Analysis of Herpes Test Results

[med3510]

Hi there,

I'd like some feedback on my test results which I got back recently.  Firstly, some background.  I discovered some sores on the top of my penis 3 months ago (prior to which I had some pain down the back of my legs for a few days).  I went to the doctor and they cultured it, but it came back negative - due, apparently to there not having been much to culture. The doctor said it didn't look like herpes.  I went the next day to the STD clinic and they said it did look like herpes.  I had all other STDs tested including syphilis twice - second one a month after exposure.

So I basically believed that I must have herpes, even though I asked the two guys I had been with and they said they had never had any symptoms or cold sores etc.  I do realize it can be passed on asymptomatically though.

I went to the doctor at about 4 days before the 3 months were up since the most recent sexual exposure - so it was at about 11 1/2 weeks.

These were my results:

HSV1 IGG  0.15
HSV2 IGG  0.56
which they said was negative

HSV 1/2 IGM 0.97
which they said was abnormal

My doctor has suggested having another IGM test in a few weeks but thinks I am negative as she said antibodies would show up at 3 months.

On the other herpes forum, Grace said that I am negative and not to question it, but other sites say that people can take longer than 3 months to develop antibodies.  

Hence my posting on the expert board to ask for your advice as to whether these are pretty definitive results.  

Many thanks.

Chbolero

[Terri Warren, RN, Adult Nurse Practitioner]

You're welcome.  I think the woohoo should come very soon.

Terri

[med3510]

So got my iGG results back today, which were 16 weeks and 1 day from the last sexual exposure.  They were:

HSV1 - 0.14
HSV2 - 0.47

So my doctor thinks the iGM positive result is erroneous, which I know is what you have said too.

I'm a little confused still as I still feel like I have some symptoms, but I have to believe the medical professionals.  Trying to say woohoo but not quite there yet!

Thank you to for the support and information.

[Terri Warren, RN, Adult Nurse Practitioner]

As I said in an earlier post, the ELISA test is not as sensitive for HSV 1 as it is for HSV 2.

Since you have HSV 1 orally, him giving you oral sex is not a risk to him and neither is mutual masturbation and neither is digital penetration of the anus.

This will be my last response on this thread.

Terri

[med3510]

So the other night, I got rather drunk and ended up 'fooling around' with another guy.  I'm now feeling very guilty about it, and paranoid that I could have passed on herpes (if of course I do have it).  Can you let me know what the risks are based on the following that occurred:

1.  He gave me oral sex.
2.  He masturbated me, then masturbated himself.
3.  I masturbated myself, then used the same hand to finger his anus.

Other than that, there was no real genital to genital contact and no penetrative sex.

From my research on these boards, it seems that this would be low risk, and hand to genital contact is very low for transmission, but I'd appreciate an expert's opinion.

Thank you.

[med3510]

Thanks Terri - what confuses me is, if I have hsv1, why did it not show up on the iGG antibody test?  Considering I had the culture done two years go, it should have antibodies by now right?  I don't understand why it came back negative for hsv1.

[Terri Warren, RN, Adult Nurse Practitioner]

So you do have HSV 1 infection.  The oral infection can extend to the neck nerves at times, and also on the lips, chin, nose, and sometimes eye.  As I said in an earlier post, the ELISA test is not as sensitive for HSV 1 as it is for HSV 2.  However, having said all this, it is great news that you already have HSV 1 infection somewhere else on your body because that makes it far less likely that you have new genital HSV 1 infection.  I would recommend just retesting with western blot when 4 months have passed since the concerning encounter, forget the IGM totally.

terri

[med3510]

Another confusing thing for me is that a couple of years ago, I had a rash on my neck which was cultured and came back positive for HSV1.  If that is the case, why didn't it show up on the iGG test this time?

[med3510]

Thanks Terri,

So when I go to the doctor, you are recommending a western blot rather than the iGM that she has suggested?  I am going to wait until post 16 weeks to get it done, so that should be a good indication I'm guessing.

Another question I have, which might help in my diagnosis.  I've had uncomfortable feelings in my penis and groin area which are intermittent - sometimes nothing, other times it hurts slightly but no lesions have come out.  Is it likely with a new infection that there will be a lot of sensations in the genital area as the body deals with it?  If there are normally prodrome symptoms that then become lesions, would they last for such a long period?

[Terri Warren, RN, Adult Nurse Practitioner]

One of the reasons I suggested the western blot is to confirm that you don't have HSV 1 infection.  The ELISA test that you had done is not as sensitive for HSV 1 as it is for HSV 2.  Having said that, if you were positive for HSV 1 by western blot, it wouldn't confirm that you have the infection genitally, only that have you it somewhere.  

I recognized when I posted my response that you would like my post to agree more with others, and that mine was slightly less certain than others that you are not infected, but for the three reasons that I posted before, I have a slight concern, nothing huge, just slight, and I think a western blot would give that certainty if taken in a about a month from now. You are receiving OPINIONS from everyone, including me.  No one of us can see you or has seen you when you had symptoms, so we are all giving our best thoughts on the topic.  

The IgM test would be worthless in helping us here.

Oral sex is most safe when protected in any case.

Terri

[med3510]

Terri - would enjoy hearing your response when you have time.  Thanks.

[med3510]

Thanks Terri for your response.  I thought that if the result was under 0.9 it was negative regardless and that figure can change on different tests?

Another thought I had is that I have just started seeing someone who has oral HSV1 - is it possible he passed it onto me and that was why the iGM was equivocal?  The couple of exposures I had 3 months prior were receiving oral sex and protected anal sex (me being the giver), so the fact that I got sores I would think would have been from oral sex not genitally?  What do you think?

I do live in the USA so could get a western blot.  My doctor recommended getting another iGM test in a few weeks, but it sounds like you don't think that would be worthwhile.

I was hoping that your response would be more in line with other posts (including Grace on the free forum who said I shouldn't worry about it and was negative), so now am feeling worried that I may have it.

In the meantime, should I use protection for any oral sex just to protect my partner?

Thanks for your feedback.

[Terri Warren, RN, Adult Nurse Practitioner]

I also believe it is very likely that you don't have herpes.  I am concerned by your statement that you had sores on the penis.  You specifically said sores, and there aren't very many things that cause sores on the penis, actually, so that comment still concerns me just a bit.  I am also just very slightly concerned about your relatively high negative value on your HSV 2 antibody test. The last thing I am concerned about is is the STD clinician's opinion that the sores looked herpetic.   I actually also believe that you are negative, but if you were my patient, given the three things described above, I would like to see you get tested once more in about 4-6 weeks, and maybe this time with a western blot if you can get it.  You might not live in the US, in which case, the IgG is fine, but absolutely forget the IgM test.  

My response is very cautious here, admittedly.  There is just something about the contents of your post that give me slight concern.

Terri

[med3510]

Thanks for your comments.  Terri, I'd like to hear your remarks on this too.