Chance of Herpes?

[FRED68]

Exposure on Sept 8, 2011.
Nov 6 (8 weeks) –marathon masturbation session (3 hrs). The following 48 hrs I had a severe burning prodromal pain on my penis – after 48 hrs a small single 2 mm painful blister appeared on the edge of the glans. Applied Neosporin & Abreva kept moist – blister healed and disappeared after 5-7 days continued to have prodromal type pain near the site of the blister for 3 more weeks, general genital discomfort, general urethra itching crawling sensation, significant at times, and some slight burning.

Dec 12 (13 weeks) – LabCorp, STI tests for Chlam, Gon, Hep B&C, HIV, Syph, all negative – Blood test using Herpes Select IgG Type Specific 1 & 2 both <.91 Negative.  However I continued to have discomfort near the site of the blister in an area the size of a nickel, to the touch it felt like a very fine paper cut or rug burn, but no sore or even redness was visible, but pain was very real. All during this time I experienced back pain near the base of my spine – it felt like it was inside my spine and not muscular pain.  Ejaculation (the day after) appeared to cause more itching/burning sensation and caused the “paper cut/ rug burn” type pain to appear more pronounced, pain always at the same site.  I experienced odd sensation thru Dec, then slowly diminished.  Now, occasionally  will get a mild rug burn type pain always in the same area. But all other symptoms are gone.

May 4, 2012 (8 Months) went to Pland Partnhd  did a Chemluminescence thru LabCorp for HSV I/II IgG reflect i-Ii type specific which was <.9 negative.  (Is this an accurate test? – chances of a false negative?)

Shocked that both tests were negative for HSV 1, and with the blister, and symptoms I’m greatly concerned these results are false negative? Chances/probability that I have HSV I or II and the tests did not find the anti-bodies?  What are the specificity and sensitivity of the two different HSV tests? Are more tests warranted? – Western Blot? – what about PCR testing?

[Terri Warren, RN, Adult Nurse Practitioner]

The test that you had picks up about 97% if HSV 2 infections and 91% of HSV 1 infections.  When was your last sexual contact?  Have you had any more blisters like this since the first on?  

Given your description of an actual blister that lasted about a week, I do have some concerns about herpes, as, apparently, do you.  

I'm thinking that you might want to try a western blot which is more sensitive for HSV 1 and perhaps a bit more sensitive for HSV 2.  The test code through Quest labs is 34534 if you can get your regular provider to order the test for you.  If you can't work that out, you can become a distance patient of our clinic and we will order it for you.

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

You're welcome.


Terri

[FRED68]

Thanks again.  I could certainly be confused as I'm not very familiar with the various tests.  (Just want to make sure they are accurate tests) I did speak with LabCorp and gave them my "case number" - they looked it up and said the test was a chemiluminescent immunoassayproduced by Trinity Biotech.  She said it is a very similar test to the ELISA but the CLIA was slighly more sensitive.  I asked about the sensitity & specitivity numbers which she then said to give her a minute to look up the information, after which she gave me the previous numbers.

I'm still considering the WB, just as you stated for peace of mind and a final resolution.
Thanks again

[Terri Warren, RN, Adult Nurse Practitioner]

I think there is some confusion here.  They do the captia test, I believe, which is an ELISA format.  Unless I really don't know what they do or they are doing something new.  Did they say it is more sensitive than the herpeselect, which is a brand name of an ELISA.

You could just rely on these tests and move on, if you can move on.  Sometimes I recommend the western blot for people who are having difficulty believing the results, just as a confirmation to help them be at peace.  Your call.  I think you can also just believe the results that you have, if you can.

Terri

[FRED68]

I spoke with LabCorp regarding the CLIA Herpes blood test - they said the test is more sensitive than the ELISA test? - They said the Sensitivity was documented at 96.7% and the Specificity was 90.3%.

Having completed 2 seperate blood tests 13 week and 8 months after exposure, do you think the efforts and expense of a WB test are necessary?

I appreciate your thoughts.

[Terri Warren, RN, Adult Nurse Practitioner]

I don't know anything about the comparison between the sensitivity of those two tests, honestly.    I know lots about the herpeselect but nothing about the other.  

I would strongly suggest that you get a western blot.  We can order the test to be drawn at a Quest lab near you and shipped to UW.  You can easily become a phone patient of the clinic, I would suggest asking to speak with Sheryl as I am away from the office for 6 weeks, camping in Alaska.  she can set things up for you if you wish to go that direction.

Terri

[FRED68]

Thanks Terri, I greatly appreciate your work on this board!
Nov 2011 was the only blister I have ever had (I want to convince myself that maybe it wasn’t a blister – but I think that is wishful thinking. – Or that it was caused by friction…but I want to be sure if I have HSV or not.)   I had Chicken pox and Shingles 20+ years ago – I didn’t know if those antibodies affect the other HSV tests? – Also I have never taken any anti-viral medication.

Also I did 2 separate type blood tests – the Herpes Select (Dec 2011)  and the Chemluminescence  (May 2012) – and the lab did by mistake an IgM test in May 2012 (negative).  Is the Chemiluminescence more sensitive than Select? – The Lab indicated as such, said the Chemiluminescnce was very sensitive (of course no figures to back it up)

I might do the distance patient of your clinic? – is it hard to set up, do the kits contain everything (needle work etc? – I have an RN friend that can draw blood, etc?)
Thanks again