Aa
Equivocal?
I have a few questions that I would really love help in answering.
I recently ended a relationship with a HSV-2+ woman who was treated with Valtrex (every day) since testing positive for HSV-2 approximately 2 years ago. She told me that she had never had a recurrence after starting the Valtrex. We did not use protection during the relationship, though I did take oral acyclovir (at least 400mg twice a day) throughout the entire time we were intimate (~ 50 encounters over 2 months). I have not found any genital lesions, but I have had an intermittent bizarre "coolness," one sided hip pain, one small, nontender lymph node (.5 X .2 cm) and nonreproducible (when I apply pressure to the area) genital pain that I think might be all in my head. I have had these feelings since the relationship ended until today (~ 20 days). I was tested for HSV-2 about 5 days after the last encounter. The results for the IgG ELISA were negative for both HSV-1/2, however the IgM ELISA was equivocal. Finally, at around the time of the blood test, I developed a head cold (no fever, runny nose, sneezing) and a bad bout of geographic tongue (which I had before). Though I know I need to retake the IgG and IgM tests (Ive read your post on IgM tests),
1) Does an equivocal test, given the circumstances above, indicate (more often than not) that I am ultimately going to test positive for HSV? Could the cold+tongue thing have been the cause for the equivocal result?
2) Could those symptoms mean that I have an atypical presentation of Herpes. Also given the fact that she was on Valtrex and me on Acyclovir?
3) When and what blood tests should I take to confirm?
4) Should I restart the Acyclovir (I stopped it about a week ago per my internist), and if I do, could it a) give me an incorrect reading when I retake the test, b) possibly have protected me against acquiring the infection, or c) decrease my infectivity if I do ultimately test positive?
THANK YOU SO MUCH
James
I recently ended a relationship with a HSV-2+ woman who was treated with Valtrex (every day) since testing positive for HSV-2 approximately 2 years ago. She told me that she had never had a recurrence after starting the Valtrex. We did not use protection during the relationship, though I did take oral acyclovir (at least 400mg twice a day) throughout the entire time we were intimate (~ 50 encounters over 2 months). I have not found any genital lesions, but I have had an intermittent bizarre "coolness," one sided hip pain, one small, nontender lymph node (.5 X .2 cm) and nonreproducible (when I apply pressure to the area) genital pain that I think might be all in my head. I have had these feelings since the relationship ended until today (~ 20 days). I was tested for HSV-2 about 5 days after the last encounter. The results for the IgG ELISA were negative for both HSV-1/2, however the IgM ELISA was equivocal. Finally, at around the time of the blood test, I developed a head cold (no fever, runny nose, sneezing) and a bad bout of geographic tongue (which I had before). Though I know I need to retake the IgG and IgM tests (Ive read your post on IgM tests),
1) Does an equivocal test, given the circumstances above, indicate (more often than not) that I am ultimately going to test positive for HSV? Could the cold+tongue thing have been the cause for the equivocal result?
2) Could those symptoms mean that I have an atypical presentation of Herpes. Also given the fact that she was on Valtrex and me on Acyclovir?
3) When and what blood tests should I take to confirm?
4) Should I restart the Acyclovir (I stopped it about a week ago per my internist), and if I do, could it a) give me an incorrect reading when I retake the test, b) possibly have protected me against acquiring the infection, or c) decrease my infectivity if I do ultimately test positive?
THANK YOU SO MUCH
James
MEDICAL PROFESSIONAL
As I said above, it is logical that acyclovir would prevent HSV if exposed, and it is true that research shows it prevents HSV if animals are injected with the drug before being exposed to the virus. (Those studies were done 15-20 years ago, maybe even more, and I can't cite specific references.) It's also true that the drug has virtually no side effects and likely is harmless. However, in the absence of human data, there are potential downsides, such as fostering infection with acyclovir-resistant herpes -- which you certainly would not want! In the absense of better studies, antiviral drugs to prevent herpes transmission should be taken only by the infected person, not the susceptible one. Having said that, personally I believe it would usually prevent infection and not cause any harm, but for all these reasons I don't prescribe it that way and don't know any STD expert who does so.
MEDICAL PROFESSIONAL
Directly to the bottom line: Almost certainly you didn't catch HSV-2. The IgM HSV antibody test is notoriously unreliable. It commonly gives false positive results. Without a positive IgG test, almost certainly you aren't infected. If you'll use the search link and enter "IgM", "HerpeSelect", and/or "herpes diagnosis", you'll find many detailed discussions that will further convince you to ignore the equivocal IgM test result.
In addition, the symptoms you describe do not suggest genital herpes, which does not cause the vague sorts of things you mention. I find it interesting that you took acyclovir during your sexual relationship with your HSV-2-infected partner. No knowledgeable provider would prescribe it in that fashion; there are no data to show it prevents transmission when the uninfected partner takes anti-herpes therapy. (Logically, it probably would help, just no data available.) That your infected partner took Valtrex and had no outbreaks suggests there was not much risk of transmission anyway.
To the specific questions:
1) As I said, IgM testing is meaningless. In 30+ years, we have never once requested an IgM HSV test in my STD clinic, although we do IgG testing all the time. IgM is just a waste of time and money. Your cold makes no difference one way or the other. Ignore the result.
2) No. Herpes doesn't cause such symptoms in the absence of more typical outbreaks (genital blisters, sores, etc).
3) I recommend against any additional testing. Just go forward in life, secure in the knowlege you are not infected with HSV-2.
4) Acyclovir does not have any effect on HSV test results. You should not take acyclovir at all, unless and until a herpes-knowledgeable health care provider prescribes it. Based on the information you provide here, no such provider would prescribe it at this time.
You seem overly concerned about this problem,. You were at low risk and you didn't catch it. Time to move on.
I hope this helps. Best wishes--- HHH, MD
In addition, the symptoms you describe do not suggest genital herpes, which does not cause the vague sorts of things you mention. I find it interesting that you took acyclovir during your sexual relationship with your HSV-2-infected partner. No knowledgeable provider would prescribe it in that fashion; there are no data to show it prevents transmission when the uninfected partner takes anti-herpes therapy. (Logically, it probably would help, just no data available.) That your infected partner took Valtrex and had no outbreaks suggests there was not much risk of transmission anyway.
To the specific questions:
1) As I said, IgM testing is meaningless. In 30+ years, we have never once requested an IgM HSV test in my STD clinic, although we do IgG testing all the time. IgM is just a waste of time and money. Your cold makes no difference one way or the other. Ignore the result.
2) No. Herpes doesn't cause such symptoms in the absence of more typical outbreaks (genital blisters, sores, etc).
3) I recommend against any additional testing. Just go forward in life, secure in the knowlege you are not infected with HSV-2.
4) Acyclovir does not have any effect on HSV test results. You should not take acyclovir at all, unless and until a herpes-knowledgeable health care provider prescribes it. Based on the information you provide here, no such provider would prescribe it at this time.
You seem overly concerned about this problem,. You were at low risk and you didn't catch it. Time to move on.
I hope this helps. Best wishes--- HHH, MD
Thank you! Sorry!
James
James
MEDICAL PROFESSIONAL
Good grief. Herpes doesn't cause anything you have to look so hard to see. Stop examining yourself; if you don't notice anything from a casual glance at your penis, then nothing is wrong. If despite the overwhelming evidence you don't have genital herpes you find yourself still worrying about it, you need professional counseling.
Any more anxiety-provoked BS and I will delete the entire thread without further comment. Good bye.
Any more anxiety-provoked BS and I will delete the entire thread without further comment. Good bye.
Last thing.
Ive noticed some very small red dots on the tip of my penis that really only appear when I stretch the skin around my glans. They dont hurt at all, not even when I wash with pretty serious soap... Should I be worried?
Thank you
James
Ive noticed some very small red dots on the tip of my penis that really only appear when I stretch the skin around my glans. They dont hurt at all, not even when I wash with pretty serious soap... Should I be worried?
Thank you
James
Thank you again!
J
J
You asked about my preemptive acyclovir use. I found out about it through a friend of mine who does medical research. He said that there is some mouse research that shows some risk reduction. I asked my doctor who said that since the side effects were so minimal, she'd put me on it just in case it might have an effect. I have also been looking for that research without any luck... maybe you know something?
Thank you again for the response above... it really put my mind at ease.
James
Thank you again for the response above... it really put my mind at ease.
James
Thank you!
James
James
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
