GENERAL

[worried_down_south]

Hi,

In February  I slept with a guy 1 unprotected. He later told me that his ex wife had Herpes (don't know if it was type 1 or 2). He has assured me that he has never had any symptoms.

Since then I have had bouts of flu-like symptoms. I have chronic tonsillitis. What I mean is, that I have had occasions where my immunity wasn't great (and I didn't get any herpes lesions).

I actually suspect that I have Epstein Barr, also in the Herpes family.

Anyhow, in July I slept with a guy 2 unprotected. 6 days later I got an itch, day 7 discharge, then painful urination. It looked like thrush. Doctor prescribed meds for thrush, they didn't do anything. Day 10 I got sores that looked like Herpes. I also had swollen lymph nodes in the groin.

I took Valtrex and used Acyclovir cream. It went away in 3 days.

We both went for blood tests. Here are the results of out HSV Type 2 test in July:-  
HIS test results were= IGM 0.13, IGG 2.30.
MY test results were = IGM 0.12, IGG 3.64.
Doctor A said: You are both negative.
Doctor B said: You have both been exposed in the past.

In September I had another HSV 2 test and the results were: IGM= 0.1, IGG = <2.0.  

Doctor A said: Results still look negative.
Doctor C said: Serology doesn't mean anything. And if it visually LOOKED LIKE Herpes, and it cleared up with the meds, then that's what it was.

I would like your general thoughts on what I have written above, but specifically I would like to ask:

* Was this a Primary Herpes outbreak because I had swollen lymph nodes?
* Is it possible to have swollen lymph nodes in the groin with a recurrence?
* Is it possible that I may have caught this from Guy 1 in February but not had an outbreak?
* Can Epstein Barr cause swollen lymph nodes in the groin?
* Could it have been another STI that looked like herpes?
* Could it be Type 1 HSV?
* Would a Herpes outbreak go like this?  - itchiness/discharge/painful urination THEN sores
* Could bad Thrush have caused sores?

Thank you for your help.

[H. Hunter Handsfield, M.D.]

Good question; I wondered a bit about the timing as well.  You don't state the exact intervals, but based on your story I calculated that you were tested around 2 weeks after onset of symptoms (and maybe a few days longer since exposure). The HSV-2 blood test can be positive as soon as 10 days after onset of infection, and more than half the time it is positive by 3 weeks.  So most likely it fits.  However, if the interval from exposure to the blood test was under 10 days, I would have to reevaluate my conclusions.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  The short reply:  It is highly probable you have genital herpes due to HSV-2; the apparent yeast infection probably was your initial herpes infection; and your second (July) partner also is probably infected with HSV-2 and likely was the source of your herpes.

You can ignore the IgM antibody results, which are very unreliable in diagnosing HSV-2; and although in theory IgM is supposed to help distinguish early from late infection, it doesn't do that with any accuracy.  Here is a thread that explains it.  Although 4 years old, the information remains accurate:  http://www.medhelp.org/posts/show/248394

Your IgG test results are somewhat confusing, because you had a definitely positive result in July and apparently a negative result in September.  However, that might be due to treatment with valacyclovir (Valtrex), which can delay positive results and sometimes might make a previously positive test turn negative again.

Dr. A is wrong in saying you were negative to start.  Your initial test was unequivocally positive.  Dr. B is partly right:  both your blood tests were positive for HSV-2, but there is no such thing as being only "exposed"; a positive result means a person is infected with HSV-2.  Dr. C's comments make no sense; visual diagnosis of herpes is much less reliable than laboratory diagnosis.  To your specific questions:

1-3) It was probably a primary outbreak mostly because it caused diffuse genital irritation (which I assume involved both sides of the genital area, even though you don't say it) as well as the lymph node involvement.  You can be quite certain you caught the infection 3-5 days (possibly as long as 10 days) before your symptoms started, and extremely unlikely you caught it in February.  Recurrent herpes is rarely so severe and rarely causes lymph node inflammation.

4) EBV doesn't gential ulceration and lymph node inflammation localized to the groin.  Also, you have no basis to assume your sore throat and "bouts of flu like symptoms" were due to EBV.  At least 20 other conditions could cause the identical symptoms; and initial EBV infections (i.e. infectious mononucleosis, often called glandular fever in the UK) generally last no more than 2-4 weeks.

5) Nothing except herpes is likely to cause the symptoms you describe.

6) HSV-2 is more likely, but conceivably it was HSV-1.  Apparently you were not tested for HSV-1.  If you were, and can provide those blood test results, I can comment further.

7) Yes, that sequence of symptoms certainly could be herpes.  It probably was.

8) Yeast infections (thrush) rarely cause open sores.  Also, the treatments for yeast usually are very effective; that you didn't respond well to the initial treatment argues against yeast as the cause.

If you could provide more detail about your and your partner's HSV blood tests, I might be able to comment further.  What brand of test?  If HSV-1 was tested, provide those results as well.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

As suggested by Still_Worried, these are atypical numbers.  However, a number of new manufacturers have begun marketing HSV-2 antibody tests in the past year; maybe this is one of the new ones.  Please try to find the manufacturer and/or trade name of the test; the lab will be able to provide that information, but let's not have other comments until then.  For now you should assume you do not have HSV-2.

[Still_Worried_]

What's the name of the test you have been taking?  Are you in the U.S.?

As far as I know, 16.0 & 22.0 are not typical values of the Herpeselect or Captia.....?

[worried_down_south]

IGM Normal values with this test:  
Negative LESS THAN 0.8
Positive GREATER THAN 1.1    

IGG Normal values with this test:  
Negative LESS THAN 16.0
Postive  GREATER THAN 22.0

[worried_down_south]

Hi Doctor,.

It seems the Medhelp website didn't let me put the figures in the for reference bit. I don't know why - I'll try again.


IGM Normal values with this test:  Negative  1 . 1    
IGG Normal values with this test:  Negative  2 2 . 0

JULY
HIS test results were=  IGM 0.13, IGG 2.30.
MINE WERE=             IGM 0.12, IGG 3.64.

My results in September, 9.5 weeks after exposure of 12th July:
IGM= 0.1       IGG = <2.0

Maybe Doctor C, who said that Serology is not reliable had a point?

As you said, my symptoms and the appearance of Herpes that went away with the medication and the severity makes it look like it was a Primary herpes infection..

Unless I'm in the very small percentage who had a primary outbreak that was very subtle?

This is all very confusing !!

Regards

[H. Hunter Handsfield, M.D.]

This all remains somewhat confusing.  The timing of your first positive HSV-2 test is indeed a bit early assuming you were infected in July.  But your symptoms etc also are not really consistent with an earlier infection.  It is possible you have a chronic HSV-2 infection, i.e. even before last February.  Or no HSV infection at all, if the September result is the valid one.

Probably the best way to sort this out is for you to have yet another HSV-2 antibody test; and if that shows anything other than a definite negative (3.5), have an HSV Western blot test as well.  WB is the ultimate gold standard in herpes antibody testing.

[worried_down_south]

I messed up the FOR REFERENCE section:


(Normal values with this test) .
IgM    Negative  1.1
IgG    Negative 22.0

[worried_down_south]

Thank you for your detailed response.

I believe IgG shows a 'later response', so yes the IgG being positive in July but negative in September is confusing. Also IgM (which you have said said is unreliable was also negative in July AND September.
*Could this indicated I was first exposed in February?

I'll clear up the confusion over timings:

12th July - Slept with him for the first time
16th July - Bad headache
17th July - Itchiness
18th July - painful urination /maybe abnormal discharge
19th July - worsening of painful urination and discharge.
                Took meds for Thrush
21st July - got sores on both sides, all over that looked like herpes.
                We both had blood tests:
                HIS test results were= IGM 0.13, IGG 2.30.
                MY test results were = IGM 0.12,  IGG 3.64.

FOR REFERNCE: (Normal values with this test) - I don't know which brand of test.
IgM    Negative <0.8,    Positive 1.1
IgG    Negative 22.0

22nd/23rd: Noticed swollen lymph glands in groin
24th July - Started meds for Herpes - took Valtrex 500mg x 10 tablets and Acyclovir
27th July - Sores had cleared up

Haven't taken any meds since.

My results in September, 9.5 weeks after exposure of 12th July:
IGM= 0.1,
IGG = <2.0

The EBV and groin inflammation I think I read somewhere. I'm probably mistaken. Here's and article regarding genital ulcerations. However these ulcerations are much more severe. http://www.jabfm.org/cgi/content/full/18/1/67

We didn't get tested for HSV 1.

Could it have been a different STD that could cause sores? Or does a rapid response to the meds certainly indicate Herpes.

Also just yesterday I noticed 3-4 small red marks all on the same side. They don't look anything like the initial outbreak, they look kind of like razor burn, though I don't shave, so I assume they are a light recurrence. I have applied cream to stop it worsening.

I look forward to hearing from you

Regards

[Still_Worried_]

I agree w/ 100% of what you stated; not here to argue -- simply to learn (I'm new to HSV, as well).

It is possible to have been infected in July & have a positive of 3.64 in the same month?  Have you ever seen that happen?

Thank you.  I value your expertise.