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I am having some doubts about an HSV 2 diagnosis.

I was diagnosed with a yeast infection and prescribed terconazole.  After using this medicine for a day, I experienced an increase in severity, especially externally.  I used this medicine for 4 days with no alleviation in symptoms.  I returned to the doctor and she suspected herpes although I never had any fluid filled blisters or scabs.  She swabbed and the result was hsv 2 positive.  I requested a blood test because I am convinced that this irritation was external yeast because the anti fungal anti inflammatory cream she prescribed healed it in just 2-3 days.  The result of my blood test was 3.3 igg and negative igm for hsv 2.  The igg was 33 for HSV1 and negative for HSV1 igm.
The doctor told me that the blood test indicates that I am newly infected and that this would be a primary infection.
Is it possible that the swab is wrong considering I am almost certain (I know my body) that this was irritation from yeast?
Also, she laid the swabs directly on the table before using them on my body which seems very unprofessional/ unsanitary especially during the covid pandemic.
I do not trust the doctor or this diagnosis.
Please any clarity would be so appreciated.
3 Responses
207091 tn?1337709493
COMMUNITY LEADER
Okay, so your doctor is mixed up about some things, but your blood tests seem to confirm your swabs.

The IgM is designed to look for new infections (though it's terribly unreliable and shouldn't be used at all on anyone other than newborns), and the IgG looks for established infections. "Established" can be anything longer than a few weeks, though it varies from person to person. It can take up to 4 months to develop these antibodies, though some do as soon as 2-3 weeks.

So you've had a positive swab for hsv2 and a positive IgG blood test for hsv2. You're also positive for hsv1, meaning that you wouldn't actually have a "primary" hsv2 outbreak. A primary outbreak means your first hsv outbreak - having no antibodies for either hsv1 or hsv2. It's usually pretty bad. Having hsv1 prior to getting hsv2 usually keeps hsv2 fairly mild, but that's not a hard rule.

You could have a yeast infection, and a herpes outbreak. You could have a yeast infection that triggered hsv2 shedding that the culture picked up. Your yeast infection could have triggered a herpes outbreak, or vice versa.

I'm really hoping that they clean the table between patients in normal times (that's pretty standard), and do so now even more, but you won't get COVID from the swabs, and the swabs aren't sensitive enough to pick up herpes from the table, and herpes dies pretty quickly outside of it's host (the body).

So I'm sure you have a ton of questions, and I'm happy to help answer them. In the meantime, you can read the Herpes Handbook at https://westoverheights.com/herpes/the-updated-herpes-handbook/. It's free and written by one of the world's leading experts on herpes.

I've had hsv2 for over 15 years. You're going to be fine, I swear.

2 Comments
Maybe I should be more upset that I have been diagnosed but I’m not.  I have definitely been sexually adventurous enough for this to not come as a surprise.  I’m not ashamed.
I’m more frustrated with the lack of knowledge that my physician displayed.
I contracted the yeast infection after becoming sexual active again after three years of abstinence after having my daughter.  I am a single mother.
I called the office that delivered my baby and asked if I had been screened for hsv during my prenatal testing and I was not.
I think it is possible that I have had this for many years or would a low igg indicate otherwise?  I have read that anything below 3.5 should not be considered positive, but the swab is the problem.
Is there some crossover between hsv 1 and hsv 2 in swab testing and blood testing?
I truly believe I had severe contact dermatitis from the terconazole rather than an actual outbreak.  It appears that I have 10 times as many antibodies to hsv 1.  This does not come as a surprise because I was in a relationship with a man for 4 years in my early twenties that had frequent cold sores, but I have never had one.
Does a low igg indicate a new infection?
I have been sexually active with 3 men in the last year.  I know, I know.  One of them is aware and got tested.  His igg for hsv 1 and hsv 2 was almost identical to mine.  His hsv 2 igg was 2.2 and mine was 3.3.  Is this indicative of anything?
Should I contact the other two men?  These were prior to the encounter with the confirmed positive.
I am so confused about moral obligation to tell people.  Most men have slept with have slept with more than 4 women, so maybe they have it, don’t know it, and have exposed me?
Thoughts and I am sure I have more questions.
Ugh I typed a really long comment, and it's gone. I'm going to try to redo it - if I miss something, let me know.

*Maybe I should be more upset that I have been diagnosed but I’m not.  I have definitely been sexually adventurous enough for this to not come as a surprise.  I’m not ashamed. -

Good. There is no shame here.


*I’m more frustrated with the lack of knowledge that my physician displayed. -

Yes, this is very frustrating. I'm sorry you're having to deal with it.


*I called the office that delivered my baby and asked if I had been screened for hsv during my prenatal testing and I was not.

This is more frustrating than you may realize. As you'll see below, if they had done this, you'd have a much better idea of when you were infected. And really, this should be standard during pregnancy.


*I think it is possible that I have had this for many years or would a low igg indicate otherwise?  I have read that anything below 3.5 should not be considered positive, but the swab is the problem.

Yes, the swab is basically your confirmation. If you didn't have the swab, I'd be telling you to get it confirmed, but a 3.3 isn't nearly as likely to be a false positive as a 1.5 is, for example.


*Is there some crossover between hsv 1 and hsv 2 in swab testing and blood testing?

I'm not sure what you mean, unless you mean can having hsv1 cause false positives? No, especially not on type specific tests and on cultures.


*I truly believe I had severe contact dermatitis from the terconazole rather than an actual outbreak.

Yes, this is quite likely. It's harsh stuff. Next time you get a yeast infection, ask for diflucan. It's a pill, and works just as well, or better.

*It appears that I have 10 times as many antibodies to hsv 1.  This does not come as a surprise because I was in a relationship with a man for 4 years in my early twenties that had frequent cold sores, but I have never had one.

Not necessarily true - you could test for hsv1 tomorrow and get a very different number. It's just the way your antibodies respond to the test. It doesn't actually measure the level of antibodies in your blood. No one ever gets a true zero.

You could have gotten hsv1 from your ex, or from an adult who kissed you in childhood. You'll probably never know.


*Does a low igg indicate a new infection? No, unless you have a fairly low number and take another test and it rises. That's probably not the case here, though it could be. How long has it been since your last possible exposure?


*I have been sexually active with 3 men in the last year.  I know, I know.  

No shame here, but honestly, with your statement at the beginning, I'd have thought this number would be a lot higher. I hear a lot of different stories here. Three is not that high lol. It's perspective. ;)

*One of them is aware and got tested.  His igg for hsv 1 and hsv 2 was almost identical to mine.  His hsv 2 igg was 2.2 and mine was 3.3.  Is this indicative of anything?

He needs to get that 2.2 confirmed. Right now, it's probably a 50/50 chance it's a false positive. That's really all we know right now.


*Should I contact the other two men?  These were prior to the encounter with the confirmed positive.
I am so confused about moral obligation to tell people.  Most men have slept with have slept with more than 4 women, so maybe they have it, don’t know it, and have exposed me?

Let's wait and see what the guy's confirmation test says, if he's willing to do that. There's a lot to think about when telling others. Yes, on the face of it, letting partners know is a good thing, but your safety (physical, emotional, etc) is important, how they'll receive it, etc., all comes into play.


*Thoughts and I am sure I have more questions.

I'm not usually around on the weekends, but check the Herpes Handbook if you have questions, and I'm happy to answer anything on Monday.

Go do something fun (safely) this weekend, even if it's staying home and binging something you've been waiting to watch. :)


207091 tn?1337709493
COMMUNITY LEADER
.
3 Comments
Okay so follow up questions:

What exactly is seroconversion from HSV 1 to HSV 2?  This is very confusing.  A pediatrician once told me that pretty much hsv 1 and 2 are the same now.  My daughter had a strange rash on her knee and asked if she had been exposed to herpes.  No.  She was in a daycare at the time where she would get sick every other week.  It went away with antibiotic ointment.  Another doctor misdiagnosed it mollescum contagiousm.  I trust lawyers more than doctors at this point.

Why is the numerical value of the IgG negligible?  My doctor specifically said that HSV 2 had a lower value than HSV 1 indicating a new infection.  Where did she come up with that conclusion if these numbers can fluctuate constantly?
On that same note, if the numerical value is negligible, why is anything under 3.5 cause for confirmatory testing?

I read an interesting article about a woman with a positive culture and a negative blood test.  She was misdiagnosed a couple times.
My doctor used  SURESWAB®, HSV TYPE 1/2 mRNA, TMA.  Is it possible that in her negligence in collecting swab by placing the swab directly on a countertop that it was contaminated along the way?
As far as I know, she did not clean the area before collecting the sample.  I put everything from hydrocortisone to desitin on this area prior to this appointment.  Possible that anything I applied topically could skew the result?

Any idea the legal implications of this doctor not keeping tools sterile?  I left the office and realized what the doctor had done and really regretted not realizing it at the time and saying something.  Strongly considering writing the office manager.

I am strongly considering Western Blot.  I am the kind of obsessive person that needs to know all the information and have the most accurate definitive answer.

My last sexual encounter was with the 2.2 igG HSV 2 on April 12.  Before that, February 1 was with someone questionable.  The third man I have referenced has been everywhere in between but not in the last 2 months.

I want to get retested because my gut is telling me that the swab is wrong.  This is the kind of thing that would happen to me, a positive resulting from a clerical error or something.
How long do I need to wait if my last encounter was April 12 to get an absolutely accurate result?

What are the implications of a positive diagnosis on a future pregnancy?

Kind of obsessing and can’t stop.  Please help.

Also, are you a medical professional or just an expert on this?
Also, it is important to note that the site that the doctor swabbed remained unchanged for the duration of the symptoms.  There were no stages.  It was a cracked area of skin that looked a little lighter than the surrounding areas and was visible when I was originally diagnosed with a yeast infection.  Symptoms persisted from April 12 - May 12.  Improved drastically after application of clotrimazole and betamethasone dipropionate.  It immediately felt better and cleared with 2 -3 days of using this.
It is my understanding that at this stage of infection, Valtrex would not have done much, especially clear it in just 2 - 3 days.  I was also very farther into an “outbreak” than 48 hours to have a swab come back positive.
The last yeast infection I had was 6 years ago (ironically after sleeping with the same man) and I actually went to the doctor and asked him outright if it was herpes and he said no, it was an external yeast infection.  This was so similar, although increased in severity.  I am absolutely convinced it was not a herpes outbreak.  It disappeared after the anti fungal anti inflammatory cream.
Just trying to provide all the information I can.
My doctor is a moron and didn’t respond to any of my questions or symptoms.
207091 tn?1337709493
COMMUNITY LEADER
*"What exactly is seroconversion from HSV 1 to HSV 2?  This is very confusing.  A pediatrician once told me that pretty much hsv 1 and 2 are the same now.  

Seroconversion means developing antibodies. Hsv1 doesn't seroconvert to hsv2. It will stay hsv1, no matter where you have it (orally or genitally). If you have it genitally, it's known as genital hsv1, or ghsv1. The number indicates the strain of the virus, not the location.


*"Another doctor misdiagnosed it mollescum contagiousm."

This is shameful. The two look and act nothing alike.


*"Why is the numerical value of the IgG negligible?  My doctor specifically said that HSV 2 had a lower value than HSV 1 indicating a new infection.  Where did she come up with that conclusion if these numbers can fluctuate constantly?
On that same note, if the numerical value is negligible, why is anything under 3.5 cause for confirmatory testing?"

It's not negligible, it just can't tell us everything. We just need to know if we have antibodies, not how many, and we've established that your doctor is a moron. The only thing that she might be right in is if you test again in a few weeks and your number is remarkably higher, indicating that you may have been seroconverting when you tested.

When the IgG tests were first used, there was this big study done, and we thought that 90% of those who tested positive for hsv2 didn't know they had it. Many of those people were low positives. Another study proved that about 50% of those who tested under a 3.5 on the hsv2 IgG didn't test positive on the Western Blot, which is how we know that the 1.10 positive range is too low. Also, we know that the closer you are to 1.10, the better the chance of a false positive.


*My doctor used  SURESWAB®, HSV TYPE 1/2 mRNA, TMA.  Is it possible that in her negligence in collecting swab by placing the swab directly on a countertop that it was contaminated along the way?
As far as I know, she did not clean the area before collecting the sample.  I put everything from hydrocortisone to desitin on this area prior to this appointment.  Possible that anything I applied topically could skew the result?

It's pretty hard to contaminate your swab with someone else's herpes. It dies quickly outside it's host. I'd be more interested in how long before your test did you use the hydrocortisone and desitin and terconazole, etc.


*Any idea the legal implications of this doctor not keeping tools sterile?  I left the office and realized what the doctor had done and really regretted not realizing it at the time and saying something.  Strongly considering writing the office manager.

I'm not a legal expert, so I couldn't begin to answer this question. Standard practices, especially now, include cleaning the table between patients, so I'd be very surprised if they didn't, though I'd wonder how they could prove that. Again, though, it would be hard to contaminate your swabs from the table. Even so, laying them on paper - either the paper on the table or the packaging of the swab - is a better idea.



*I am strongly considering Western Blot.  I am the kind of obsessive person that needs to know all the information and have the most accurate definitive answer.

I can't say I'd be any different. My own tests were so conclusive from the start, so it's hard for me to say for sure what I'd do, but if you need the definitive answers, then get them.


*My last sexual encounter was with the 2.2 igG HSV 2 on April 12.  Before that, February 1 was with someone questionable.  The third man I have referenced has been everywhere in between but not in the last 2 months.

Had you been with HSV2 guy before April 12? When was your test? It can take up to 4 months to develop antibodies, so if April 12 was your first time with him, and you are actually positive, it didn't come from him if you tested sooner than a few weeks after. The earliest antibodies can develop is a few weeks. However, if your antibodies rise, it would make sense for it to be him.

*I want to get retested because my gut is telling me that the swab is wrong.  This is the kind of thing that would happen to me, a positive resulting from a clerical error or something. How long do I need to wait if my last encounter was April 12 to get an absolutely accurate result?

12 weeks. If it's from April 12 guy, and you're already starting to develop antibodies, you will probably know for sure by now. 70% test positive by 6 weeks.

*What are the implications of a positive diagnosis on a future pregnancy?

The only possible complication would be is if you had an outbreak during delivery. Most doctors will put you on daily suppressive therapy for the last trimester to prevent this. If you do have an outbreak, you can have a c-section.



*Also, are you a medical professional or just an expert on this?

A bit of both, kind of. I've worked in the STD field for a long time, doing education stuff, not clinical, and have had herpes for 15+ years.


*Also, it is important to note that the site that the doctor swabbed remained unchanged for the duration of the symptoms.  There were no stages.  It was a cracked area of skin that looked a little lighter than the surrounding areas and was visible when I was originally diagnosed with a yeast infection.  Symptoms persisted from April 12 - May 12.  Improved drastically after application of clotrimazole and betamethasone dipropionate.  It immediately felt better and cleared with 2 -3 days of using this.

I'm wondering, if you have herpes, that you had a really bad yeast infection, and the swab picked up herpes viral shedding, which can be triggered by another infection, like yeast or BV.

*It is my understanding that at this stage of infection, Valtrex would not have done much, especially clear it in just 2 - 3 days.  I was also very farther into an “outbreak” than 48 hours to have a swab come back positive.
The last yeast infection I had was 6 years ago (ironically after sleeping with the same man) and I actually went to the doctor and asked him outright if it was herpes and he said no, it was an external yeast infection.  This was so similar, although increased in severity.  I am absolutely convinced it was not a herpes outbreak.  It disappeared after the anti fungal anti inflammatory cream.

This is possible. It's also possible that since you have hsv1, it is keeping your hsv2 milder, so you aren't getting big, bad blisters.

A western blot would help sort this all out.

*My doctor is a moron and didn’t respond to any of my questions or symptoms.

I'm sorry. I hate doctors most of the time. :(



2 Comments
You answered all my questions so thoughtfully and thoroughly.  Thank you for that.  To address some of yours and ask a few more:

I am sure I put something on it the day before I had the swab.  I was only washing that area with water.  Are you curious how long before because something could in one of the medications could have skewed the swab result?  It says on my labs that it’a a quantitative test, but only says detected for HSV 2.  I realize that it’s impossible for the swab to have picked up the virus from the countertop in the office.

My doctor said something about the iGm and that was negative.  I realize that this test isn’t very reliable, but does it provide any clues as to what is going on?  Is it always positive with an active infection?

I became sexually active last August and I think it’s most possible it was either the 2.2 guy from April 12 or a different guy that from February 1.  I specifically asked the February guy if he had it and he said no.
Would my iGg of 3.3 be consistent with contracting this 3 months ago?
I am wondering if there is a chart or something somewhere that gives iGg values based on time after contracting the virus.

The western blot is probably something I will do eventually, especially if I don’t experience anymore symptoms.  It’s hard to think about it when everything is healthy and normal.

I do see the area where I had so much irritation looks a little different.  Does
HSV 2 change the skin or leave a scar?
*I am sure I put something on it the day before I had the swab.  I was only washing that area with water.  Are you curious how long before because something could in one of the medications could have skewed the swab result?  It says on my labs that it’a a quantitative test, but only says detected for HSV 2.  I realize that it’s impossible for the swab to have picked up the virus from the countertop in the office.

Yes, that's why I'm curious. 24 hours, I'm not sure. If you had the day of, I'd definitely be wondering, but since you are only using water (and good for you - you don't need soaps, etc.), maybe it contributed. That's a HUGE maybe.

*My doctor said something about the iGm and that was negative.  I realize that this test isn’t very reliable, but does it provide any clues as to what is going on?  Is it always positive with an active infection?

The IgM is designed to look for new infections. The IgM antibody is active for a few weeks, give or take. The herpes IgM antibody test is unreliable. It could be reactive during a recurrence, and sometimes just doesn't react when it's supposed to, and reacts when it shouldn't. Every expert in the field and the CDC says this test shouldn't be done on anyone except newborns. My own was positive when it should have been negative and negative when it should have been positive. Unfortunately, your negative tells us nothing since we can't rely on it.

*I became sexually active last August and I think it’s most possible it was either the 2.2 guy from April 12 or a different guy that from February 1.  I specifically asked the February guy if he had it and he said no.
Would my iGg of 3.3 be consistent with contracting this 3 months ago?
I am wondering if there is a chart or something somewhere that gives iGg values based on time after contracting the virus.

There is no chart for determining the time frame because the number can't determine when you became infected. As I've explained before, you could be 3.3 today, and 5.5 tomorrow. By 12 weeks, most everyone who will test positive will have, so there wouldn't be an increase in antibody number. (The hsv2 IgG test misses 8% of infections - that's a flaw with the test, not the person.) There's some background noise to this test, so no one will ever get a true zero.

February guy can't know for sure if he has it unless he tests.

2.2 guy needs to get that confirmed. Right now, it's probably 50/50 that he has it.

*The western blot is probably something I will do eventually, especially if I don’t experience anymore symptoms.  It’s hard to think about it when everything is healthy and normal.

I do see the area where I had so much irritation looks a little different.  Does
HSV 2 change the skin or leave a scar?

No, hsv2 doesn't generally scar. The reaction you had to the yeast treatment might, though. It might fade, though. It has still barely been a week or so.


I don't want to give you false hope. You had a positive test and culture. Chances of this being a false positive on both are pretty slim. I think maybe the reaction from the yeast treatment caused either an outbreak you couldn't see under the reaction or viral shedding that the swab picked up. I can't say that for sure, obviously. Get the WB if it will help you, for sure. I could be wrong. Don't trust me over your own instincts.

Let me know what happens. :)
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