Possible HSV Infection...

[jtt2]

Hello,

I recently dated a man who revealed to me that he has genital herpes. Unfortunately, he told me this after we had unprotected sex about a 12X over a 1 month period. He's had the infection for over 10yrs and claims to have never given it to anyone, including his ex-wife. He hasn't had an outbreak in 2yrs. I don't know if its HSV1 or HSV2. He isn't taking medication for it.

I immediately had bloodwork done but was unaware of the IGM testing problems at the time and had both the IGM and IGG done. My first round of testing was only about 10 days post my last possible exposure, but it came up with a + IGM at 1.87 and - IGG (< .91). I knew it was early, but I became particularly concerned because I remembered that I had had a yeast infection nearly a week after the first time we had sex, and another yeast infection a month later (right after the last time we had sex). I had no other symptoms and I treated them with otc medication and they went away within a week and seemed normal.

I've been tested another 3x (the last being just over 4 weeks from the last exposure and 8 weeks from the 1st exposure), and my IGG has come up - each time. But I decided to continue with the IGM to see if it increased. The IGM went from 1.87 to 2.85 to 2.73 over the last month. Interestingly, the lab made a mistake once and did the IGG for HSV1 which came up + somewhere between 2.2 and 2.4. I've never had symptoms of HSV1, but I know that doesn't necessarily mean anything.

Additionally, I visited my gyno and did a screen for everything. I didn't tell her about the possible HSV exposure because of insurance issues. Again everything came up -, except for an abnormal pap possibly indicating HPV and I now have to have a colposcopy.

I know I have to wait a full 3 months to be sure, but how likely is it at this point that I am + given this information? I read that most people will test + by 6 weeks? Could my abnormal pap be a sign of HSV?

Thanks so much in advance.

[Edward W Hook, MD]

No, these events really don't suggest HSV.  Far more consistent with yeast.  eWH

[jtt2]

Thanks very much for that. That is what I was hoping, but I suppose I was concerned that my yeast infections were not actually yeast infections, but HSV outbreaks. They seemed like yeast infections (white discharge, a little itchy and burny and seemed to respond to treatment), but given the circumstances, I am panic stricken. Also, both times after the start of the yeast infection treatment, I had a blood tinged discharged that I assumed was just from being irritated. Does this sound like a possible outbreak?

[Edward W Hook, MD]

Most exposures to sex partners who have herpes do not lead to transmission of infection and it is unlikely that you acquired infection.  By now (4+ weeks) well over half of people who had acquired HSV would have positive blood tests.  When this fact is combined with the absence of a clinical outbreak (which would have been expected to appear 4-10 days following exposure), the chances that you got HSV from your partner is very low.

The rising IgM, like all IgM tests remains essentially worthless and is primarily feeding your anxiety.  In addition, that you already have HSV-1 (as do over 60% of adults) helps to explain the origin of whatever is being measured by the IgM assay.

While HSV can cause abnormal Paps, the results are relatively specific and are identified as probable HSV.  Thus your abnormal pap is likely an unrelated issue.

Hope this helps.  EWH

[jtt2]

Forgot to mention that we also had oral sex and that he didn't have any obvious symptoms. He also said that he had managed to avoid transmitting the infection by abstaining from sex when he felt an outbreak coming on until it was healed.