HSV 1 & 2 Testing Results and Treatments

[knollwood]

Dear Nurse Practioner Terri Warren,

I was tested for STD's.  All were negative except the HSV 1 and 2 tests.  Here are the results:
SHA1 and2-Specific Ab, IgG
HAV 1 IgG, Type Spec   4.51       High                            Index                    0.00-0.90
                                                 Negative                        <o.91
                                                 Equivocal                0.91 - 1.09
                                                 Positive                         < 1.09
Note:  Negative indicates antibodies detected to HSV-1. Equivocal may suggest early infection.  If clinically
appropriate,  retest at later date.  Positive indicates antibodies detected to HSV-1;  coinfection with HSV-2 cannot be excluded without type specific testing.

What does this mean in practical terms ?  Do I have HSV-1 infection?  If so, what treatments should I undertake?
If I share this information with my primary,  is he obligated to share it with NY State Health Department?  Does the
health dept. notify my wife ?  If I am infected,  what is the best way to tell my wife and family who will be absolutely devastated by the info ?  I would appreciate your best advice because I have been dealing with this for the past 3 months.  I beginning to become unglued from the stress and strain.  By the way,  I am 73 years old and had oral sex (unprotected) by a massage theapist. I am very worried about passing this on to my wife, daughter and grand-daughters.  I have touched them and kissed them on the cheek prior to knowing these test results.  Have I placed them in danger ?  Please respond asap.  Thanks so much.
Please note that I have previously communicated with Dr. Jose Garcia and Dr. Sean (HIV International) and Dr.
Handsfield ( HIV Prevention) with regard to HIV.  You may wish to view those posts and responses.  Thanks.

[Terri Warren, RN, Adult Nurse Practitioner]

I think there may be some typos in your posting of the results, but it does look like your are positive for HSV 1.   Certainly, the vast majority of people in your age group are infected with HSV 1.  It is the cause of cold sores.  Have you ever had a cold sore in your entire life, even as a child?  If yes, then your test will always be positive.  Has your wife ever in her life had a cold sore?  If yes, then she too will be positive for HSV 1 also.  Let me know the answers to these questions and I will be able to provide you more help.

Terri

[sosa89]

A related discussion, So what do I have and ist it bad,fatal,decent,no worries? was started.

[Terri Warren, RN, Adult Nurse Practitioner]

Your result is equivocal for HSV 2.  It is just over the negative line.  
Let's look back at your exposure - it was oral sex only, right?  The kind of herpes you would most likely acquire from oral sex is HSV 1.  If you have HSV 2, and I think it is highly unlikely that you do, it would likely be from an old infection, not this exposure.  Your symptoms that you describe sound nothing at all like herpes.  

There is no worry about transmitting this to any grandchildren.

Terri

[knollwood]

Hi Terri,

Here's additional testing data done at 12 weeks after exposure:
RBC  Result - 0-3     Units  /hpf   Reference Interval = 0-3
Epithelial Cells ( non renal )   Result = 0-10    Units = /hpf   Reference = 0-10
Mucus Threads   Result = Present     Reference Interval = Not Estab.
Bacteria    Result = none seen     Reference Interval = none seen/Few

Panel Q83824
HIV 1/0/2  Abs-ICMA
HIV 1/0/2 Abs - Index Value  ,1.00   Reference Interval = 1.00
       Index Value:  Specimen reactivity relative to the negative cutoff.
HIV 1/0/2 Abs, Qual  = non reactive

Chlamaydia/GC Amplification
Chlamydia trachomatis,  NAA    negative
Neisseria gonorrhoeae, NAA  negative

HSV 2 IgG,  Type Spec    Result = 0.91    Ref. Interval = 0.00-0.90
                                                   Negative  = 0.91-1.09
                                                   Equivocal  = 0.91-1.09
                                                   Positive =  > 1.09
   Note:  Negative indicates no antibodies detected to HSV-2.  Equivocal may suggest early infection.  If clinically appropriate,  retest at later date. Positive indicates antibodies detected to HSV-2;  coinfection with HSV-1 cannot be excluded without type specific testing.

RPR, Rfx Qn RPR/Confirm TP
   RPR                 Result = non-reactive
HCV Antibody
  Hep C Virus AB    result = ,0.1    units = s/co ratio    ref. interval = 0.0-0.9
                                    Negative =  ,0.8
                                    Indeterminate = 0.8-0.9
                                    Positive =  .o.9
HBsAg Screen             result = negative            ref interval = negative

Other Positive Reports:

Glucose,  Serum   result = 102    High    ref. interval  65-99
Sodium, Serum  result = 147  High   ref. interval 135-147
Urinalysis:   Protein  result = 1+  abnormal   ref. interval =  ;negative/trace
eGFR If Africn Am    result =87  reference interval = >59  units = mL/min/1.73
  Note:  a persistent eGFR .60 mL/min/1.73 m2 ( 3 months or more) may indicate chronic kidney disease.

I also had other HIV testing done as follows:  Home Access Blood Blotch = negative after
2nd week of esposure;  Rapid Ora- Sure Test = negative after 6 weeks  and Repeat Ora Sure Test = negative after 10 weeks.

Do you have any further recommendations for me.  I am really concerned about my two grand-daughters ( 3 and 4 yrs. old).  They are showing little round puss bumps on face and arms.  My son-in-law is having a sore throat and sore ears similar to what I have had.
By the way,  my total symptoms in order of chronological appearance are:  testicle pain, low-grade fever, inflammation of prostate ( treated for 4 weeks with Septra), rash on left wrist which went away with cream treatment,  sore throat and sore ears with strep throat confirmed with swab, strep went away after 10 days of amoxicillin,  sore throat and ears remain,  ***** little bumps on hands and arms,  rash on left ankle, horizonal sore with red
line going through the middle of it on right hand,  fatigue and worry.  I am very upset seeing what is happening with my grand-daughters, and blaming myself for visiting this horror upon my two beautiful innocents who love me so much.  It's heartbreaking !  I hope you understand  and will respond. Thanks so very, very much.

[Terri Warren, RN, Adult Nurse Practitioner]

OK, let's take this one step at a time.
If you have ever in your life had a cold sore, then that is why you are positive for HSV 1.  HSV 1 causes cold sores.  Period.  It has nothing to do with the sexual encounter.  
Now go to your primary care provider and show them the rash.  Your symptoms are not at all consistent with herpes anyway, and you need to get this sorted out.  I don't feel that you need to disclose the sexual encounter if all the STD tests that you had done were negative and you waited long enough after the encounter to have them done.  If you have waited less than 4 months to have the testing done, then you probably should disclose the encounter and have the appropriate testing done at the correct time.  But the HSV 1 is NOT, repeat NOT an issue from this encounter.

Terri

[knollwood]

Yes, I have had cold sores.I BELIEVE MY WIFE HAS ALSO.The rash seems to be spreading.  I have a blister with a red line through it on he knucle of my right thumb. I have several bright red marks on my upper left arm.  I have small itchy marks on my right wrist. Just this morning,  I noticed a large rash on my left ankle made up of many red dots. If you wish I can send you a full lab report if you wish to send me your e-mail address.  As you may surmise,  I am a nervous wreck worrying about infecting my family.  I should also
tell you that I have not as yet spoken to my primary about these symptoms nor the lab report which I did independently.  Before I speak to him,  I would like to hear from you.  
Thank you for taking time to spend with you.