Confusing Results

[mq123456]

Nurse Warren,

If you have time please review my previous posts with you. About 2 weeks ago I had a bump on the shaft of my penis. It was not a blister, it was more solid. I squeezed the bump (gently) and the skin broke a little. There was no fluid, pain, or itching. By the next day when I saw my PCP it had subsided and there was only a faint line (he needed a magnifying glass to see it) were the skin slightly broke and had healed. He said there was nothing there to swab for a culture or a PCR and that it did not look like herpes considering how quickly it healed.

I asked for another Western Blot. I got the results today some 8 months since my exposure in question and no sexual activity since. The report said “low level antibody detected by Western blot assay. Indeterminate for HSV. No antibody to HSV2 detected by Western Blot assay. Atypical reactivity was noted against proteins on the HSV1 western blot. This reactivity may or may not be due to HSV specific antibody. Full antibody profiles to HSV may take 12-16 weeks especially if antiviral therapy was given.”

I know oral HSV1 is no big deal but my main concern is that I don’t know if I was infected orally and genitally at the same time (my exposure included kissing and receiving protected oral sex, however my scrotum was sucked and licked.) The only lesions I had swabbed were on the inside of my lip and a PCR test was negative (this was about 8 weeks past exosure.) Given the time frame (8 months) I would think the test (the western blot) would be more definitive, shouldn’t I have had plenty of time to build up antibodies?

Any suggested next step. My PCP thinks that the likelihood is good that I am not infected but does not know why the conflicting tests (+ for HSV1 by herpes select at 15 weeks, then negative by Western blot at 16 weeks, now indeterminate for HSV1 by western blot at 8 months.)

Is it common for the Western Blot to indeterminate? What is your gut feeling about my status?

[Terri Warren, RN, Adult Nurse Practitioner]

Cold sores could come once a month, yes, the usual number per year is about 4

Terri

[mq123456]

Thanks for all you advise. At this point I have not follow-up with any additional testing or tow have my tests compared. I think I will go with the assumption that I am infected at least orally.

My question at this point is how frequent can outbreaks be expected? What is the minimum amount of time between outbreaks. Could you have cold sores 3 or 4 weeks apart.

[Terri Warren, RN, Adult Nurse Practitioner]

Our clinic website is westoverheights.com, the information to make a consultation appointment is there.  We will just need the dates of the western blots and any numbers from the test results so that UW can look them up.

Terri

[mq123456]

If possible could I arrange a phone consultation with you. If so, what do I need to do?
What information would you need?

[Terri Warren, RN, Adult Nurse Practitioner]

Your current provider could request the comparison or you could arrange a phone consult with me at my office and I could request the comparison directly from UW.  Your HSV 1 at 3.6 is just 0.1 over the number where we suggest confirmation of a positive   .  Remember that the ELISA becomes positive sooner than the western blot, so the only reason I might suspect new infection is this and the fact that your previous herpeselect tests were negative.

Terri

[mq123456]

Here is a link to our previous interactions:

http://www.medhelp.org/posts/Herpes/HSV/show/1058529?personal_page_id=866784&post_id=post_5066255

[genx7]

oh man this is the type of cases i am scared about.  I tested negative for both at 6 weeks and 3 months past exposure but still have symptoms.  

[mq123456]

Of course would I just be better off not knowing. At this point I am not sure. This has been such a roller coaster ride for me I don't know what we be better. Assuming I have it, assuming I don't, or confirming I do?

[mq123456]

My HepersSelect tests were negative for both types at 7 and 11 weeks. At 15 weeks it showed a 3.6 for HSV1. The 16 week western blot was negative and now the current (about 8 month) westerb blot is indeterminate. You suspect I am positive for HSV1, if so, given the serology, this would most likely be related to my June exposure?  

The Western blot tests were oredered by 2 different providers, both through quest. Would my current provider (he ordered the second western blot) be able to request the comparison. Would the lab still have the fisrt sample to compare with the current? Would it best for him to contact quest or the UW lab directly?

[Terri Warren, RN, Adult Nurse Practitioner]

The thing that needs to happen here is that the two western blot samples need to run at the same time, next to each other.  The lab may well have both samples in house.  Your doctor needs to call the UW lab, or Quest if it went through Quest, to ask that the samples be run at the same time and compared.  That will give a better answer.  Type 1 is a little trickier than type 2 when it comes to antibody testing.  None of the blood tests are as sensitive for type 1 as for type 2, though western blot is better than the ELISA.  I would suspect that you might have type 1, but you could have had it for years and didn't know it.  Was your first test done at 15 weeks post contact?  If so, you can never know if you had it before then.  

I would recommend that your provider order this extra testing done and see if you can get something more definitive.  Or he/she might just want to ask for the two blots to be compared visually as a place to start.  They will have both blots on file, I'm certain.  

The bump you describe on your penis does NOT sound herpetic.

Terri