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Is my 14 weeks after stopping antivirals results conclusive?

Hello.
So almost six months ago (June 27), I had an unprotected vaginal sex with a female associate (unknown HSV Status). She said she doesn’t have HSV but not very convincing.
I’m a male, married and prior to this encounter never taken a HSV Test. My wife never had any HSV symptoms throughout our 10+ years of marriage.
Three days post encounter I began to experienced discomfort in my genital area. I trimmed my pubic hair the morning of the encounter so I assumed it was the hair growing back that was irritating the skin. A week later (10 days post encounter) I noticed three bumps that itches on the left side of the tailbone, inside the butt cheeks. Bumps seems to have hair in the middle. Worried, I tested 17 days post encounter; IGG results from QUEST came back HSV1 positive (30.20) and HSV2 Equivocal (.96). The bumps did not developed into blisters or lesions and disappeared 10 days later However, the left perianal area continues to itch to this day. I also think I developed hemorrhoids. The skin near the anal opening (left side) seems to itch the most and it is constantly raw. My partner and I did not do anal sex during the encounter and from what I read on this site, initial outbreak almost always at the point of infection.
Exactly three weeks post encounter I was VISUALLY diagnosed with herpes. I was prescribed a 10 days doze (3x a day)of acyclovir. I was also tested same day for other STIs (prior to taking first antiviral pill) and given a shot of penicillin. All the test came back negative EXCEPT HSV1 (The test was IGG but no number given).
I finished the 10 day doze of acyclovir on day 31 post encounter. The whole time, I noticed strange red pimples that itches and would appear in my buttocks/shoulder and disappear in less than 3 days. I also suffered lower back pain and sciatica. But no bumps or lesion on the genitals. I also did not suffer any flu like symptoms up until three days ago. My scrotum sometimes itches and noticed dark red pin head blood blisters which I found out called angiokeratoma of Fordyce. The anal itching continued so after 7 days (38 days post encounter) without antivirals, I started taking 500 mg vacyclovir a day to test out if It would go away... It did not.
on 1 September (9 weeks and three days post encounter) I stopped taking the antivirals. Since then I tested several times for HIV 4th generation and HSV.

-September 21 LabCorp (1 day short of 3 weeks off antivirals)
IGM: HSV1/2 Negative, no number given.
IGG: HSV1: 30.00 H and HSV2 <.90
HIV non reactive

-November 2 LabCorp (over 8 weeks off antivirals)
NAAT: HSV1 /2 Negative, Bacterial infection negative.

-November 25 LabCorp (12 weeks off antivirals)
IGG: HSV1 27.40 H and HSV2:<90

-December 11 QUEST (little over 14 weeks off antivirals and 24 weeks post exposure) I wanted to get tested at Quest where I initially tested HSV2 equivocal. The result this time is IGG HSV2 <90
HIV Non reactive.

In September my wife tested negative for HSV 1/2 both IGG and IGM

I am clearly Positive for HSV1 but I don’t recall having oral sores.

Here are my questions:

1. Is my HSV1 old or new infection?

2. Should I continue to test for HSV2 or can I consider my 14 weeks of antivirals (24 weeks post exposure) result conclusive?

3. I still suffer from anal itch near the anal opening and strange pimples that itches, is this HSV or something else?

Appreciate your response.
2 Responses
207091 tn?1337709493
COMMUNITY LEADER
Did your partner in June give you oral sex? You don't mention that, but if she didn't, you couldn't have gotten genital hsv1 from her, which means that your hsv1 infection is a pre-existing oral infection. 90% of people with hsv1 orally never get any symptoms.

If she did give you oral, testing at 3 weeks means that your antibodies for hsv1 could have developed. The IgM is supposed to look for new infections, but it's a terribly unreliable test, and is wrong at least as often as it is right, so don't rely on that.

Has anyone tested the pimples you are seeing? It would be really easy for them to pop one and test the fluid in it and find out what's causing it. Maybe it's time for a dermatologist.

Your hsv2 is conclusively negative. You don't need any more hsv2 testing, and if you keep testing for that, you're likely to get a false positive. Those are fairly common, and besides the stress they cause, they take weeks and several hundred dollars to unravel.

If the antivirals aren't helping, I'd doubt this is herpes.
1 Comments
Auntiejessie,
Thanks for your reassurance that I don’t have HSV2. Glad to hear it from someone who is knowledgeable to this virus. To answer your question.
Yes my partner in June did performed oral on me; I also reciprocated the act. However I am wondering  how my initial antibodies would be that high (30.20),17 days post exposure and why it has not risen on follow up test results if it is indeed a new infection. Everything thing I read so far would be low positive or equivocal.

I am currently seeing a dermatologist who took a swab of the anal rash(raw skin) back in October which came back NAAT negative on both. Last week she took a sample of a skin pigmentation. I am hoping to get the results back this week.
Several follow questions if I may:

1. If this is indeed a new infection, would you consider the anal rash and bumps that did not blister the primary outbreak. I did not have flu like symptoms (up until 3 days ago) or swollen lymp node.

2. Going back to HSV2, I read 12-16 weeks off antivirals is recommended before retesting (I stopped taking antivirals 14 weeks from last IGG test) should I take one more test at 16+ weeks to be definitive? (I understand that false positive results could be costly). I worry that the HSV1, if old infection could delay HSV2 antibodies production.

3. In my case, would you recommend Western Blot?

Thanks in advance
Avatar universal
Auntiejessie,
Thanks for your reassurance that I don’t have HSV2. Glad to hear it from someone who is knowledgeable to this virus. To answer your question.
Yes my partner in June did performed oral on me; I also reciprocated the act. However I am wondering  how my initial antibodies would be that high (30.20),17 days post exposure and why it has not risen on follow up test results if it is indeed a new infection. Everything thing I read so far would be low positive or equivocal.

I am currently seeing a dermatologist who took a swab of the anal rash(raw skin) back in October which came back NAAT negative on both. Last week she took a sample of a skin pigmentation. I am hoping to get the results back this week.
Several follow questions if I may:

1. If this is indeed a new infection, would you consider the anal rash and bumps that did not blister the primary outbreak. I did not have flu like symptoms (up until 3 days ago) or swollen lymp node.

2. Going back to HSV2, I read 12-16 weeks off antivirals is recommended before retesting (I stopped taking antivirals 14 weeks from last IGG test) should I take one more test at 16+ weeks to be definitive? (I understand that false positive results could be costly). I worry that the HSV1, if old infection could delay HSV2 antibodies production.

3. In my case, would you recommend Western Blot?

Thanks in advance






1 Comments
You were already pretty high on the HSV1 IgG. We look for numbers rising if they are on the low side of positive - around a 1.10 or below a 3.5. Yours were in the 30s. That can be an established infection, but that's not a hard rule. Given that they didn't rise, though, points more to an established infection.

Your NAAT results are very encouraging, assuming you had the rash at the time of the swabs, and it was fresh. If it hadn't had a chance to dry up - if there is ever any fluid - then you can rely on those results.

I really don't think this is herpes. Have they ever done a more general swab on it, looking for bacteria?

I don't think you need any further testing. A couple of weeks isn't going to change your results. Your hsv2 numbers aren't rising, and in fact, went down. I've never seen anyone test positive past 12 weeks. Your NAAT swabs were negative. If you need it for peace of mind, then go for it, but I don't see it coming back as positive. The hsv2 IgG does miss 8% of infections, but I don't think that's the case here.

If you decide to do more testing, do the WB if you can afford it. I'd rather you do that than the IgG. I understand that it's expensive, though, and prohibitive for many people. I don't think you need it, so please don't take this as me recommending you do it. It would be spending a lot of money for peace of mind.



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