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HSV-2 testing: am I crazy or is this doctor crazy?
Hi,
I know, false dichotomy.
15th of Jan. I had an encounter after 10 months of celibacy (sex with condoms few times times and once bareback). 2 weeks later (could've been less --I'm uncertain), I noticed something like warmth, itching or burning on the skin of the shaft of my penis. No lesions or signs of irritation. No symptoms in my life until this time. Plan to get STD screen at a Planned Parenthood clinic, as a matter of policy, amended to include HSV-2 serology (not in standard screen).
Appointment was on the 23rd of February (no HSV-1 serology as pointless). Did not mention symptoms since I considered they might be "in my head" and, thus, a little embarrassed. Report gave results as non-reactive for all but HSV-2 serology.
Test was HSV 2 IgG HerpeSelect Type Specific Ab giving a 1.88. 2nd call informed that, with no lesions, they like to test again in 6 - 8 weeks for readings < 5. Since I am having symptoms I considered myself positive and speculated I may be seroconverting. Symptoms are now, if anything, more pronounced, and sometimes feel as if I had coated the skin on my shaft (but not my glans or the skin near it) with a weak solution of capsaicin.
I told my sexual partner and suggested that she might want testing.
She requested the test at a pre-existing appointment for last Tuesday but her doctor refused to test her while she presented without lesions. Justification was, apparently, that the test would likely come up positive and not be meaningful. It struck me as crazy as I understood that modern HSV-2 tests are fairly type specific and don't cross react heavily with HSV-1 antibodies (my interpretation of my sex partner's comments was that her doctor must have been referring to that). Is not the responsible thing to do with likely transmission to test for HSV-2 exposure? I feel and she feels that if she is asymptomatically shedding viruses she should know it. She told me she'll request testing from a different doctor.
I know, false dichotomy.
15th of Jan. I had an encounter after 10 months of celibacy (sex with condoms few times times and once bareback). 2 weeks later (could've been less --I'm uncertain), I noticed something like warmth, itching or burning on the skin of the shaft of my penis. No lesions or signs of irritation. No symptoms in my life until this time. Plan to get STD screen at a Planned Parenthood clinic, as a matter of policy, amended to include HSV-2 serology (not in standard screen).
Appointment was on the 23rd of February (no HSV-1 serology as pointless). Did not mention symptoms since I considered they might be "in my head" and, thus, a little embarrassed. Report gave results as non-reactive for all but HSV-2 serology.
Test was HSV 2 IgG HerpeSelect Type Specific Ab giving a 1.88. 2nd call informed that, with no lesions, they like to test again in 6 - 8 weeks for readings < 5. Since I am having symptoms I considered myself positive and speculated I may be seroconverting. Symptoms are now, if anything, more pronounced, and sometimes feel as if I had coated the skin on my shaft (but not my glans or the skin near it) with a weak solution of capsaicin.
I told my sexual partner and suggested that she might want testing.
She requested the test at a pre-existing appointment for last Tuesday but her doctor refused to test her while she presented without lesions. Justification was, apparently, that the test would likely come up positive and not be meaningful. It struck me as crazy as I understood that modern HSV-2 tests are fairly type specific and don't cross react heavily with HSV-1 antibodies (my interpretation of my sex partner's comments was that her doctor must have been referring to that). Is not the responsible thing to do with likely transmission to test for HSV-2 exposure? I feel and she feels that if she is asymptomatically shedding viruses she should know it. She told me she'll request testing from a different doctor.
MEDICAL PROFESSIONAL
Several comments which I hope will be helpful to you.
HSV symptoms do not last a month. Even first episodes, which tend to be present for the longest period, tend to heal completely in less than 3 weeks.
The proper approach to evaluation of suspicious or concerning lesions is to culture or PCR them. Not all lesions are positive on the first test but this is the recommended and most appropriate approach. Should the lesion recur, have it tested again. If you do this 2-3 times and cultures are not negative, it is most likely something else.
When people acquire HSV, lesions typically appear in 4-10 days following exposure
Hope this helps. EWH
HSV symptoms do not last a month. Even first episodes, which tend to be present for the longest period, tend to heal completely in less than 3 weeks.
The proper approach to evaluation of suspicious or concerning lesions is to culture or PCR them. Not all lesions are positive on the first test but this is the recommended and most appropriate approach. Should the lesion recur, have it tested again. If you do this 2-3 times and cultures are not negative, it is most likely something else.
When people acquire HSV, lesions typically appear in 4-10 days following exposure
Hope this helps. EWH
MEDICAL PROFESSIONAL
I think you are over reacting. There is no evidence you have HSV-2 and no scientific studies which suggest that early initiation of therapy modify the natural history of infection.
I will briefly answer your final question. Current data indicates that many people who find out that they have HSV on the basis of a blood test go on to notice subsequent outbreaks. The reasoning is that they may have discounted their original and possibly recurrent symptoms or attributed them to something else. It is also known that the rates of aymptomatic shedding rates for persons who have never had an outbreak are, on average, the same as for persons who have had and detected outbreaks. Thus they are just as contgious to sex partners as persons who have recurrences that are detected.
The time has come for this thread to end. Your question was addressed and there is limited time that can be devoted to any one person's question. You seem not to believe the advice given. I have other threads to attend to. There will be no further answers. For additional information I suggest the Americal Social Health Association web site. It is very good. (Disclosure, Dr. Handsfield and I are both on the ASHA Board of Directors). Take Care. EWH
I will briefly answer your final question. Current data indicates that many people who find out that they have HSV on the basis of a blood test go on to notice subsequent outbreaks. The reasoning is that they may have discounted their original and possibly recurrent symptoms or attributed them to something else. It is also known that the rates of aymptomatic shedding rates for persons who have never had an outbreak are, on average, the same as for persons who have had and detected outbreaks. Thus they are just as contgious to sex partners as persons who have recurrences that are detected.
The time has come for this thread to end. Your question was addressed and there is limited time that can be devoted to any one person's question. You seem not to believe the advice given. I have other threads to attend to. There will be no further answers. For additional information I suggest the Americal Social Health Association web site. It is very good. (Disclosure, Dr. Handsfield and I are both on the ASHA Board of Directors). Take Care. EWH
I do have another question. My question is how much is known about people who claim to never have had an outbreak?
What I mean is that we know that when you find people who are seropositive for HSV-2 but do not remember ever having had an outbreak they shed less virus than people who have outbreaks but they still shed viruses. How much do we know about how HSV-2 presents in them?
The way I see it, people visiting a health care provider who have HSV-2 are a very strongly self-selected population. People with outbreaks looking like pictures used in abstinence based education programs are almost sure to seek medical assistance. People who present with more representative lesions are slightly less likely do the same. People who present with a mild initial outbreak are even less likely to seek assistance. Whereas people who present with no lesions at all are the least likely to be seen in a medical practice.
What is the representative course of the disease in this group and how do we know this?
What I mean is that we know that when you find people who are seropositive for HSV-2 but do not remember ever having had an outbreak they shed less virus than people who have outbreaks but they still shed viruses. How much do we know about how HSV-2 presents in them?
The way I see it, people visiting a health care provider who have HSV-2 are a very strongly self-selected population. People with outbreaks looking like pictures used in abstinence based education programs are almost sure to seek medical assistance. People who present with more representative lesions are slightly less likely do the same. People who present with a mild initial outbreak are even less likely to seek assistance. Whereas people who present with no lesions at all are the least likely to be seen in a medical practice.
What is the representative course of the disease in this group and how do we know this?
I started myself on 250 mg. famciclovir 3 times a day yesterday. The reasoning behind this is that if I am infected early intervention may make things better down the road (there exists some evidence for this --both from mice & human studies); whereas if I am not infected, the side effect profile is relatively benign and I am unlikely to harm myself with a 10 day course. I'm also supplementing heavily with arginine hoping to discourage latency while on the antiviral (I'm skeptical about the whole arginine vs. lysine thing but I'm trying it anyway).
Curiously, I found that by the time I took my third dose, the burning sensation was gone (but not earlier than the third dose --I was expecting an earlier effect and hoping for the lack of a noticeable effect, had it continued, to mean that the symptoms are unrelated to HSV).
Curiously, I found that by the time I took my third dose, the burning sensation was gone (but not earlier than the third dose --I was expecting an earlier effect and hoping for the lack of a noticeable effect, had it continued, to mean that the symptoms are unrelated to HSV).
Culture results should be back in a week and I'll redo HerpeSelect in two or three months so I guess all there is to do is wait.
Thanks.
Thanks.
MEDICAL PROFESSIONAL
I am not sure why you are repeating yourself. The symptms you list, as I said, are not suggestive of HSV. A culture of a lesion which is not ulcerative, if due to HSV can still be positive.
I really think it is time for you to stop worrying about this. If you really have questions, I suggest you ask a dermatologist to take a look. EWH
I really think it is time for you to stop worrying about this. If you really have questions, I suggest you ask a dermatologist to take a look. EWH
When I refer to symptoms, I refer to having had on and off feelings of burning, warmth or itching on my skin with no other signs that I was aware of.
Lesion is extremely inconspicuous, indolent and on scrotal skin. It is completely flat about 4 mm x 3 mm on relaxed but not contracted skin with a rougher, drier, less pliable texture than the skin around it.
I truly cannot tell what the lesion is but I shall offer possibilities. It could be:
* A developing blister
* An old blister healing over
* Something else completely different
If the lesion is an old blister healing over, then my report of showing no lesions for a month should be considered suspect. It may be that lesions were there all along and not noticed due to being located on skin of the scrotum. In fact, the more I look at it, the more it looks like to me like the finding could be an old blister.
In case I was not clear, an attempt to culture was made (it's just that I was told that, without an open lesion, a negative would be both likely and meaningless).
Lesion is extremely inconspicuous, indolent and on scrotal skin. It is completely flat about 4 mm x 3 mm on relaxed but not contracted skin with a rougher, drier, less pliable texture than the skin around it.
I truly cannot tell what the lesion is but I shall offer possibilities. It could be:
* A developing blister
* An old blister healing over
* Something else completely different
If the lesion is an old blister healing over, then my report of showing no lesions for a month should be considered suspect. It may be that lesions were there all along and not noticed due to being located on skin of the scrotum. In fact, the more I look at it, the more it looks like to me like the finding could be an old blister.
In case I was not clear, an attempt to culture was made (it's just that I was told that, without an open lesion, a negative would be both likely and meaningless).
I have a bad habit of answering my own questions, it seems.
After a month of feeling symptoms I did find a lesion, this very morning, on some scrotal skin of the penis. It was very inconspicuous and I'm not sure how typical it is of HSV-2 but I'm sort of convinced that that's what it is. I did have it looked at and an attempt at a diagnosis by culture will be made but I was warned that without having an open blister it would probably come up negative even if it was HSV.
How typical are symptoms for a month with no lesions or even signs of irritation or inflammation? I guess the answer is not important since, even if it were atypical, I cannot imagine that it would be inconsistent with HSV-2.
Original question was regarding the advisability of not recommending HSV-2 serology when there may be evidence of HSV-2 having been transmitted. I'm guessing the answer depends on the evidence of transmission having taken place.
After a month of feeling symptoms I did find a lesion, this very morning, on some scrotal skin of the penis. It was very inconspicuous and I'm not sure how typical it is of HSV-2 but I'm sort of convinced that that's what it is. I did have it looked at and an attempt at a diagnosis by culture will be made but I was warned that without having an open blister it would probably come up negative even if it was HSV.
How typical are symptoms for a month with no lesions or even signs of irritation or inflammation? I guess the answer is not important since, even if it were atypical, I cannot imagine that it would be inconsistent with HSV-2.
Original question was regarding the advisability of not recommending HSV-2 serology when there may be evidence of HSV-2 having been transmitted. I'm guessing the answer depends on the evidence of transmission having taken place.
MEDICAL PROFESSIONAL
Welcome to our Forum. the reason for the character limit on questions is so we can address everyone's questions in the limited time available. Please restate your question with less than 2000 characters. If the question cannot be stated in that space, it is too complex to be addressed at this site. EWH
Reading around I am building a certain picture in my mind:
* This HerpeSelect test has very few false negatives
* The manufacturer's ranges are not always taken very seriously. Specifically, there seems to be a consensus around these parts that anything below 3.5 may, at least sometimes, be considered equivocal.
* On the other hand, I've seriously underestimated the time-span required or building decent titers and 32 days is not anywhere near what is required for seroconversion in many people. If I had been exposed, I would need more time to produce a significant titer and, thus, even a negative result would have been meaningless.
* However, strong positives with this test are apparently pretty good indicators of exposure. If in 6-8 weeks I produce a high titer I would consider that a pretty strong indicator of exposure to HSV-2 and I would also consider it an indication that my sex partner from the 15th of January is extremely likely to be the source (seroconversion may take a long time but it is not going to take over 11 months). The significance of this is that it would imply she is carrying and shedding HSV-2 no matter what her doctor says.
* I don't think that my symptoms are "in my head". The sensation just seems too strong at times. As I related above, it kind of feels like I've put on a mild capsaicin solution around the skin of my penis.
* Is feeling pro-drome like symptoms for a month while not producing skin lesions even typical of HSV-2? Have I "jumped the gun" in assuming HSV-2? If these symptoms were not of HSV-2 (and I am assuming that they are), what could they be?
* I can't think of anything else for now. I'm still assuming that I am infected but perhaps I overreacted in the first place. If so, I might have been worrying my sex partner from January needlessly.
* This HerpeSelect test has very few false negatives
* The manufacturer's ranges are not always taken very seriously. Specifically, there seems to be a consensus around these parts that anything below 3.5 may, at least sometimes, be considered equivocal.
* On the other hand, I've seriously underestimated the time-span required or building decent titers and 32 days is not anywhere near what is required for seroconversion in many people. If I had been exposed, I would need more time to produce a significant titer and, thus, even a negative result would have been meaningless.
* However, strong positives with this test are apparently pretty good indicators of exposure. If in 6-8 weeks I produce a high titer I would consider that a pretty strong indicator of exposure to HSV-2 and I would also consider it an indication that my sex partner from the 15th of January is extremely likely to be the source (seroconversion may take a long time but it is not going to take over 11 months). The significance of this is that it would imply she is carrying and shedding HSV-2 no matter what her doctor says.
* I don't think that my symptoms are "in my head". The sensation just seems too strong at times. As I related above, it kind of feels like I've put on a mild capsaicin solution around the skin of my penis.
* Is feeling pro-drome like symptoms for a month while not producing skin lesions even typical of HSV-2? Have I "jumped the gun" in assuming HSV-2? If these symptoms were not of HSV-2 (and I am assuming that they are), what could they be?
* I can't think of anything else for now. I'm still assuming that I am infected but perhaps I overreacted in the first place. If so, I might have been worrying my sex partner from January needlessly.
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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.
