Do I need additional HSV testing?

[MDiamnot]

Heterosexual mid-30's male. Test done at 9 weeks post (Labcorp). Results: HSV1 positive and HSV2 negative.  I've had recurring cold-sores most of my life. Another test done (Quest -HerpesSelect) at 13 weeks. Results: HSV1: 5 and HSV2: 1.18

I was terribly upset, but then read on this forum that with HSV1, such low-positive HSV2 should be confirmed. So, I had a Biokit test at 13.5 weeks. It was negative

I’m neurotic, and not certain I’m not experiencing symptoms.  

Possible symptoms: Then about an inch above my rectum, the line of skin that runs in the center of my cheeks became red like a red line up the center crease. Recently developed a couple very small fissures on that line (tiny specs of blood on TP). Reoccurred 2 wks later. Then had a bump with no head or sore but redish & mildly sensitive - pimple from all the creams applied (yeast, diaper, polysporin)?? Proactive pimple cream applied and it's gone in a couple days, but week or two later there is another small bump at the very top of the "crack" that only appears red when rubbed - not sensitive. Had a bit of pain in my rectum, which could be hemorrhoids, as I've dealt with them in the past, and Prep-H ointment seemed to help (not new for me). And, a couple of times near the tailbone, an inch or so up from rectum, it has felt slightly bruised if pressed. "Symptoms" seem to resolve in less than a week, then return about every week or two for last couple months - the skin there has just felt just slightly off. I have not had any blisters or scabs - nothing like cold sores I’ve had.

Other factors to consider:  I’ve had external anal itching and occasional hemorrhoids for years, and been relentlessly checking the area (spreading to look in the mirror) for the past two months just to see if anything popped up (maybe that causes the fissures???).

So, do you think I need more testing, or am I way over thinking and need to put this to rest.

[Edward W Hook, MD]

The second value of 1.18 in the context of a highly psoitive HSV-1 test and a negative Biokit is a flase positve result.  No change in my assessment.

Regarding your symptoms.  HSV is transmitted by direct contact.  Your soreness is not herpes.  EWH

[MDiamnot]

My sincere thanks for your time.  You are providing a wonderful service here.

[MDiamnot]

Thank you for your reply.  I just want to make sure I was clear.  

The first test was performed at Labcorp, procured via an online testing company.  I got those results over the phone, and did not receive numbers, just verbal report of negative for both HSV types.  The second test was done at Quest, procured via another online company - tstd.org. Tstd.org's webpage indicates that the test is "Herpes Symplex Virus Type 1 and 2 IgG, Type Specific Antibody HerpesSelect".  That was the test that gave me an online report (which I have unfortunately deleted).  It showed a Positive for HSV1 at 5 or greater than 5 (I don't recall whether it was 5.xx or just 5).  It showed HSV 2 as 1.18.   The report indicated that positive was 1.10 and above.

So, as I understood it, I had one test with negative for both - maker of that IgG of test unknown to me. A second test, which I understood to be HerpesSelect with a positive for HSV1 and low-positive for HSV2. And then a Biokit with negative.  If that is the case, would you still recommend no further testing?

Also, regarding the "symptoms" around the buttock crack and rectum, am I understanding your comment to indicate that outbreaks only occur in that location if transmitted their (i.e., anal sex)?  You are correct, I am heterosexual, so no transmission/contact would have occurred in that location.

[Edward W Hook, MD]

I would not suggest further testing.  The Quest result is not reported out in the way the HerpeSelect results are reported and likely was not a HerpeSelect. On the other hand, the Biokit result is consistent with earlier results and makes sense.  I would believe it.  Thus you have two relaibe test results, a HerpeSelect which confirms that you have HSV-1 as you thought but not HSV-2 and a Biokit which confirms that you do not have HSV-2

As far as your symptoms, nothing you have described suggests herpes to me. the inflammation and irritation in your buttock crack is normal, perhaps worsened a bit by your hemorrhoids and certainly is not herpes.   (besides, you are heterosexual.  Why would you have rectal herpes.)

My advice, realize that you do not have HSV-2 and move on. You do not need further testing.  EWH