Herpes and/or EBV: situation analysis, please help

[Palerider547]

Hi.  I hv Ulcerative Colitis & on Pentasa 2grs/day for 2 yrs/uncirc- Oct11(4 protected vaginal & 4 unp BJ, 1 deep FrenchKiss - CSWs in Germany) after 5 weeks: hi fever, major fatigue, heavy sore throat, 1 cold sore upper lip, chest congestion. Then on Dec1: 3 protected vaginal and 1 unprotected BJ all in w/in 8 hrs &i was sick that day: after 15 days & over 6 weeks: Acne on back, tiny wht pimplex4 below head of penis, insect-like pimples on arms legs& abdomen, mild fever, Athlete foot, yeast infection on penis head, 2 blisters on groins, left side neck lymph node mild, night sweats for 3 weeks, brown blotches on back, coughing for 3 weeks, loss of appetite, loss of 2.5KG, abdominal pain, diarrhea once per day but for 3 week, mouth thrush. WBC on day 36 after 2nd expo (usual 8.2 & down to 6.42). HIV Duo on day84 (after first) & day34 (after 2nd exposure)+HepB&C+Syph: Nega then took the following at took tests on day 124 after 1st exposure & day 76 after 2nd exp: CBC normal but WBC hi 9800 & RBC hi 6.16–Urine  RBC 2-4 & WBC 8-10–SGOT/AST & SGPT/ALT normal–Gamma GT normal–CR Protein normal –Syphilis nega–CMV nega–Chlami nega– EBVac anti VCG IgM 0.7 -Ac anti VCA (IgG) 2.7 above the 0.8–Ac anti HSV IgM normal 0.3–HSV 1+2 IgG is 4.6 above 0.8.  HIV 1 PCR RNA (Absence of detection of HIV1RNA (20-10,000,000l 1,3-7,0log) Further to 2 medhelp docs &  5 other doctors all confirmed that I am HIV Nega (very conclusive).
Q1: Do I have Herpes and/or EBV? Were they due to my 2 episodes of exposure? Which episode do you think (Oct 11 or Dec 1 2011)?
Q2: could my described symptoms from either exposure be caused by Herpes or EBV: back acne, pimples, brown blotches on back, fungal infection..? hope it is yes to eradicate HIV:)
Q3: if yes, what should I do to protect my wife and kid from possible infection?
Q4: now it is 110 days after second exposure, do you recommend further tests?
I’m so afraid due to my family & transmission. Thank you

[Terri Warren, RN, Adult Nurse Practitioner]

You don't need to treat your HSV 1 unless you have symptoms, like a cold sore.  

None of the symptoms that you list here, with the exception of groin blisters, and I'm not really sure what that means, have anything definitive to do with herpes.  I suggest that if you get the groin blisters again, you should have a bacterial culture done of them.

Terri

[Palerider547]

Dear Dr Terri,
Thank you for your constructive input and for putting the HSV analysis/result into perspective.
1 - Sorry but I am still left with a major intrigue which non of the doctors i've  talked to provided me with an answer: the symptoms that I faced were kind of drastic and never experienced before and happened within a very critical timing (15days post exposure): from brown blotches, to acne, athlete's foot, night sweats, lots of coughing, low fever, groin blisters, penile head burn, penile tip burn, diarrhea, gingivitis x 2 times recently, lower back pain, etc....

2 - About my Herpes, should I leave it untreated or should I do something about it?

Thanks Dr, I'm getting myself mentally ready to have all STDs (except HSV) repeated after 8 days in order to wrap up my relentless anxiety since I am a father of an angel. I appreciate every single effort Dr.

[Terri Warren, RN, Adult Nurse Practitioner]

I'm not sure what percentage of people who are HIV + have HSV 1, but the percent of the population that has HSV 1 is high.  And also it is a little like saying 90% of people who have gonorrhea wear seat belts when they drive.  Is it related?  Who knows!  No alarms for me about HIV.  the change from 4.6 to 8 is likely not significant.  All values are in comparison to a control which changes each time so we see significant changes in these numbers from time to time.  Besides, wasn't it a combined test that was positive at 4.6?  That's comparing apples and oranges if it was a combined test.  

Also, you don't know that you didn't have HSV 1 before this happened, do you?

I don't have any reason to believe that your symptoms are necessarily related to HSV 1 infection.  You may have had this since childhood, no way to know.  

Terri

[Palerider547]

Dear Dr. Terri,
Actually, I work in Kuwait and I am from Lebanon. The clinic said that the HSV test are sent to France for analysis. I already received them a couple of days ago and here are the results:
Arpil 1st  test  separately HSV 1 IgG positive 8+ and HSV2 IgG negative -0.4 - HSV1+2 IgM negative 0.4.
Q 1   ---   Scenario 1: I read that 90% of HIV infected prs have HSV1 - besides, the level of my Herpes had been drastically increased from HSV1+2 IgG 4.6 to HSV1 IgG 8.0. Question: does it ring an alarm of an HIV.
Q 2   ---- Scenario 2: I am building high hopes that I contracted Herpes whether from the french kissing (first episode) or skin-to-skin contact (2nd episode). So ulcerative Colitis and Herpes would have resulted in my symptoms.

Q3 ---  Hopefully, if it is mere Herpes, what should I take or so,,, currently I only have a couple of small and non-itchy blisters around my mouth. Still have the brown blotches on my upper back and still have around 20 small rash (red bumps) non-itchy on my upper back.

Thanks a lot Dr. I appreciate it.

[Terri Warren, RN, Adult Nurse Practitioner]

France?  Where do you live>

Terri

[Palerider547]

Dear Dr. Terri,

Just to keep you posted, yesterday I took a urine test and all turned out to be normal: RBC 0-2 and WBC 0-2 (unlike the previous test). Indeed, I've been drinking too much water recently. As per your suggestion, I did the Herpes 1 and Herpes 2 tests (IgG) around 10 days ago and the results will be out in 9-12 days (Dr. said they send the tests abroad to France that's why it takes so long). Once received, I will provide you with the results for your kind feedback. Till then, I wish you well Dr.

[Terri Warren, RN, Adult Nurse Practitioner]

The only other test I think you should take is a urethral gram stain.  You don't have to but that's a thought.  Urethritis wouldn't cause skin symptoms, just urethral symptoms.

Humans, by nature, make errors.  I hope you can move on from here.

Terri

[Palerider547]

Many thanks for your reply.
A big and probably an indefinite relief for your statement regarding HIV.
Answer 1: Actually, I never had a cold sore before. It only appeared once after the first episode and I thought it was due to Voltaren since it was the first time I took an anti-inflammatory medicine and which already disturbed my guts due to Ulcerative Colitis.
Answer 2&3: No antiviral therapy was taken.
Answer 4: I will book an appointment with the Dr. to take a urine test and Herpes 1 / Herpes 2 separately and will keep you posted accordingly.

Q1: Any other tests you recommend?
Q2: Should I inform my doctor that I might have Urethritis or you would rather wait until I provide you with the results and we will take it from there?
Q3: General question: would Urithritis, EBV, and/or Herpes affect the WBC for some time after infection resulting in some fungal infections, brown blotches, rashes, and other symptoms that I faced. Hope it is yes:)

Thanks a lot Dr and sorry for the sharing with you my anxiety because I am a devoted family man (son 1.9 yrs) but committed a relentless sin which will haunt me every now and then. Godspeed

[Terri Warren, RN, Adult Nurse Practitioner]

I don't believe there is anything that you want to do if you have EBV.  Most people do, at some time, in their lives.  

I don't think HIV should be a concern for you.  I mean, I know it is, but I mean that you don't need to worry about this one.

A few more questions:
1) have you ever had a cold sore on your lip before this episode?
2) did you taken any antiviral therapy?
3) if yes, how many days>
4) are you able to obtain type specific antibody testing, that is, one that can test separately for HSV 1 and HSV 2?

Urethritis is simply the presence of pus cells in urine (there shouldn't be any and you have some)

Terri

[Palerider547]

Hi Dr. Terri,
In effect, the test for HSV is combined for both 1&2. Exact wording:
Ac anti-HSV IgM: 0.3 result (negative -- below 0.9)
HSV1+2 IgG Total: 4.6 (if negative below 0.8 and if positive above 1.2)
Regarding EBV, I think it is high as well at 2.7 as you mentioned. No treatment received for urethritis because I haven't been told so by the doctor who mainly focused on HIV.
My main concern doctor is that all of the docs in this forum and hometown were telling my that I don't have HIV due to low risk, non-specific symptoms, and tests result. I still have a small doubt since I am on Pentasa due to UC through which there are some cases where people on Mezalazine/Mezalamine got positive much later. Therefore, I am trying to fetch the causes of my multiple symptoms from EBV, Herpes, and so forth to remove the idea of HIV from my head. Thus, my questions though not that directly related: I could be infected by urethritis, herpes, EBV, .. :
Q1: what recommendation/tests should I take further since now it is day 105 after last exposure in order to identify and clear infection.
Q2: Hope some results of the aforementioned EBV and Herpes have nothing to do with the slight chance of having HIV. What do you think?
By the way, thanks for suggesting treatment for urethritis (never heard of it before and will google it).
Regards,

[Terri Warren, RN, Adult Nurse Practitioner]

I am unable to interpret your HSV 1 and 2 results from what you have written here.  you say 4.6 above 0.8.  Is that HSV 1 is 4.6 and HSV 2 is 0.8?  Were they done separately or together?  I just can't interpret this.  As for your EBV infection, I can't interpret that either from what you have written.  It appears that your IgG is slightly higher at 2.7, is that what you were trying to say?  It also looks like you have a urethritis to me.  Have you received any treatment?

Terri