I need help!

[debidoo]

Dr. Handsfield or Dr Hook: I posted a question a couple of weeks ago on the forum and felt a lot better, I had my first breakout of  hsv1  on March 9, 2011 and it was getting a little better, but yesterday it came back terribly!  I went to the doctor on March 9 and now it is April 12 and I have it worse than ever - should I have it for 5 WEEKS - GOING ON MY 6TH WEEK? Should I have it again so soon?  I called the doctor today and they gave me the test results from March, there are two sets of test results because they tested me for it in May 2010 as part of my physical last year:

Test:  Herpes 1 & 2 Titer IGG
................................March 9, 2011..................May 13, 2010
Herpes 1 (lGG) AB..............>5.00H..............................>5.00H
Herpes 2 (IGG)..AB.............<0.90..................................<0.90

It says on the test: "A single positive result only indicates previous immulologic exposure and the level of antibody response may not be used to determine active infection or disease stage"

What do you think is going on?  Thank you.

[Edward W Hook, MD]

Please re-read my suggestion related to possiblity number 1 above.  I think you need to see a knowledgeable dermatologist.  You are correct, even an initial episode of HSV would not last this long.  EWH

[debidoo]

Dr. Hook:  I never had lesion, a rash or anything in my genitals until this episode.  If this is a reoccurence, it was VERY BAD and LONG.  I thought only your first outbreak was bad and the other rare and not bad. Can you suggest anyone else for me to see - a infectious disease doctor and a dermatologist?

[Edward W Hook, MD]

The doctor is correct.  A culture is definitive evidence that you have HSV-1.  In addition, I agree with the doctor who told you that because you already had antibodies to HSV-1, this must have been a recurrence.  Several possibilities from here:

1.  If you have had the rash for more than 3 weeks and or if it is still present, the rash, despite the positive culture is not the cause of the rash.  In this situation the positive culture would be a coincidence, but not the cause of the rash.

2.  You may have had prior recurrences which you did not note.  Then your positive culture lead to the diagnosis.

there are several unusual aspects to your situation which I have mentioned above.  For me to try to help sort them out over the internet is not in your best interest.  It sounds however as though, that the doctor you saw today is knowledgeable.  I would suggest you continue to work with him/her to sort this out.  EWH

[debidoo]

Dr. Hook:  I went to the gynocologist this morning, this time I saw a doctor, not the nurse practictioner -- Dr. Hook, I am very confused.  She said they did do a culture in March 2011 when they did the Herpes 1 & 2 Titer and here are the results:

3-9-11
Culture: Herpes Simplex Virus with Typing
Micro Number 11146585
Test Status: Final
Specimen Source: Lesion
Specimen Quality: Adequate
HSV Culture: Positive
HSV Type 2: Negative
HSV Type 1: Positive

The doctor said cultures do not lie, and  it was a "recurrence outbreak" - because I had antibodies in May 2010.  I told her that I NEVER had any outbreak before in genitals, but she said I must have or it was just a cold sore on my mouth.  Is that possible?  She did check me and the pain I was feeling she said was neuralgia because there were no lesions present at all.

[Edward W Hook, MD]

Correct.  EWH

[debidoo]

So when it says "abnormal"  in the specimen (below) on the test sheet it does not mean I have an outbreak of herpes - it means that I was positive for the antibodies - that was not a culture?

3/9/10  3:49pm specimen collected,
3/10/11 1:16pm  final result: abnormal

[Edward W Hook, MD]

It appears that you had a blood test for herpes IgG (antibodies), not a culture. Your positive result indicates that you acquired HSV-1 at some time in the past.  Most people with HSV-1 have acquired it in childhood and are otherwise unaware that they are infected unless they hae a blood test as you have.  I suspect your positive test for HSV-1 antibodies is unrelated to the rash you are concerned about.  I would suggest you see a dermatologist regarding your rash- it is most unlikely to be herpes.  EWH

[debidoo]

Dr Hook, I looked closer at the Herpes 1 & 2 Titer,IGG paperwork and down further down the page it said:
3/9/10  3:49pm specimen collected,
3/10/11 1:16pm  final result: abnormal

Does that mean I do have herpes now or does it mean I have had it? Thanks

[debidoo]

Dr Hook, what is the Herpes 1 & 2 Titer IGG? I thought the nurse practioner said that she cultured it, but all she gave me was the results of Herpes 1 and 2 Titer IGG - I asked her if there was more results from the lab and she said no.

[Edward W Hook, MD]

I think your doctor needs to take a look and provide an assessment. Please be sure to see a doctor who has expereince lookingat and diagnosing skin lesions. EWH

[debidoo]

I am calling the doctor's office tomorrow, do you have any idea what it could have been? What I could ask them to test?  I have been wearing new pants the jeggings (tight elastic pants) since February could some infection be caused by this?

[Edward W Hook, MD]

Welcome back to our Forum.  In preparing to answer your question today I went back to our earlier exchange.  I note that you never answered my question about how genital HSV-1 was diagnosed when I ask if the only evidence you had was a blood test or if you had been tested with a culture or PCR test of lesions as well.  This question is now important since the clinic descriptions you provide suggest that your genital lesions are something other than HSV.  

It is most unusual for HSV-1 to recur in persons with the infection.  Also,  herpes infections would not normally persist for more than 3 weeks ff the infection was a newly acquired infection or for less than a week if it was a recurrence.  For you to have lesions for 5 weeks suggests that your genital lesions are something other than HSV.

The antibody tests that you report from as far back as May 2010 indicate that you have HSV-1 infection but do not indicate the location.  Is it possible that you, like many people have longstanding oral HSV-1 that you were unaware of and that your genital lesions are due to something else?
  EWH