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HSV 1 & 2 Results Negative; yet concerned
I am a single male in my mid-forties. About 8 months I was diagnosed with Molluscum Contagiosum (MC). I was diagnosed without lab work; it was based on a physical examination by a physician. The pictures the Dr showed me in his reference book of MC as compared to the bumps on my skin (abdomen) looked identical to me so I assumed his diagnosis was right. (okay…. Now time elapses) About 4 months ago I received a battery of tests for STD –all tests came back NEGATIVE. (I did so just to be certain I had nothing as I was considering becoming sexually active.) After the STD testing, I saw a woman on and off over the course of 6 months. We had several sexual encounters during that timeframe a few w/o protection. Recently, we had an unprotected sexual encounter which produced in her multiple symptoms of HSV2 about six-days later. She saw her doctor, she was tested and her test results came back POSITIVE for HSV2. She shared with me she had not had any other partners other than me (I have no reason to doubt her.) and so she thought I had possibly given it to her; which makes sense if I was her only partner and she has her first symptoms 6-days after our encounter. Almost three weeks to the day of our sexual encounter, I was tested for HSV 1 & 2 and they returned, both of them < 0.091 and NEGATIVE. Now, I am wondering after doing some reading, if: 1) I tested too early, earlier than the formation of any HSV2 antibodies, and therefore none showed up and my negative is actually a positive? 2) If my prior diagnosis was not Molluscum Contagiosum and in fact it was HSV 2? (but if so, why did it not show up on the most recent HSV 1&2 test or the battery of STD tests I took nearly 4-months ago.) 3) Do I need to be retested? 4) If my occasional itching of my scrotum and abdomen is really psychosomatic (…because I’ve been wondering more about it of late) or symptoms of HSV2? The test was an igG test; not an igM test.
I welcome counsel, guidance and information….
I welcome counsel, guidance and information….
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
Just yesterday I responded to a question about the risk of HSV-2 after sex with an infected partner. It answers most of your quesitons, directly or indirectly. Take a look:
http://www.medhelp.org/posts/STDs/HSV2-Exposure/show/1675277
To assure clarity, here in addition are my replies to your specific questions:
1,3) In the absence of symptoms to suggest a new HSV-2 infection, as well as the low odds of transmission as discussed in the other thread, it is unlikely you were infected. However, your test was too soon to be certain. About half of people newly infected with HSV-2 have positive blood tests by 3 weeks, but it can take up to 3-4 months. For definitive results, have another test about that long after your last sex with the infected woman.
2) No physican with any experience with herpes and/or molluscum would confuse the two. Also, your negative blood test shows you weren't infectd 6 months ago.
4) Although itching is commonly listed as a herpes symptom, context is as important as the symptom itself. Herpes lesions may itch; but genital skin itching, by itself, is never a herpes symptom.
Finally, you definitely do not want an IgM test for HSV. Such tests are inherently unreliable, with many false positive results. And although in theory IgM antibody appears first and a positive result should indicate early infection, it doesn't work that way with HSV. Many initial infections develop IgG antibody just as rapidly as IgM; and IgM often reappears in people with recurrent herpes. It's a useless test that is never used by any legitimate STD or herpes experts.
All things considered, it is extemely unlikely you have HSV-2. If I were in your place, I wouldn't even have another test for it. However, that's what you need to do (IgG only, not IgM) if you need 100% assurance. You can expect it to be negative.
I hope this helps. Best wishes-- HHH, MD
Just yesterday I responded to a question about the risk of HSV-2 after sex with an infected partner. It answers most of your quesitons, directly or indirectly. Take a look:
http://www.medhelp.org/posts/STDs/HSV2-Exposure/show/1675277
To assure clarity, here in addition are my replies to your specific questions:
1,3) In the absence of symptoms to suggest a new HSV-2 infection, as well as the low odds of transmission as discussed in the other thread, it is unlikely you were infected. However, your test was too soon to be certain. About half of people newly infected with HSV-2 have positive blood tests by 3 weeks, but it can take up to 3-4 months. For definitive results, have another test about that long after your last sex with the infected woman.
2) No physican with any experience with herpes and/or molluscum would confuse the two. Also, your negative blood test shows you weren't infectd 6 months ago.
4) Although itching is commonly listed as a herpes symptom, context is as important as the symptom itself. Herpes lesions may itch; but genital skin itching, by itself, is never a herpes symptom.
Finally, you definitely do not want an IgM test for HSV. Such tests are inherently unreliable, with many false positive results. And although in theory IgM antibody appears first and a positive result should indicate early infection, it doesn't work that way with HSV. Many initial infections develop IgG antibody just as rapidly as IgM; and IgM often reappears in people with recurrent herpes. It's a useless test that is never used by any legitimate STD or herpes experts.
All things considered, it is extemely unlikely you have HSV-2. If I were in your place, I wouldn't even have another test for it. However, that's what you need to do (IgG only, not IgM) if you need 100% assurance. You can expect it to be negative.
I hope this helps. Best wishes-- HHH, MD
MEDICAL PROFESSIONAL
I'm glad to have helped. Take care.
Dr. HHH: Yes, as you said, she is rather upset and my most re cent inquiry to get more exacting information was denied; which means I have all the information, I think I can gather about our situation at this time. She is not pregnant. It would appear there was another or she was infected prior to our meeting and the recent outbreak is a reoccurring one. I will follow your advice and take another test at the six week time-frame you mentioned.
I appreciate your insight and advice. I've learned a lot from this experience that has resulted in positive personal changes.
I appreciate your insight and advice. I've learned a lot from this experience that has resulted in positive personal changes.
MEDICAL PROFESSIONAL
Thanks again for the additional information. It would still be useful to know the numerical value of your partner's blood test, but at this point it seems it would be unnecessarily upsetting to press her on it. No doubt she's pretty upset as it is.
But even without that information, a positive blood within 2 weeks of onset of symptoms, maybe even less, suggests she was experiencing a recurrent HSV-2 outbreak, not the initial infection. However, I cannot say this with certainty, since her symptoms seem more suggestive of an initial infection. Taking into account your belief that she could have had another partner during the preceding weeks, I have to suspect that there is a third party responsible for her infection -- if indeed her herpes is new.
Is there any possibility she is pregnant? During pregnancy, recurrent herpes outbreaks can be quite severe, mimicking initial infections.
In summary, I continue to doubt you are the source of her infection. Both the other options -- another recent partner, or a longstanding HSV-2 infection that preceded your relationship with her -- are statistically more likely than the chance you are infected with negative blood tests.
So to close the loop: concluding that you were exposed, but probably not the source, what is the chance you caught HSV-2? It's quite low, especially since you haven't had symptoms of a new genital herpes infection, which normally would start within 3-5 days after exposure. It can be longer, but 3 weeks is the ouside interval -- and I believe you're beyond that. And your negative blood test at 3 weeks also is reassuring; about half of newly infected people would have positive results by then.
All things considered, I believe it is quite unlikely you were infected. To be certain, my recommendation is that you have another HSV blood test at about 6 weeks after your last sexual intercourse with her. If that's negative (as I think it will be), one more at 12-16 weeks. My prediction is that all future tests will be negative.
But even without that information, a positive blood within 2 weeks of onset of symptoms, maybe even less, suggests she was experiencing a recurrent HSV-2 outbreak, not the initial infection. However, I cannot say this with certainty, since her symptoms seem more suggestive of an initial infection. Taking into account your belief that she could have had another partner during the preceding weeks, I have to suspect that there is a third party responsible for her infection -- if indeed her herpes is new.
Is there any possibility she is pregnant? During pregnancy, recurrent herpes outbreaks can be quite severe, mimicking initial infections.
In summary, I continue to doubt you are the source of her infection. Both the other options -- another recent partner, or a longstanding HSV-2 infection that preceded your relationship with her -- are statistically more likely than the chance you are infected with negative blood tests.
So to close the loop: concluding that you were exposed, but probably not the source, what is the chance you caught HSV-2? It's quite low, especially since you haven't had symptoms of a new genital herpes infection, which normally would start within 3-5 days after exposure. It can be longer, but 3 weeks is the ouside interval -- and I believe you're beyond that. And your negative blood test at 3 weeks also is reassuring; about half of newly infected people would have positive results by then.
All things considered, I believe it is quite unlikely you were infected. To be certain, my recommendation is that you have another HSV blood test at about 6 weeks after your last sexual intercourse with her. If that's negative (as I think it will be), one more at 12-16 weeks. My prediction is that all future tests will be negative.
I think it is a realistic to believe my partner could have been with another. Realistic in the sense that my relationship with her was not bound by a commitment either of us had made to the other and so the freedom to be with another was certainly there for her as it was for me.
If an encounter with another had to occur prior to our encounter by one to about 3-weeks, the proximity of encounters mine and her's with another may have caused shame and caused her to withold that information.
If given what I told you about what I know removes me as the likely candidate for giving her the virus, I wish to know if I need to retest because I tested 21-days after the encounter? Could I have been too premature on taking the test and really be positive tho showing no symptoms -it's just the virus is slowly doing it work and I either will not have symptoms or will shortly and be found to be positive? Does that make sense?
If an encounter with another had to occur prior to our encounter by one to about 3-weeks, the proximity of encounters mine and her's with another may have caused shame and caused her to withold that information.
If given what I told you about what I know removes me as the likely candidate for giving her the virus, I wish to know if I need to retest because I tested 21-days after the encounter? Could I have been too premature on taking the test and really be positive tho showing no symptoms -it's just the virus is slowly doing it work and I either will not have symptoms or will shortly and be found to be positive? Does that make sense?
Dr. HHH: Yes, she was w/o question determined to be POSITIVE for HSV2 by a Dr issued blood test and a culture, both of which were performed within 14-days of our encounter -it is likely that they could have been done within 10-days of our encounter -I do not have exact dates. I'm pretty sure, she started to experience symptoms of an outbreak around 5 to 7 days after our encounter.
I took a blood test after I was told by her that she was positive -which was 21-days to the day of our last encounter. My blood test was done via labcorp and it came back NEGATIVE. A culture was not performed on me; as I don't think I have any lesions (all I have are bumps that seem like what I mentioned to earlier and what I've had for about 8 months -the MC I was diagnosised with prior to even meeting her. I listed this in prior postings.) I took my blood test about 7-days after she took hers and about 14-days after she started showing symptoms.
I asked her the numerical value of the test and I asked her if she was positive for HSV1 and she said,"My doctor said I was POSTIVE for HSV2." She did not seem to know the numerical value or where she stood with HSV1; I don't know why she did not have this information.
It is my understanding this is her first initial outbreak of HSV2 and it occurred within 5 to 7 days of our encounter; the exact nature of those symptoms are sketchy beyond what I've shared with you earlier.
It has occurred to me that she may feel shame to tell me that she had been with another prior to our encounter. I do not know for sure either way.
Given what you've said, I would gather it is possible she had been with another before me and that I did not give it to her given my blood test taken 21 days after our encounter shows me to be NEGATIVE -no presence of the antibody.
With what I do know and what I have shared with you: 1) is it safe to assume that I did not give it to her? 2) Given I was tested within 21-days of my encounter with her and it turned out NEGATIVE, do I need to retest or can I assume I am good to go and did not through my encounter with her contract the virus from her?
Is there more I need to know... understand???
Thank you for patiently working through the details and for helping me gain an understanding of the situation.
I took a blood test after I was told by her that she was positive -which was 21-days to the day of our last encounter. My blood test was done via labcorp and it came back NEGATIVE. A culture was not performed on me; as I don't think I have any lesions (all I have are bumps that seem like what I mentioned to earlier and what I've had for about 8 months -the MC I was diagnosised with prior to even meeting her. I listed this in prior postings.) I took my blood test about 7-days after she took hers and about 14-days after she started showing symptoms.
I asked her the numerical value of the test and I asked her if she was positive for HSV1 and she said,"My doctor said I was POSTIVE for HSV2." She did not seem to know the numerical value or where she stood with HSV1; I don't know why she did not have this information.
It is my understanding this is her first initial outbreak of HSV2 and it occurred within 5 to 7 days of our encounter; the exact nature of those symptoms are sketchy beyond what I've shared with you earlier.
It has occurred to me that she may feel shame to tell me that she had been with another prior to our encounter. I do not know for sure either way.
Given what you've said, I would gather it is possible she had been with another before me and that I did not give it to her given my blood test taken 21 days after our encounter shows me to be NEGATIVE -no presence of the antibody.
With what I do know and what I have shared with you: 1) is it safe to assume that I did not give it to her? 2) Given I was tested within 21-days of my encounter with her and it turned out NEGATIVE, do I need to retest or can I assume I am good to go and did not through my encounter with her contract the virus from her?
Is there more I need to know... understand???
Thank you for patiently working through the details and for helping me gain an understanding of the situation.
MEDICAL PROFESSIONAL
Thanks for the additional information. Those symptoms are consistent with an initial HSV infection. On the one hand, you apparently were the only likely source; but if you infected her, your own blood test should have been positive for HSV-2.
So we have a mystery, but most likely we can solve it. It still isn't clear to me whether both the culture and blood test were positive for HSV-2. Can you clarify that? Also, exactly when was her blood test done; i.e. how long after her symptoms began? Can you learn the numerical value of the blood test result and the exact kind of test done (several types are on the market)? Her doctor/clinic or the lab where the test was done should be able to provide this information. Also, let me know if her blood test, like yours, was done by LabCorp or by Quest, another large national laboratory.
If her blood test was positive for HSV-2, and if it was done within 2 weeks of onset of her symptoms, it means that she was infected before, i.e. that that her symptoms were not caused by a new HSV infection.
If it turns out she indeed had an initial HSV-2 infection, then there are only two possible explanations. First, that she had sex with someone else soon before her symptoms began (probably within a week, certainly within 3 weeks). Second, that you are infected but one of those rare persons who doesn't develop detectable antibodies by the standard blood tests. Of these two options, in my experience the first is more likely. However, I do not know your partner and cannot judge whether this is a realistic possibility.
So we have a mystery, but most likely we can solve it. It still isn't clear to me whether both the culture and blood test were positive for HSV-2. Can you clarify that? Also, exactly when was her blood test done; i.e. how long after her symptoms began? Can you learn the numerical value of the blood test result and the exact kind of test done (several types are on the market)? Her doctor/clinic or the lab where the test was done should be able to provide this information. Also, let me know if her blood test, like yours, was done by LabCorp or by Quest, another large national laboratory.
If her blood test was positive for HSV-2, and if it was done within 2 weeks of onset of her symptoms, it means that she was infected before, i.e. that that her symptoms were not caused by a new HSV infection.
If it turns out she indeed had an initial HSV-2 infection, then there are only two possible explanations. First, that she had sex with someone else soon before her symptoms began (probably within a week, certainly within 3 weeks). Second, that you are infected but one of those rare persons who doesn't develop detectable antibodies by the standard blood tests. Of these two options, in my experience the first is more likely. However, I do not know your partner and cannot judge whether this is a realistic possibility.
Dr. Yes, in fact I was concerned about both.. That I may have infected her and that I may have contracted the virus from her. She has taken blood test and a culture. I know she had pain, discomfort in the vagina, flu like symptoms and fatigue around 5/7 days after our encounter. Until that time, I am not aware she had any symptoms. He symptoms were enough that she sought counsel from her physician. A blood test was taken and a culture was done and the results were she is POSITIVE for HSV2. I don't know if she had all the symptoms you asked. I believe she had fever, not sure about the lesions or inflamed lymph noids in groin. I do not think, at least I am not aware, I've every had symptoms like these. I was tested months before we had our encounter and my tests showed I was negative to HSV2 & I was tested 3 weeks to the day, after she informed me she was POSITIVE and my results were NEGATIVE. I did a igG blood work test through labcorp.
MEDICAL PROFESSIONAL
To be honest, I misunderstood part of your question -- that you and your partner are concerned you may have been the source of her herpes, not simply exposed to her. Can you say more about her "multiple symptoms"? Did she have multiple genital lesions? Fever? Enlarged lymph nodes in the groin? Was her positive HSV-2 test from a lesion swab or a blood test?
Dr. Thanks for replying to my questions and offering me perspective and some desired relief. The link to your earlier post was helpful. Specific to my questions, if I heard you correctly, I tested a bit early and if I wish to have 100% assurance that I've not contracted HSV2 about three months from the time of our encounter I could retest. But on the whole, it is highly unlikely I have contracted it from the woman or that I gave it to her given the odds of contraction you sited in the research, my testing prior to our encounters that came back NEGATIVE and the recent test that came back NEGATIVE after our encounter. I must say, I do find her outbreak and her POSITIVE test after our encounter (especially because it was so close to our encounter) rather hard to understand given my results. I will be seeing my physician soon and will have him confirm what I see on my lower abdomen is still just the MC I was diagnosised with early and not some new HSV2 blisters or lesions. I'm not a DR but they sure look to be the same kinds of bumps I previously had with MC.
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