Herpes Misdiagnosis

[Marcus734]

Last October I had sexual contact with another guy.  No further contact with anyone, including him, since.  Before that nothing for several months.  Three weeks after our encounter I discovered in total about a dozen sores located on my penis and scrotum (spherical and pea shaped) and about 4 located in a straight line along my pelvic line (dark in color and not raised).  I went to the doctor who upon visual exam diagnosed herpes.  With a prescription of Valtrex I went on my way thinking I had genital HSV2.  He also prescribed me an oral antibiotic for acne which I took at the same time.  The sores went away within a week to 10 days.  To identify when I was exposed I got tested with LabCorp about 6 weeks after the encounter - results IgG HSV1 positive, HSV2 negative.  I have had cold sores since childhood, so the HSV1 result was not a surprise.  The sores I had genitally never itched or burned and contradicted my long experience with painful cold sores.  After 8 weeks, HSV2 negative.  After 13 weeks, HSV2 negative.  I now know I do not have HSV2.

However, I cannot rule out genital HSV1.  The guy I was with gets cold sores (didn't have one at the time) but asymptomatic shedding may have put me at risk.  During the initial test, I also got an IgM test result 1.04 equivocal, 12 days after the genital sores were gone.  I understand you think this test is worthless.  But because I got a cold sore two weeks before my latest test at 13 weeks I did another IgM test.  My logic is if I had a genital HSV1 outbreak my inital IgM score should have been higher.  The second IgM test 5-7 days after the cold sore subsided was 1.32.  Can I now be reasonably comfortable that I did not have a genital HSV1 outbreak?  I have never had multiple oral cold sores.  The genital sores never crusted over and reduced in size until they dissapeared.  Because I was taking Valtrex I'm not sure what effect that had.  Perhaps it was bacterial and the acne medicine helped instead.

[Edward W Hook, MD]

Your post from yesterday was a but convoluted so I may not have followed perfectly.  I think you are asking if you might not have generated antibodies from a long standing infection because you had not experienced an initial, detected clinical episode.  If that is the question, while there are not data to answer your specific question, I would remind you that most people with positive antibody tests do not know they have been infected. this would argue against the situation you suggest.

It appears that there is more and more information here to suggest that you do not have HSV-2.  I would take that information and urge you to now move forward.  EWH

[gracefromHHP]

Are you still taking valtrex? If so stop it. Should you get a return of symptoms - see your doctor within 24-48 hours of their appearance for culture.  Otherwise wait a few months and then retest for peace of  mind.

grace

[Marcus734]

Thanks.  I would like to point out that the guy from October got tested after I informed him of my situation.  He tested negative as well for HSV2 at 6 weeks out.  I'm not aware of any further tests for him.  Assuming he did not pass it to me, my next question would naturally be if I had been exposed many months or years prior to that is it still possible given my negative HSV2 results that I could still have been exposed prior to October but had not noticed and also had never generated antibodies to that because I hadn't had my primary occurence until November of last year which had been influenced by my taking Valtrex?  That is, do my repeated negative results preclude a long-term latent exposure to HSV2?

[Edward W Hook, MD]

The fluctuation in your IgM test is uninterpretable and is of no help whatsoever in sorting things out.  As you point out, having negative serologic tests for HSV-2 this far out makes it quite unlikely that you had HSV-2 although there is a small chance that with early valacyclovir therapy you might have prevented the HSV-2 antibody response (there are a small number of people who do not develop antibodies following an inital episode of HSV).  Furthermore, had your episode been HSV-2, the chances are rather high that you would have had a recurrence by now.

Putting all of this together, it is hard to say exactly what went on last October. Hsv-2 is very unlikely, HSV-1 very rarely causes detectable genital herpes in people who have had cold sores before.  It could have been another process which is now ressolved.  there is simply no way to tell what happened at this time. So what do do?

1.  If there is a recurrence (it should occur in the same place), get a culture ASAP (the sooner the culture is obtained, the les likely it ss to be negative).
2.  No recurrences, nothing to be concerned about and no real choice but to try to move forward.

Hope this helps.  I realize it is a difficult situation.  Wish I could be more certain.  EWH