How to interpret test results

[TyFor]

Several years ago when I was in college I was given unprotected oral sex once from a girl I was dating.  About 3 months later I became sick with flu-like symptoms.  I went in to the University clinic and was found positive for mononucleosis. A few days later noticed a scab on my penis.  I peeled the scab off and noticed what appeared to be a sore on my penis (wet looking ulcer where the scab was).  I did not remember feeling any type of prodromal symptoms before this.  I asked the girl I was dating whether or not she ever got cold sores and she said she did but assured me that she did not have one at the time of our sexual encounter which I believe because I didn't notice any.  I went to the clinic at the University and saw a doctor there who looked at it and said by appearance he did not believe it to be herpes but wasn't sure.  He said it was too late to have a swab test done since the sore had already scabbed over once.  I was given an STD screen and everything came back negative.  I was told to come back in a month to get HSV2 blood test done.  A week after the original visit a few small un-clustered red bumps appeared near the original sore, only one looked a little like a blister which I scratched until it opened into a small wet sore which healed within a few days, before I could get it inspected.  Went back for the blood test and the result came back negative for HSV2.

Since then I have never had any symptoms of herpes except for a tingling sensation once a year.  No sore bumps or blisters.  Nothing that I could get a swab test for.  I want to know for sure so I am getting HSV1 and HSV2 igG testing done tomorrow.  My questions are:

1)If HSV1 comes back positive does that mean I have that on my genitals?  I seem to think I remember having a cold sore at a young age but have never had any since then (maybe just a scab).

2)The night of my encounter we kissed a lot too, wouldn't I have gotten a cold sore on my mouth as well if she had herpes at the time?

[Edward W Hook, MD]

Your doctor may not appreciate that you are aware of the importance of numberical results in evaluating tests results. My guess is that your tests were entirely negative and I would acceptt he results. The problems with HSV tests are rarely falsely negative tests and more often falsely postive tests.   EWH

[TyFor]

Dr. Hook,

I received mail from the Doctor I went to for my HSV 1 and HSV 2 testing today.  While I expected to receive the actual numerical results from the Doctor, instead I just received a note from him saying, "no signs of Herpes 1 and 2, Best Wishes!" I guess my only question at this point is whether or not to ask the doctor for my specific test results or simply take his word for it and put all of this behind me.  I trust that my doctor was knowledgable about the disease, and he did end up doing a full screening for both HSV1 and HSV2 IgG and IgM although I only specifically asked for IgG, but having just this note with no numbers seems strange from what i've heard from other people in my situation.  I would truly love to believe this is the case, and I feel a little bad about asking for the results as it may seem like I'm second guessing my doctors ability to determine them.  What would you do in my shoes?

[Edward W Hook, MD]

Welcome to the STD Forum.  You are asking good, but difficult to answer questions.  I anticipate that your blood test for HSV-2 will be negative but the chance that your HSV-1 test will be positive is at least 60%, just as it is for the rest of the population (that is, 6 out of 10 Americans have HSV-1, whether they know it or not).   While the encounter you describe was relatively low risk, there is a small chance that you caught genital HSV-1 as a result.   If your test shows you have HSV-1, it will not be useful for determining the location of your infection.  In most infection the site of such infections turns out to be the mouth/lips but in a smaller proportion there is genital infection.  The good news is that when one had genital HSV-1 they are less likely to have recurrences and less likely to transmit infection to others than persons with HSV-2.  the oly way to definitively know where your infection is would be to have a positive culture or PCR test from a penile lesion or site.

In answer to your specific questions:
1.  See above. If the test is positive for HSV-1, odds are still high that you do not have genital HSV-1.
2.  Another good question. when people are exposed at multiple sites to HSV (oral, genital, other) interestingly the infections tend to occur only at one site, not multiple sites.

Regarding your testing.  A few suggestions:
1.  Please do not let them do an IgM test.  They typically just confuse things.
2. Feel free to follow up this post with your results if you wish to discuss their interpretation.

Hope this comment is helpful.  EWH