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Negative HSV2 blood tests after nearly 3 yrs?!
Dear Dr
I was diagnosed with HSV2 (genital) in May'08. I went to a gynaecologist immediately upon noticing lesions on my labia which I had never had before, after sex with a new partner. I had no other symptoms. Results of blood test and culture for tests were:
“HSVI (IGG) positive 4.552 Index (pos=>1.0) (I have had oral for 18 yrs)
HSVII (IGG) negative 0.190 Index (pos=>1.0)
The significance of this result depends on the clinical context. Rising antibody level is more significant. Suggest testing a second sample in 1-2 weeks”
Swab culture results (from the same lab):
“ Herpes Simplex Antibodies special pathology
Herpes simplex Typ I/II Detected Type II
Sample type Green swab”
Diagnosis was a newly contracted HSVII infection. No further tests were done. I had outbreaks of blisters every once in a while for the first 18 months but none for almost a year. I did not require antivirals.
Just had a full STD screening (L12) as well as an IGG HSV2 blood test for confirmation. Blood test results are NEGATIVE for HSVII after nearly 3 years!!!!.. Test used was EIA. I am confused. This doctor says that it must have been a genital HSVI infection, not HSV2. But, if I already had it (orally, 18 yrs), how can this be?. I had a bikini wax the day before intercourse and had small skin tears as you do. Could my partner have had genital HSVI and the virus entered the skin on labia– similar to auto-inoculation?.
What do I do now?. Ask for a repeat HSV2 blood test and HSVI Igg test too?. My initial doctor is now retired so can't follow up with him. Results of my recent STD tests will be ready soon. But, if I wasn’t shedding virus when it was taken, HSVII will probably not show up.
What I need to verify with the doctor?. Is it possible that I don’t have genital herpes but some other misdiagnosed/undiagnosed disease?. Could it have been something which my body has now cleared?. Please help.
I was diagnosed with HSV2 (genital) in May'08. I went to a gynaecologist immediately upon noticing lesions on my labia which I had never had before, after sex with a new partner. I had no other symptoms. Results of blood test and culture for tests were:
“HSVI (IGG) positive 4.552 Index (pos=>1.0) (I have had oral for 18 yrs)
HSVII (IGG) negative 0.190 Index (pos=>1.0)
The significance of this result depends on the clinical context. Rising antibody level is more significant. Suggest testing a second sample in 1-2 weeks”
Swab culture results (from the same lab):
“ Herpes Simplex Antibodies special pathology
Herpes simplex Typ I/II Detected Type II
Sample type Green swab”
Diagnosis was a newly contracted HSVII infection. No further tests were done. I had outbreaks of blisters every once in a while for the first 18 months but none for almost a year. I did not require antivirals.
Just had a full STD screening (L12) as well as an IGG HSV2 blood test for confirmation. Blood test results are NEGATIVE for HSVII after nearly 3 years!!!!.. Test used was EIA. I am confused. This doctor says that it must have been a genital HSVI infection, not HSV2. But, if I already had it (orally, 18 yrs), how can this be?. I had a bikini wax the day before intercourse and had small skin tears as you do. Could my partner have had genital HSVI and the virus entered the skin on labia– similar to auto-inoculation?.
What do I do now?. Ask for a repeat HSV2 blood test and HSVI Igg test too?. My initial doctor is now retired so can't follow up with him. Results of my recent STD tests will be ready soon. But, if I wasn’t shedding virus when it was taken, HSVII will probably not show up.
What I need to verify with the doctor?. Is it possible that I don’t have genital herpes but some other misdiagnosed/undiagnosed disease?. Could it have been something which my body has now cleared?. Please help.
MEDICAL PROFESSIONAL
I'm glad you came back. Grace (from the community forum) and I exchanged emails about your situation, and she pointed out my error. I guess I skimmed part of your question too quickly; I missed that you had apparent recurrent herpes for the first 1-2 years after the initial diagnosis. That changes things, i.e. it now seems more likely that you just are one of those people (5-10%) with HSV-2 whose blood tests remain negative.
However, I'm still not certain. The pattern of recurrences you describe may be consistent with herpes, but it is not typical. The most common pattern is for genital HSV-2 is to have fairly consistent outbreak numbers for several years -- with a gradual decline, but not usually so soon as you experienced.
Having more severe symptoms with recurrences than with the initial infection also is atypical. Contrary to common beliefs and your experience, it is unlikely that stress has any effect on the frequency or severity of herpes outbreaks. And no real herpes outbreak can clear up in "a day or two", even with highly effective treatment like oral acyclovir. Once the virus damages the cells and causes a sore, healing cannot even begin for 2-3 days, and complete healing generally takes at least another week. If a lesion progressed only minimally, e.g. to a red bump that had not become an overt blister or sore, it might regress in 2-3 days, but even that is somewhat unusual.
And with apology for perhaps bursting another bubble, lysine is useless against herpes. It isn't exactly quackery, since there is theoretical support for it based on the biology of HSV replication. However, it has little if any benefit in the real world.
I agree with your doctor about acyclovir cream; I never prescribe it.
For all those reasons, I would still be interested to know exactly what test was done on the swab specimen 3 years ago. Until then, I continue to believe there is a good chance you don't in fact have genital herpes. At the same time, I don't want you to get your hopes up. You may still have it; and, perhaps even more troublesome, it might not be possible to know for sure. Of course, you can always hope (maybe not the right word!) for a new genital outbreak, in which case you should immediately see a doctor or clinic for a culture or, preferably, a PCR test for HSV.
However, I'm still not certain. The pattern of recurrences you describe may be consistent with herpes, but it is not typical. The most common pattern is for genital HSV-2 is to have fairly consistent outbreak numbers for several years -- with a gradual decline, but not usually so soon as you experienced.
Having more severe symptoms with recurrences than with the initial infection also is atypical. Contrary to common beliefs and your experience, it is unlikely that stress has any effect on the frequency or severity of herpes outbreaks. And no real herpes outbreak can clear up in "a day or two", even with highly effective treatment like oral acyclovir. Once the virus damages the cells and causes a sore, healing cannot even begin for 2-3 days, and complete healing generally takes at least another week. If a lesion progressed only minimally, e.g. to a red bump that had not become an overt blister or sore, it might regress in 2-3 days, but even that is somewhat unusual.
And with apology for perhaps bursting another bubble, lysine is useless against herpes. It isn't exactly quackery, since there is theoretical support for it based on the biology of HSV replication. However, it has little if any benefit in the real world.
I agree with your doctor about acyclovir cream; I never prescribe it.
For all those reasons, I would still be interested to know exactly what test was done on the swab specimen 3 years ago. Until then, I continue to believe there is a good chance you don't in fact have genital herpes. At the same time, I don't want you to get your hopes up. You may still have it; and, perhaps even more troublesome, it might not be possible to know for sure. Of course, you can always hope (maybe not the right word!) for a new genital outbreak, in which case you should immediately see a doctor or clinic for a culture or, preferably, a PCR test for HSV.
MEDICAL PROFESSIONAL
Oh, and one more possibility. Assuming the swab test was a culture or PCR, despite the wording, it could still be a false result. False positive can occur, especially by PCR; or a specimen mix-up could have occurred, i.e. someone else's swab gave the positive result.
MEDICAL PROFESSIONAL
Finally -- that confirms the initial test indeed was a PCR. I agree exxactly with the statements from the lab virologist, which fit well with our discussions up to this point. Undoubtedly you would have been happiest had you learned you didn't have genital herpes at all, but at least now there is certainty -- which will probably provide a measure of help.
Not to burst any bubbles, but you should not hold your breath on curative treatment for established HSV infections. It isn't likely, certainly not in the "near future".
Thanks for the thanks. Best wishes.
Not to burst any bubbles, but you should not hold your breath on curative treatment for established HSV infections. It isn't likely, certainly not in the "near future".
Thanks for the thanks. Best wishes.
Dear Dr
I have received a response from the Consultant Virologist at the lab which did all the tests:
"The results are a little unusual but I have seen this sort of combination before. I suspect that the lesions you had in 2008 were most likely due to HSV type 2. This would fit with the clinical picture you describe. Not every patient who gets infected with HSV develops antibodies that the tests can detect. The HSV was detected by PCR and these tests are very sensitive.
I would not do any further antibody tests for the moment as these will not help. Hopefully you will not have any further lesions, but if you do, I would have them swabbed and tested for HSV again by PCR. That would give you a definitive answer."
Therefore, this confirms that I do have HSV2. I'm not sure whether or not this means that I have a low viral load with less risk of transmission to others or not but I will take the necessary precautions nevertheless.
Thank you from the bottom of my heart for your time and consideration. You provide a wonderful service to people who desperately need answers. Hopefully through research carried out by dedicated doctors like yourself, there will one day be a cure for this in the near future.
God bless you, doctor.
I have received a response from the Consultant Virologist at the lab which did all the tests:
"The results are a little unusual but I have seen this sort of combination before. I suspect that the lesions you had in 2008 were most likely due to HSV type 2. This would fit with the clinical picture you describe. Not every patient who gets infected with HSV develops antibodies that the tests can detect. The HSV was detected by PCR and these tests are very sensitive.
I would not do any further antibody tests for the moment as these will not help. Hopefully you will not have any further lesions, but if you do, I would have them swabbed and tested for HSV again by PCR. That would give you a definitive answer."
Therefore, this confirms that I do have HSV2. I'm not sure whether or not this means that I have a low viral load with less risk of transmission to others or not but I will take the necessary precautions nevertheless.
Thank you from the bottom of my heart for your time and consideration. You provide a wonderful service to people who desperately need answers. Hopefully through research carried out by dedicated doctors like yourself, there will one day be a cure for this in the near future.
God bless you, doctor.
Dear Dr
Many thanks. Now that I have been retested (blood) at the same lab, I have written and asked for their specialists to comment on the whole range of tests and to verify whether or not the initial swab was tested for PCR and for which type.
Their admin person said that the swab would have been tested by PCR even in 2008 but I will wait until I hear it from the horse's mouth.Having come this far, I need to be sure that I have left no stone unturned.
I will definitely let you know. It will be interesting to hear what the doctors at this top European lab will say. Regardless, I believe in your diagnosis.
Best regards
Many thanks. Now that I have been retested (blood) at the same lab, I have written and asked for their specialists to comment on the whole range of tests and to verify whether or not the initial swab was tested for PCR and for which type.
Their admin person said that the swab would have been tested by PCR even in 2008 but I will wait until I hear it from the horse's mouth.Having come this far, I need to be sure that I have left no stone unturned.
I will definitely let you know. It will be interesting to hear what the doctors at this top European lab will say. Regardless, I believe in your diagnosis.
Best regards
MEDICAL PROFESSIONAL
1) Your HSV-2 test remains entirely negative. It is normal for negative results to have different numerical values on repeat testing. Any result below 0.9 is totallly negative, i.e. no HSV antibody is detectable. A result of 0.59 is just as negative as 0.19.
2) As we have already discussed, what is needed is to learn for sure whether a PCR test was done on the swab specimen and to confirm whether it was positive.
3) That phrase refers to the HSV-1 result.
I think this thread has gone as far as it can, until and unless you can confirm that a PCR test was done and positive, and for which virus type. If done and positive for HSV-2, you have to assume you are infected despite the negative blood test results. If PCR was not done, or was positive for HSV-1, you can go forward secure in the knowledge that you do not have an HSV-2 infection.
2) As we have already discussed, what is needed is to learn for sure whether a PCR test was done on the swab specimen and to confirm whether it was positive.
3) That phrase refers to the HSV-1 result.
I think this thread has gone as far as it can, until and unless you can confirm that a PCR test was done and positive, and for which virus type. If done and positive for HSV-2, you have to assume you are infected despite the negative blood test results. If PCR was not done, or was positive for HSV-1, you can go forward secure in the knowledge that you do not have an HSV-2 infection.
Dear Dr
I just received the repeat HSV Igg results from the lab that originally did them and the swab test:
"HSV1 Igg Positive 4.308 Index (pos=>1.0)
HSV2 Igg Negative 0.594 Index (pos=>0.9)
Serological evidence of HSV infection at some time"
Just to recap, these were the blood test results from the same lab in 2008:
“HSVI (IGG) positive 4.552 Index (pos=>1.0)
HSVII (IGG) negative 0.190 Index (pos=>1.0)
The significance of this result depends on the clinical context. Rising antibody level is more significant. Suggest testing a second sample in 1-2 weeks”
As you can see, their HSV2 index has been reduced from >1.0 as positive to >0.9 as positive.
My HSV1 results have reduced from 4.552 (in 2008) to 4.308. My HSV2 stands at 0.594 vs 0.19 (in 2008).
I was told verbally by the lab that the swab test was a PCR test. The lab offered to get its doctors to comment on all the test results (from 2008 and 2011) once the latest ones came through.
These are my questions:
1- What is your take on the new IGG results comparing with the results from 2008?
2-Shall I ask the lab doctors to comment on the case now that I have their second results?.
3- What does the lab mean by "Serological evidence of HSV infection at some time"?. Are they referring to HSV1 or HSV2 infection?.
Grateful for your advice and comments.
Best regards
I just received the repeat HSV Igg results from the lab that originally did them and the swab test:
"HSV1 Igg Positive 4.308 Index (pos=>1.0)
HSV2 Igg Negative 0.594 Index (pos=>0.9)
Serological evidence of HSV infection at some time"
Just to recap, these were the blood test results from the same lab in 2008:
“HSVI (IGG) positive 4.552 Index (pos=>1.0)
HSVII (IGG) negative 0.190 Index (pos=>1.0)
The significance of this result depends on the clinical context. Rising antibody level is more significant. Suggest testing a second sample in 1-2 weeks”
As you can see, their HSV2 index has been reduced from >1.0 as positive to >0.9 as positive.
My HSV1 results have reduced from 4.552 (in 2008) to 4.308. My HSV2 stands at 0.594 vs 0.19 (in 2008).
I was told verbally by the lab that the swab test was a PCR test. The lab offered to get its doctors to comment on all the test results (from 2008 and 2011) once the latest ones came through.
These are my questions:
1- What is your take on the new IGG results comparing with the results from 2008?
2-Shall I ask the lab doctors to comment on the case now that I have their second results?.
3- What does the lab mean by "Serological evidence of HSV infection at some time"?. Are they referring to HSV1 or HSV2 infection?.
Grateful for your advice and comments.
Best regards
MEDICAL PROFESSIONAL
I'm not certain, but it sounds like the lab found no evidence of HSV on your pap smear (that's what "Thinprep" is.) That means nothing; pap testing for herpes is pretty much meaningless.
So the question remains whether some lab somewhere did a PCR test on a swab from your genital lesion(s). The lab seems to think so, in referring to "current and previous PCR results".
So the question remains whether some lab somewhere did a PCR test on a swab from your genital lesion(s). The lab seems to think so, in referring to "current and previous PCR results".
Dear Dr
I finally got a response from the lab:
"I have looked at the results from 2008 and the most recent result and from these results you can interpret that this patient has no current HSV infection in the thinprep sample.
Unfortunately, I can't comment on the patients' most recent Igg results as they were not performed by us. Our previous antibody result were positive which shows that the patient has had an HSV infection in the past, which conforms to both the current and previous HSV PCR results. You will have to confirm the new igg results with the lab that performed them and perhaps they can comment further".
I was not satisfied with this response as it did not answer the question about the swab test. I assume that the "past hsv infection" they are referring to is because of my initial blood test with them which showed positive for HSV1 and negative for HSV2. I called the lab and they suggested I send them a blood sample for testing to compare with the previous results (which I have already done). I was told that they would then get the doctors to look at all the tests and comment. The test results are not yet back. However, the person I spoke to (not a doctor) said that my swab test would have been tested by PCR even in 2008.
I think I mistakenly said I was going to do PCR tests - what I meant was another igg blood test at the overseas lab that did my swab and recent sexual health tests.
I thought I'd just update you and will let you know the results of the new blood tests and lab doctors comments once I receive them.
Thank you as always for your time.
I finally got a response from the lab:
"I have looked at the results from 2008 and the most recent result and from these results you can interpret that this patient has no current HSV infection in the thinprep sample.
Unfortunately, I can't comment on the patients' most recent Igg results as they were not performed by us. Our previous antibody result were positive which shows that the patient has had an HSV infection in the past, which conforms to both the current and previous HSV PCR results. You will have to confirm the new igg results with the lab that performed them and perhaps they can comment further".
I was not satisfied with this response as it did not answer the question about the swab test. I assume that the "past hsv infection" they are referring to is because of my initial blood test with them which showed positive for HSV1 and negative for HSV2. I called the lab and they suggested I send them a blood sample for testing to compare with the previous results (which I have already done). I was told that they would then get the doctors to look at all the tests and comment. The test results are not yet back. However, the person I spoke to (not a doctor) said that my swab test would have been tested by PCR even in 2008.
I think I mistakenly said I was going to do PCR tests - what I meant was another igg blood test at the overseas lab that did my swab and recent sexual health tests.
I thought I'd just update you and will let you know the results of the new blood tests and lab doctors comments once I receive them.
Thank you as always for your time.
MEDICAL PROFESSIONAL
HSV lesions rarely if ever appear and resolve in a matter of hours; and it is impossible that acyclovir cream could clear it up that quickly. Perhaps a very early lesion, i.e. a red bump that has not prorgressed to a vesicle (blister) stage, could resolve in 2-3 days. But at the vescular stage or beyond, more rapid healing than 7-10 days conflicts with the known biology and pathology of HSV infections. Skin lesions result because HSV kills skin cells, and during outbreaks the virus typically continues to replicate and kill cells for 2-3 days. Once virus replication has stopped, but only then, healing can begin. And any skin lesion associated with tissue death -- whether a cigaret burn, a small cut, herpes, or anything else -- requires at least a few days to heal.
So if your recurrent genital "outbreaks" were as short lived like the recent one on your lip, herpes was not the likely cause. So I would say the evidence continues to mount that you do not have, and probably never had, genital herpes. However, like you I continue to be interested in more information about the initial positive swab test.
As for PCR testing: If a person has asymptomatic shedding say 5% of the time, then only 1 in 20 swabs on asymptomatic days can be positive by PCR; and even then. Even with 100 negative PCR results, it won't tell for certain whether the hundred and first would have been positive. Therefore, although testing asymptomatic persons by PCR can establish a diagnosis of herpes if positive, negative results never exclude the diagnosis with certainty. If you can afford a number of tests, feel free; but don't get your hopes up that this will sort things out with certainty.
So if your recurrent genital "outbreaks" were as short lived like the recent one on your lip, herpes was not the likely cause. So I would say the evidence continues to mount that you do not have, and probably never had, genital herpes. However, like you I continue to be interested in more information about the initial positive swab test.
As for PCR testing: If a person has asymptomatic shedding say 5% of the time, then only 1 in 20 swabs on asymptomatic days can be positive by PCR; and even then. Even with 100 negative PCR results, it won't tell for certain whether the hundred and first would have been positive. Therefore, although testing asymptomatic persons by PCR can establish a diagnosis of herpes if positive, negative results never exclude the diagnosis with certainty. If you can afford a number of tests, feel free; but don't get your hopes up that this will sort things out with certainty.
Dear Dr
Had the consultation with my dr about the discrepancies with the test results and he says I probably didn't have hsv2 in the first place or that maybe it did not enter my blood and just stayed on the skin and caused the outbreak. I reminded him that I had subsequent outbreaks so he's e-mailed the lab and we are waiting to hear back on the query re the swab test. Got the full STD tests back from the same lab and every single one has (PCR) written in front of it. All negative, including hsv1&hsv2 - although I know it means nothing. So, maybe they did only test the swab by FA or maybe they just didn't verify mode of testing on their results 3 years ago. We'll see.
Also, something strange happened the other day: I woke up with the unmistakable signs of an oral outbreak in the usual place and could even see the beginnings of the blisters (and I do have plenty of experience with them). This is the first outbreak in about 2 1/2 years. So, I dabbed on a bit of acyclovir cream and poof! it was completely gone by noon. It never developed into a fully fledged outbreak with one single application of cream - not even a patch of redness remained. Usually by nipping it in the bud, I'm able to shorten the duration of the outbreak - but not by a few hours.
What I'm getting at is your comment about the unusualness of the shortness in duration of the "alleged" hsv2 outbreaks. Maybe the same thing is happening with them. I think at least with the hsv1, it must be pretty weak by now. And, although very tempted, I did not take Lysine this time!. I was seriously thinking that I should let it develop and get that tested too - just in case it transpires that I have hsv2 oral rather than hsv1 and hsv1 genital rather than oral!!!. I just don't know anymore...
In any case, I have decided to undergo PCR blood tests for both types once we hear back from the lab. I will keep you informed.
Regards
Had the consultation with my dr about the discrepancies with the test results and he says I probably didn't have hsv2 in the first place or that maybe it did not enter my blood and just stayed on the skin and caused the outbreak. I reminded him that I had subsequent outbreaks so he's e-mailed the lab and we are waiting to hear back on the query re the swab test. Got the full STD tests back from the same lab and every single one has (PCR) written in front of it. All negative, including hsv1&hsv2 - although I know it means nothing. So, maybe they did only test the swab by FA or maybe they just didn't verify mode of testing on their results 3 years ago. We'll see.
Also, something strange happened the other day: I woke up with the unmistakable signs of an oral outbreak in the usual place and could even see the beginnings of the blisters (and I do have plenty of experience with them). This is the first outbreak in about 2 1/2 years. So, I dabbed on a bit of acyclovir cream and poof! it was completely gone by noon. It never developed into a fully fledged outbreak with one single application of cream - not even a patch of redness remained. Usually by nipping it in the bud, I'm able to shorten the duration of the outbreak - but not by a few hours.
What I'm getting at is your comment about the unusualness of the shortness in duration of the "alleged" hsv2 outbreaks. Maybe the same thing is happening with them. I think at least with the hsv1, it must be pretty weak by now. And, although very tempted, I did not take Lysine this time!. I was seriously thinking that I should let it develop and get that tested too - just in case it transpires that I have hsv2 oral rather than hsv1 and hsv1 genital rather than oral!!!. I just don't know anymore...
In any case, I have decided to undergo PCR blood tests for both types once we hear back from the lab. I will keep you informed.
Regards
Dear Dr
Thank you once again for your time and follow up.
Looks like I am an unusual case all around!: Negative blood tests and atypical outbreaks. But, as you say, there are always exceptions.
I am not holding my breath about being hsv free. Maybe I am also a rare case who acquired a secondary HSV1 infection. At the moment, it's the best outcome I can hope for.
It will take time for me to get clarification on the swab test. I will let you know asap.
With my deepest gratitude for your help.
Thank you once again for your time and follow up.
Looks like I am an unusual case all around!: Negative blood tests and atypical outbreaks. But, as you say, there are always exceptions.
I am not holding my breath about being hsv free. Maybe I am also a rare case who acquired a secondary HSV1 infection. At the moment, it's the best outcome I can hope for.
It will take time for me to get clarification on the swab test. I will let you know asap.
With my deepest gratitude for your help.
Dear Dr Hunter
Thank you so much for responding so quickly and in such detail.
1) I will ask my doctor to contact the lab as it is overseas and they will probably not respond to me. I will let you know.
Due to the 2000 word limitation, I was not able to explain in full detail:
2) As mentioned, I did have outbreaks up until a year ago. I myself have little doubt that they were herpes. I am confused by the test results and what the doctor says: No hsv2 and maybe it was something else and has been cleared . I am not a doctor but can anything else cause these symtoms?: Initial outbreak was very mild which is why first Dr thought it might not be herpes or at least not a primary outbreak. Subsequent ones (every few months) and the first few were more severe than the initial one - probably due to the extreme mental stress I was under. Sometimes individual blisters close to eachother and usually in the same place and on the same side as the initial outbreak (the labia) and once a cluster on the opposite side of the initial outbreak. I also once had a blister under the hood of the clitoris. I did not go to the doctor for outbreaks as it was established that it was HSV2. Over time, the outbreaks became less severe and more sporadic. Sometimes I only had paper cut lesions (especially after waxing)and wasn't even sure if it was an outbreak.
I self medicated for outbreaks: lysine tablets (3g daily) and olive leaf extract, swabbing the lesions with betadine several times a day. I also applied Acyclovir cream although the Dr said it is useless for genital herpes. The blisters usually went away after a few days. I did take Acyclovir tablets twice but not as suppressive therapy as the outbreaks were manageable and I was not sexually active. I continued to treat my outbreaks without the acyclovir tablets with very good results (sometimes they were gone in a day or two). I have not had an outbreak for about a year now.
3) My partner flatly denied having anything. But the day after we had sex, he was very withdrawn and did ask me how long had it been since I last had sex which in retrospect, led me to believe that he woke up and saw his blisters and was afraid that he had infected me. Given the emotional state that I was in, I never wanted to see him again. Even if I tracked him down, he would probably refuse to be tested. We did not have oral sex.
I keep thinking (and hoping) it is at least HSV1. My initial infection with oral herpes was terrible and I was told to be very careful about ever spreading the infection to other body parts - especially mucous membranes- which is why I think his (hopefully hsv1) infection may have spread to my genitals due to the broken skin. The initial outbreak with HSV2 was nothing of the sort.
I will have a proper consultation with Dr when the STD results are ready. He knows my history but is dismissive about my concerns. He says to forget about this disease and to live my life. I can't and I think about it every waking minute of every day. It has ruined my life for the past 3 years and I need a definitive diagnosis. Even hsv1 would do.
With sincere appreciation for your help and understanding.
Thank you so much for responding so quickly and in such detail.
1) I will ask my doctor to contact the lab as it is overseas and they will probably not respond to me. I will let you know.
Due to the 2000 word limitation, I was not able to explain in full detail:
2) As mentioned, I did have outbreaks up until a year ago. I myself have little doubt that they were herpes. I am confused by the test results and what the doctor says: No hsv2 and maybe it was something else and has been cleared . I am not a doctor but can anything else cause these symtoms?: Initial outbreak was very mild which is why first Dr thought it might not be herpes or at least not a primary outbreak. Subsequent ones (every few months) and the first few were more severe than the initial one - probably due to the extreme mental stress I was under. Sometimes individual blisters close to eachother and usually in the same place and on the same side as the initial outbreak (the labia) and once a cluster on the opposite side of the initial outbreak. I also once had a blister under the hood of the clitoris. I did not go to the doctor for outbreaks as it was established that it was HSV2. Over time, the outbreaks became less severe and more sporadic. Sometimes I only had paper cut lesions (especially after waxing)and wasn't even sure if it was an outbreak.
I self medicated for outbreaks: lysine tablets (3g daily) and olive leaf extract, swabbing the lesions with betadine several times a day. I also applied Acyclovir cream although the Dr said it is useless for genital herpes. The blisters usually went away after a few days. I did take Acyclovir tablets twice but not as suppressive therapy as the outbreaks were manageable and I was not sexually active. I continued to treat my outbreaks without the acyclovir tablets with very good results (sometimes they were gone in a day or two). I have not had an outbreak for about a year now.
3) My partner flatly denied having anything. But the day after we had sex, he was very withdrawn and did ask me how long had it been since I last had sex which in retrospect, led me to believe that he woke up and saw his blisters and was afraid that he had infected me. Given the emotional state that I was in, I never wanted to see him again. Even if I tracked him down, he would probably refuse to be tested. We did not have oral sex.
I keep thinking (and hoping) it is at least HSV1. My initial infection with oral herpes was terrible and I was told to be very careful about ever spreading the infection to other body parts - especially mucous membranes- which is why I think his (hopefully hsv1) infection may have spread to my genitals due to the broken skin. The initial outbreak with HSV2 was nothing of the sort.
I will have a proper consultation with Dr when the STD results are ready. He knows my history but is dismissive about my concerns. He says to forget about this disease and to live my life. I can't and I think about it every waking minute of every day. It has ruined my life for the past 3 years and I need a definitive diagnosis. Even hsv1 would do.
With sincere appreciation for your help and understanding.
MEDICAL PROFESSIONAL
Welcome to the forum. You present an interesting dilemma and I understand your concern. My best judgment is that you don't have genital herpes. Here is why.
First, the apparently positive swab test is worded in a peculiar fashion. Swab specimens for herpes are usually tested by culture (to grow the virus) or by polymerase chain reaction, or PCR (to identify HSV DNA). If either of those is positive, it nails the diagnosis, as you were told on the community forum. However, the wording of your result suggests the swab was tested for HSV antibodies, with no mention of culture or PCR. I'm not aware of how and why a swab would be tested for antibodies, but it looks like that's what was done. Perhaps what was done was a fluoroescent antibody (FA) test, which is an old fashioned, outmoded test for HSV that never worked very well and can give false positive results. FA is still used to diagnose herpes zoster (shingles or chickenpox), but rarely for HSV. In any case, because of the wording, I consider your swab test result unreliable.
Second, as you know, it is rare for people with HSV-2 to not develop antibodies in the blood. It can happen, but still the negative blood result is against you having HSV-2.
Third, the initial symptoms didn't seem typical for initial genital herpes (lesions similar to "insect bites"), and at the time your doctor agreed (according to what you wrote in the community forum).
Fourth, I disagree with your doctor about HSV-1 as the cause for your herpes: this may be possible, but it's quite unlikely. People uncommonly acquire a second infection with the same HSV type; the immune system doesn't prevent recurrent outbreaks, but it is very effective in preventing new infections. For the same reason, autoinoculation is not likely. Most HSV autoinoculation events occur during the initial infection, before immunity has developed; it is rare in people with longstanding HSV.
Fifth: Therefore, if you had genital herpes, most likely it was HSV-2. However, when HSV-2 causes symptomatic initial infections, over 90% of patients have noticeable recurrent oubreaks, at an average frequency of 4-6 times per year. But presumably you have not had such outbreaks.
Among these possibilities, my judgment is that you probably didn't have genital herpes at all; but if you did, I agree a second HSV-1 infection is more likely than HSV-2.
Here is what I recommend to sort this out:
1) Contact the lab where the initial testing was done and ask them to clarify the wording of the positive result and exactly what test was done on the swab -- and let me know what they say.
2) Tell me more about your symptoms 3 years ago: whether there were blister-like or pimple-like lesions; exactly where on your genitals they occurred; whether you were treated with an HSV drug; how long they took to heal; and whether the sexual event that preceded it included cunnilingus.
3) Tell me what you know about the HSV status of your partner 3 years ago. If uncertain and you can still get in touch with him, see if he is willing to have an HSV blood test at this time. If you find he doesn't have HSV-2, that would add to the evidence that you don't either.
One final comment: If you are one of the rare people who acquired a second HSV-1 infection, this would be relatively good news. Not as good as not having genital herpes at all, but still good. If it was HSV-1 and you've had no recurrent outbreaks after 3 years, the odds are good you'll never have one and that you have little asymptomatic viral shedding, and therefore low risk of transmitting the infection to current or future sex partners.
I look forward to hearing back with some of the missing information. Best regards--
HHH, MD
First, the apparently positive swab test is worded in a peculiar fashion. Swab specimens for herpes are usually tested by culture (to grow the virus) or by polymerase chain reaction, or PCR (to identify HSV DNA). If either of those is positive, it nails the diagnosis, as you were told on the community forum. However, the wording of your result suggests the swab was tested for HSV antibodies, with no mention of culture or PCR. I'm not aware of how and why a swab would be tested for antibodies, but it looks like that's what was done. Perhaps what was done was a fluoroescent antibody (FA) test, which is an old fashioned, outmoded test for HSV that never worked very well and can give false positive results. FA is still used to diagnose herpes zoster (shingles or chickenpox), but rarely for HSV. In any case, because of the wording, I consider your swab test result unreliable.
Second, as you know, it is rare for people with HSV-2 to not develop antibodies in the blood. It can happen, but still the negative blood result is against you having HSV-2.
Third, the initial symptoms didn't seem typical for initial genital herpes (lesions similar to "insect bites"), and at the time your doctor agreed (according to what you wrote in the community forum).
Fourth, I disagree with your doctor about HSV-1 as the cause for your herpes: this may be possible, but it's quite unlikely. People uncommonly acquire a second infection with the same HSV type; the immune system doesn't prevent recurrent outbreaks, but it is very effective in preventing new infections. For the same reason, autoinoculation is not likely. Most HSV autoinoculation events occur during the initial infection, before immunity has developed; it is rare in people with longstanding HSV.
Fifth: Therefore, if you had genital herpes, most likely it was HSV-2. However, when HSV-2 causes symptomatic initial infections, over 90% of patients have noticeable recurrent oubreaks, at an average frequency of 4-6 times per year. But presumably you have not had such outbreaks.
Among these possibilities, my judgment is that you probably didn't have genital herpes at all; but if you did, I agree a second HSV-1 infection is more likely than HSV-2.
Here is what I recommend to sort this out:
1) Contact the lab where the initial testing was done and ask them to clarify the wording of the positive result and exactly what test was done on the swab -- and let me know what they say.
2) Tell me more about your symptoms 3 years ago: whether there were blister-like or pimple-like lesions; exactly where on your genitals they occurred; whether you were treated with an HSV drug; how long they took to heal; and whether the sexual event that preceded it included cunnilingus.
3) Tell me what you know about the HSV status of your partner 3 years ago. If uncertain and you can still get in touch with him, see if he is willing to have an HSV blood test at this time. If you find he doesn't have HSV-2, that would add to the evidence that you don't either.
One final comment: If you are one of the rare people who acquired a second HSV-1 infection, this would be relatively good news. Not as good as not having genital herpes at all, but still good. If it was HSV-1 and you've had no recurrent outbreaks after 3 years, the odds are good you'll never have one and that you have little asymptomatic viral shedding, and therefore low risk of transmitting the infection to current or future sex partners.
I look forward to hearing back with some of the missing information. Best regards--
HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
