tests.

My only other thought was HPV but I had an oral biopsy done on the spots in my mouth and that came back as nothing. The timing on everything is just highly suspicious. These spots literally showed up within a week of being with this girl. I first noticed a few on the lips (which now I’m told are clogged oil pours) then the inside cheeks of my mouth just blew up with them. The penile spots and rectal itching began after being exposed to my saliva during masturbation.

I believe the spots in the mouth are natural structures but they’re definitely irritated. So I think testing them is like testing the symptom not the cause. Would something like an oral scraping reveal something? I hate to be so paranoid but I just don’t want to start dating again only to find out it is contagious. It seems like the chances of getting anything from oral alone are quite low and then passing it through saliva seems pretty remote too. I just don’t get why my mouth is burning and these spots sometimes feel like they want to burst. I could see perhaps being allergic to something or maybe even stress from worrying but I can’t see that causing the bumps on the head of the penis. If it is all unrelated then it’s a trifecta of really bad luck:) Thanks again for everything.

[kubrick1]

One other question I forgot to ask. If I choose to get a biopsy on the penile spots, which my doctor advised against but the urologist said he’d do, is there a resource to show me what I’d be getting myself into? He said he’d take a small biopsy and then cauterize the rest. I was just wonder if there are pictures anywhere to see how bad the scaring would be.

[kubrick1]

http://mitch678.checkoutmypage.com/index.php

Went ahead and posted a couple of pictures to get your take on these oral spots. I just feel better having an expert look at this rather then someone who may only see a handful of cases. Thanks again for everything.

[H. Hunter Handsfield, M.D.]

I don't look at posted photos; in my mind it comes too close to practicing medicine from a distance.  In any case, I don't attempt to address non-STD problems anyway, and it is clear that whatever you have it not an STD and almost certainly not sexually acquired.  You'll have to follow up with your own health care provider(s).  I won't have any additional comments or advice.

HHH, MD

[kubrick1]

I understand.

Could you PLEASE take a look at these test results though and tell me if I’m HSV positive or negative? I’ve been dealing with this for over a year now and I’m in hell. I have two doctors telling me I’m positive now and two doctors telling me I’m negative.

I was told today I’m positive but not contagious. Is this even possible? Will I ever be able to kiss someone again without possibly exposing them?

I really need some clarification. Thank you again for your time.

http://mitch678.checkoutmypage.com/index.php?p=1_3_new

[H. Hunter Handsfield, M.D.]

I cannot tell exactly what tests were done.  Probably HerpeSelect IgG plus some company's IgM test.  If so, the result indicate you probably are not infected with either HSV-1 or HSV-2; the positive/equivocal IgM result are falsely positive.

Of course you can kiss someone.  Half the US population, and more than that in most of the world, has positive tests for HSV-1. Do you think half of all people should kiss other people?

HHH, MD