HSV?

[mq123456]

On June 30 I had gave unprotected oral sex and received protected oral sex (she did suck and lick on my scrotum) to a CSW. The next day I I found two sores on my bottom lip. I used an OTC cold sore product and they healed in two days. In my original post, Dr. HHH dismissed this as HSV because of the short duration. At the same time, I had back pain, felt feverish, and felt tired. This continued for 4 weeks. I also had a sore mouth and burning lips and would feel bumps inside my mouth that would resolve without any blisters or sores. No genital lesions were noticed. At 7 weeks I was tested for HSV 1 and 2 IGG and they were negative. At 11 weeks both IGG tests were still negative (<.90) as well as my IGM for HSV 1 and 2 were negative.

Still the burning, bumpy, and sore mouth continued until Friday. I noticed an Ulcer the inside of my lower lip, I could not tell if it was a blister. My ENT saw it and thought it was a canker sore. On Sunday, 4 or 5 mores ulcers occurred close to the original. They were grey to white color and appeared to be covered by a thin membrane of skin. On Monday my ENT was still unsure, but he said that since they were clustered together they could be herpes. He gave me1500 Mg of FAMVIR (sp?) to take. I went to my PCP and had the lesions swabbed for both a culture and DNA PCR test. When the swabs were taken, most of the whitish layer of skin was removed and the area looked almost normal, just a little reddened. I took the Famvir last night and now the area is almost norm (still just a little red).  I never had any sores or blisters outside of my mouth or on the surface of my lips.

My question, could the contimual symptoms of burning and sore mout have been HSV? Could the ulcers I recently experienced have been HSV just showing up nearly 3 months later?  Is there any comfort in the fact that my tests were negative, even the IGM was negative.  Any thoughts you have will be appreciated while I wait for the swab results.

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, I do believe you can put this entire worry behind you now.  You waited the recommended 4 months, and that's great!

Terri

[mq123456]

I was tested at 16 weeks and 4 days post exposure.

[mq123456]

I received the results of my Western Blot test today….Negative for both HSV1 and 2. I am so glad! As this test is the “gold standard” do you think I can put this all behind me with reasonable certainty that I don’t have HSV1 or 2?

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, getting the testing is not easy for everyone.  Who thought ordering  a specific test would be so difficult???  Western blot and immunoblot are definitely not the same.  Good for you to doing extra calling and checking on everything.  I'm totally impressed with your persistence!  If the test is positive for western blot, then you will know for certain and can begin to make adjustments.  Until then, have a glass of wine, turn on some good music and have a relaxing weekend, OK?  The test should take 1-2 weeks.  Let me know how it goes, OK?
Terri

[mq123456]

Nurse Warren,

I think that I ordered the Western Blot HSV test today. I had my PCP write the order for the code you hade given 34534. I went to the local quest lab (located in the state southern to you) and had my blood drawn. As I was leaving I looked at the receipt and it listed code 96975 HSV I and II IGG, by immunoblot and said that it was being sent to a lab in Salt Lake City.

I questioned them and they said that the 34534 number crossed reference to the 96975 number in their computer. They called their supervisor and I called your clinic to verify the number you had given me and that the tests (western blot and the Salt Lake laboratory Immunoblot) were not the same.

An end to a long story is my blood is on the way to Seattle, I think to a quest lab there. I hope it will make its way to the University for the proper test.

I know that the chance that my positive result of 3.6 (HerpeSelect HSV I) is a false positive is very low. So I am preparing for the worst and hoping for the best.

Thank you again.

P.S. Have others had trouble receiving the correct test  (Western Blot) through Quest?

[Terri Warren, RN, Adult Nurse Practitioner]

The western blot routinely looks for HSV 1 and HSV 2, always together.  There really isn't a high false positive rate for HSV 2, its probably only about 3%, but for those who are told they have herpes but they don't, its not good, so we always want those low positives confirmed.

Yes, yours could be a false positive, there is always hope, of course.  
The code for western blot (which is different than the codes you are looking up) is 34534 at Quest.  

Let me know if you need other help getting this test done, OK? We will hope for the best.  Let me know how it turns out.

Terri

[mq123456]

Thank you for you kind manner and advice. I have found this website and your advice and consult invaluable. I assume that I only need to do the Western Blot for HSV1 or should I also have it performed for HSV2 as well. Also, I found the code for quest laboratory for HSV2 but I could not find the code for HSV1. Do you happen to know it. Finally, in your experience, what is the likelihood that my herpesselct HSV1 result could be a false positive in light of the high-value? I just want to know what my odds that the Western Blot would reveal a different result. I have read much about the high-false positive result for HSV2 but not much about how likely a “low positive” for the HSV1 test would be a false positive.

Thank you again for empathy and kindness. I will be keeping my fingers crossed and will be ordering the Western Blot Test next week (I may wait one more week just for good measure.)

[Terri Warren, RN, Adult Nurse Practitioner]

OK, you can do it at 16 weeks.  Yes, you could have been infected orally and genitally, we just don't know.  I'm so sorry this is happening to you.  But please, before we go much farther with this, I really want you to get the confirmatory test so we know what we are dealing with for certain.

Terri

[mq123456]

It will be 16 weeks on Tuesday (10/19) that will be 4 months. How much longer should I wait?  

Also, could I have been infected both orally and genitally at the same time?  I mean from the same exposure?

[Terri Warren, RN, Adult Nurse Practitioner]

Hmmmm, not good.  OK, my next move would be for you to get a western blot, just to confirm these test results.  But don't do it yet, its too soon.  Wait until at least four months have passed.  Though technically, you are out of the low positive range, it is just barely out, and you should confirm I think, given your circumstances.  And you are correct, no way to know if you are infected orally and/or genitally, though with the sores in your lip, I would think at least orally.  

I'm really sorry.

Terri

[mq123456]

I am not even sure where the infecction is oral or genital. Could I have been infected at both sites at the same time?  

[mq123456]

I just received the results from my 4 month IGG test and I was negative for HSV2 but positive for HSV1. The number was 3.6. I just wanted to follow-up with you. I don’t know what to do now…I am devastated. What should I expect in terms of outbreaks?  How often how severe?

[Terri Warren, RN, Adult Nurse Practitioner]

If you do it again, do it when 16 weeks have passed since the encounter.

Terri

[mq123456]

Thanks again,

Would you suggest that I have a HSV 1 and 2 IGG blood test again. If so when should I do it. My last negative test was at 3 days short of 11 weeks

[Terri Warren, RN, Adult Nurse Practitioner]

A negative PCR means there was no virus detected on the skin when the swab test was taken, it is not accurate for screening, only for diagnosing symptomatic infection.  It takes the place of culture, and is more sensitive than culture.  The antibody test that is negative for both is your best indicator of lack of infection.

Terri

[mq123456]

It will be 13 weeks post exposure on September 29.  I have not had any potential exposure in the interim

[mq123456]

Nurse Warren,

Good News….I think.  My test results came back in. HSV1 DNA “not detected”  HSV2 DNA “not detected.” For some reason a “culture” was not performed. Can I assume, at least for this outbreak, that it was not HSV?  

How reliable are the results for the PCR DNA test?  It will be 13 weeks since the exposure (non since) on Tuesday October 29, when should I do another IGG blood test? Also, I took 3 days worth of Famvir (sp?) just in case. Will this interfere with any future IGG test and delay soroconversion?  

Thank you again…..

[Terri Warren, RN, Adult Nurse Practitioner]

You would convert more quickly if you were negative for HSV and HSV 2 than if you were positive for HSV 1 and acquired HSV 2 (the reverse very very rarely happens).

I think the IGM is just of very limited usefulness when it is negative or positive, personally.  

Terri

[mq123456]

Nurse Warren,

Thank you for your kind words and sage advice. Hopefully I will have the swab results tomorrow, or Monday at the latest, and you will be the first to know.

One follow-up question, as I was IGG negative for both HSV1 and HSV2 would you have expected me to seroconvert earlier than some one who was positive for HSV 1 or 2?  Also, I have read much about the unreliability of the IGM and its high rate of false positives, however is there any clinically usefulness in a negative result in a new “exposure.” Or would the 11 weeks be long enough for the IGM antibodies to go away? (this test was performed by mistake by the lab)

Thank you again.

[Terri Warren, RN, Adult Nurse Practitioner]

I would take great comfort in the fact that your tests were negative, and at this point, would still believe, if I were you, that I didn't have herpes, either orally or genitally.  If your PCR swab turns out differently, then, we were wrong.  But since you are negative for both HSV 1 and 2, and if you had acquired HSV orally, I would have expected symptoms, like more obvious sores, to have shown up much sooner.

Also, the fact that you got symptoms that next day, I agree, is too soon for herpes.  I've seen symptoms in two days, but never one.  Let me know how the swab turns out, OK?

Terri

[mq123456]

We also kissed, open mouth.