Help with HSV contd...

[Donna03]

Dear Dr. H. Hunter Handsfield,

I am continuing off of an old post that i made back in january called "Help with HSV" it wouldn't let me post anymore questions there so i started a new post.

My unsafe exposure was Oct. 28th, 2007 (condom broke)

I had blood work done on jan. 11th
results:
HSV-IGM: positive
HSV 1 AB-IGG: positive, 4.63
HSV 2 AB-IGG: negative, 0.01
that was ~10 weeks or 75 days after my exposure

I had blood work done again on March 12th
results:
HSV-IGM: detected (positive)
HSV 1 AB-IGG: positive, 4.57
HSV 2-AB-IGG: negative, 0.12
that was ~4 months and 2 weeks, or 136 days after my exposure
all of these were Herpeselect tests

questions:
1. Has enough time passed where it is safe to say i don't have HSV-2?
2. Should i retest after a total of 6 months has passed to see if my IgM becomes negative? (my dr. made a big deal about it being positive)
3.  I just realized that in late august i had a small cold sore on my upper lip that went away in 1 or 2 days. i never had anything like that before that time or since. this was after kissing a new person and performing oral sex on them. i didn't think anything of it then, but now looking back and trying to put the pieces together, does it make sense that that was probably when i became infected with HSV-1? as later in january i did test positive.
4. and if the above is true, is it likely that my infxn. is oral HSV-1? or is it possible it could still be genital HSV-1? (i don't think the guy gave me oral sex before the cold sore appeared on my lip)
5. Is my IgM most likely still positive because HSV-1 was a new infection for me? I read it can take up to 12 months to become negative
6. Since i know i am positive for HSV-1, is this something i have to tell a new partner in the future?
7. Can you catch HSV-2 from giving or receiving unprotected oral sex?

this situation has really made me realize how uneducated i was about STD's. thank you for your help & for all the education.

[Edward W Hook, MD]

Thanks for the clarification  You were tested using both the HerpeSelect and another, non-specific IgM test.  The results indicate that you have HSV-1 but not HSV-2.  the IgM results are meaningless and of no use in formulating advice to you.  Many peole who have herpes have positive IgM tests for many years.

1.  correct.
2.Correct again.  Yes, four months are sufficient time to be able to count on the results.
3.  Correct again.

Again, thanks for the clarification.  I'm sure your doctor was working to do the right thing. The problem is that herpes does not "follow the rules".

Hope this helps.  EWH

[Edward W Hook, MD]

Dr. Handsfield and I share this site. you got me this time. In general, our advice is quite similar.  I have reviewed your earlier post so let's pick up form there.  Before I start to address your specific questions, having looked over your prior and current post, the bottom line here is you do not have HSV-2 infection.  To be honest however, I do not think you were tested using the HerpeSelect since it does not test for IgM.  Other tests claim to be specific but are not.  That aside, let's deal with your questions:

1.  Yes,   Its been 4 months.  A small proportion of people with culture proven genital herpes do not develop antibodies but they are the exceptions that prove the "rule".
2.  No.  IgM tests for herpes are a waste of time and money.  There only use to me is to tell me that the person reporting these results was not tested with a gG protein, specific test for HSV.
3.  Tough to be sure about that.  Recognition of previously unrecognized cold sores or genital herpes lesions following awareness that infection is present is actually pretty common.
4.  If you had a cold sore, it is most likely that you have oral HSV-1.  To worry about genital herpes when you have an oral lesion is not productive.  As Dr. Handsfield told you earlier, once a person has cold sores due to HSV-1, it is very rare for them to get genital HSV-1.
5.  No, see above. Many people with herpes virus infections have positive IgM tests for the rest of their lives.  It is a chronic infection, thus the body continues to produce IgM antibodies.
6.  It is advisable.  you could give them HSV-1 through a kiss or oral sex.  Disclosure and caution are the best policy.  In doing so, remember that over 60% of adults have HSV-1 but most of them are unaware of it.
7.  Yes

By the way.  did you speak with the folks at ASHA as recommended by Dr. Handsfield?  (Disclosure- both Dr. Handsfield and I are on the Board of Directors of ASHA)

Hope this helps.   EWH

[Donna03]

Hi Dr.,

these are the names of the tests from my lab sheet:

HSV 1&2 IGG AB HERPESELECT
     HSV 1 IGG HERPESELECT AB:   4.57
                                                     interpretation: positive
                                                     reference range: 0.00 to 0.89
                                                     unit: INDEX

     HSV 2 IGG HERPESELECT AB:   0.12
                                                      reference range: 0.00 to 0.89
                                                      unit: INDEX
                             this assay is type specific and will differentiate between HSV-1 and HSV-2 infections.  a single positive result only indicates previous immunologic exposure and the level of antibody response may not be used to determine active infection or disease stage.  the test should be repeated in 4-6 weeks when negative or equivocal results are obtained in suspected early herpes simplex disease
                                                  interpretation: negative

HSV IGM AB W/RFX TO TITER
           HERPES SIMPLEX AB (IGM) DETECTED
                                      reference range: NOT DETECTED
this test was performed at:
Quest Diagnostics Nichols Institute Chantilly
14225 Newbrook Drive
P.O. Box 10841
Chantilly, VA 20153

HSV IGM AB TITER       1:80
                                  reference range: <1:10
(note)
this test does not distinguish between HSV 1 and HSV 2.  A positive HSV IgM may indicate primary or reactivated infection.  IgM antibody can persist 12+ months after primary infection.  cross reactions occur with varicella zoster, CMV, and EBV, herpes simplex virus 1 &2 igG, type specific antibody (herpeselect), helps differentiate and confirm prior infection with HSV 1 or HSV 2

this test was performed at:
Quest Diagnostics Nichols Institute Chantilly
14225 Newbrook Drive
P.O. Box 10841
Chantilly, VA 20153


questions:
1. So It seems that i did have the herpeselect test, but the IgM was a seperate test my doctor did?

2. So the bottom line is that i do not have HSV-2 and 4 months has been a long enough time to ensure i don't have it?

3.  I should not worry about my IgM remaining positive because it could be positive the rest of my life while my doctor is busy waiting for it to go negative?

thank you!

[Donna03]

Hi Dr. Hook,

Thank you for all of your help, i am relieved to say the least.

I was wondering if i could ask you a few more questions. Since you read my last post with Dr. HHH you probably noticed that i mentioned having problems with a recurrent yeast infection. My doctor never really diagnosed me as having a YI but has put my on a 2 month course of fluconazole, i take a 100mg tablet 1x/week. i have been doing that for 2+ months at this point and i still have some burning upon urination, not really any discharge. the burning will come and go, it will be there some days and not others, or it will be there in the morning and not at night, or at night and not in the morning, etc. I read another of your responses to someone where you said it could be bacterial vaginosis, a YI, UTI, or trichomoniasis. i know my doctor did a vaginal culture (i guess that is to look for bacteria??) and she did a urine sample and found nothing in either of them. my doctor told me they don't really do anything about these things unless it is painful. i don't think it is normal to live with burning when u urinate and i'm trying to get to the root of the problem.
1.i was wondering what you think it could be?
2. and if the fluconazole is even treating the problem since it hasn't gone away completely? it has gotten better, however.
i have tested negative for gonorrhea and chlymadia

also, in mid-february i noticed what seems to be a small fluid filled bump on my right labia majora on the inside of the skin. it also comes and goes, sometimes it is noticeable and other times i don't even see it. i noticed that the veins in the inner labia also seem very prominent at times like they are swollen. i did some reading and read that it might by a bartholins gland cyst, and i hot packed it for weeks and it never came to a head or anything. and now it comes and goes on its own.
3. i am wondering what you think this could be?
4. and if it could be related to the yeast infection that i may or may not have? also when i went for my annual last week i told my doctor about it and she didn't see it (like i said it comes and goes) and she told me not to worry about it. i guess i am just worried about this whole scenario because i know it isn't normal for me

thank you!

[Edward W Hook, MD]

It's a bit difficult for me to put these pieces together but I do have several comments which might be helpful.

1.  If this was a yeast infection, it should be gone, not just better with fluconazole.  If it goes away with fluconazole but comes back when you stop, you may need a longer course of therapy.  I wish I knew what caused recurrent yeast infections