HSV Testing Question

[crane123]

Doctor,

My question is about the yield of having HSV testing performed at six months vs. four months in my particular situation.

I had an exposure in mid December with a massuese that included genital-to-genital rubbing with some friction, but no penetration. 20 days post exposure, I noticed a red/purplish irritated spot just under corona area. Went to G.P. right away and he prescribed Lotrimin but also asked if I'd ever been tested positive for genital herpes. That kind of freaked me out (I had never been tested for it before, never had a reason to), so I got a full battery of STD tests on my own - through tstd.org - and tested negative at 3 weeks post exposure for HSV 1 & 2 (Herpeselect IGG), HIV, Syphillis, Gonnoreah and Chlamydia).

I went to my regular dermatologist soon after. She thought it was a fungal infection (although the area had faded a bit by then) and prescribed anti-fungal cream. Got second opinion at another derm., and he thought the same thing. Wife is pregnant - due with our first child in late August - so have been concered.

Had Herpeselect test done again at 12 weeks post exposure - negative again for HSV 1 & 2 IGG. Then had full battery of all tests done again 18 weeks post exposure (Herpeselect 1&2 IGG again, HIV, Syphillis, Gonnoreah, Chlamydia - negative for all).

In between, have had some minor red irritation return to corona area. Have been back to derm, who told me just to put Lotrimin on the area if it flares up for a week or so and see what happens. Says it's not an STD.

I know that I have the opinion of two derms, negative tests at the four month mark, etc., but I want to be completely sure I don't have anything. Have I been completely overtesting? Or is there any value in performing one final Herpeselect test now that I'm at the six-month mark post exposure (this week will mark 26 weeks post exposure)?

Thank you for a great site.

[Edward W Hook, MD]

It is said that 93% of seroconversions to HSV-2 occur within 6 months, if the person already had HSV-1.  For persons who do not have HSV-1, I am not aware of later seroconversions.  If they happen, they are very, very rare.  My advice is that you should be done with testing and move on.  EWH

[crane123]

Doctor,

Just a quick update: I ended up having the Herpeselect test done one final time back in June, which was at 26 weeks past the date of possible exposure I was concerned about. It came back negative, as you suggested it would.

Have you ever heard of cases where seroconversion would take longer than 26 weeks (I know roughly 2-4% of people who are HSV positive never take positive on the test), or should I just take comfort in the fact that I've continued to test negative and put this behind me?

Thanks!

[Edward W Hook, MD]

In my opinion, there is little to be gained from further testing for herpes.  All of the evidence (and there is lots) indicates that you did not get herpes from your casual encounter.  EWH

[crane123]

Doctor,

Thank you for your reply. One further question, then that will be it: given my circumstances, would taking another Herpeselect test this week (this will be the 26th week post exposure; the last Herpeselect test I took was at 18 weeks post exposure) be of any value?

[Edward W Hook, MD]

The chances that you have herpes. even before additional testing is remarkably low- approaching zero.  Your focus on herpes is derived from an appropriate clinical question be the GP you saw (this person is asking the right questions, something that all too many MDs do not do) which lead to further testing. While that has been underway you have had multiple negative tests for HSV and have not had a typical clinical episode.  While the presentations of herpes is highly variable and warrants testing if there is any suspicion at all, the negative tests, the fact that you were examined by two specialists, and the fact that your exposure was low risk all work very much in your favor.  

Regarding the Herpeselect,  by 3 months in people who do not have HSV-1, over 93% 0f persons who acquire HSV-2 have positive blood tests.  This number changes slightly if at all by 6 months.  There are a small proportion ( around 2-4%) of persons who get herpes who do not develop antibodies which can be detected by the HerpeSelect or even the Western Blot. We do not know much about such persons because there small numbers prevent having enough to study well.

In your case, I think that following your next test, which I presume will be negative, you should be confident that you did not acquire herpes and put your casual exposure behind you.  Hope this helps.  EWH