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UPDATE: Pos GHSV-1 Culture, Neg HSV-1 IgG, Pos HSV-2 IgG (now neg)

I posted a few weeks ago after I received my initial results of blood tests and culture swabs that I had done at an urgent care after I began experiencing burning during urination.The initial tests were:

Positive HSV-1 Culture
Negative HSV-1 IgG and IgM
Positive HSV-2 IgG 2.23 and Negative IgM

The urgent care doctor was pretty resolute in his opinion that I was infected with both HSV-1 and HSV-2 and prescribed me a 10 day 3 pill a day antiviral regimen. I finished that and dreaded the future of my sex life. I did a lot of reading online about Herpes and I truly have a better grasp on the disease now that I have had to go through being diagnosed with an incurable sexually transmitted disease. All hope is not lost and the symptoms of recurrent breakouts are relatively mild, I would actually trade my eczema that I have suffered with since childhood for Herpes haha... I was also hopeful that my HSV-2 2.23 positive was actually a low positive - false positive.

Well last week, a few days after finishing my antiviral, I noticed another small spot on my penis head and decided I would go see a Urologist to get this diagnosed and start whatever treatment I needed to in order to get this under control. I went in and explained to them my recent Urgent Care visit and gave them my test results. They performed a culture on my spot and ordered blood work. I just got the results in (although not my numbers). I was told today that my IgG was negative for both HSV 1 & 2, that I had a weak positive for IgM HSV-2 (i was told to ignore that by the person interpreting my results- why they even ordered it I don't know) and a positive culture of HSV-1 and a weak positive culture for HSV-2. I am somewhat baffled by these result as well. How is it possible for there to be a weak positive for HSV-2? I thought a culture was either positive or not? Also is it possible for one lesion to have both HSV-1 and HSV-2 present? These results do confirm that my most recent girlfriend (the one that broke up with me immediately following my initial diagnosis) gave it to me, probably orally.. Thank you to everyone on this board, it is great to have a place to go to to talk about this life-altering event.
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Avatar universal
I agree this is confusing. Part of it comes back to often frequent lack of herpes expertise among many doctors, especially in understanding the HSV blood tests. However, if the culture from the lesion was indeed positive for HSV1, that is probably what you have -- and it's probably all that you have, i.e. no HSV2.

What isn't clear to me is the timing. Please summarize the time line of exposure(s), your initial and any recurrent symptoms, the various test results, and the nature of the exposure(s) that preceded your initial outbreak.

Also, contact the original doctor and/or lab for clarification of the "culture" result, i.e. the swab test. Was it really culture, or perhaps DNA testing (PCR test)? Was the result definitely typed to assure HSV1 and not HSV2?

At this point I'll just say two things. First, if you have genital HSV1 (and no HSV2), then you'll probably never have any difficulty. Genital HSV1 recurs at very low frequency if at all, infrequently is transmitted sexually to partners, and generally doesn't need treatment apart from the initial infection. Second, HSV IgM blood tests are notoriously unreliable. Whether positive or negative, the result should be ignored.

Looking forward to hearing more detail.
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Avatar universal
Thank you for responding. Here is the complete timeline of my sexual history.

Spring of 2012 I was tested for everything. I was negative for everything, including HSV-1 and HSV-2. I began a sexual relationship with girl 1 at that time. We dated for eight months and then broke up.

In the three years between then and now I have had infrequent sexual relations protected and unprotected with 4-5 women. Girl 2 I had vaginal intercourse with once (spring 13) , Girl 3 I had vaginal and oral sex with 3 maybe 4 times (summer 13), Girl 4 I had vaginal and oral sex with several times (fall of 13), Girl 5 I only received oral sex from once (winter 13), and I had vaginal sex with girl 3 once in the spring of 14. I hadn't had sex vaginal or oral from late spring of 14 until I started dating Girl 1 again in the early-mid fall of 14. At first it was protected but then we stopped using condoms.

I have never had any symptoms until late January of 15. At that time Girl 1 and I had been having a lot of sex oral and vaginal unprotected. She had assured me that she had been tested and I was pretty confident that I was STD free as well, based on my negative test from three years prior and the fact that I am very open with all my partners about discussing STDs. I know I should have insisted that we both get tested, but hindsight is 20-20 and it is doubtful that a positive HSV-1 test would have dramatically changed our sexual activity. Well around late January she complained of an itchy vaginal and burning during urination. She went to the doctor and they told her it was likely a yeast infection and gave her some cream. She never complained about it again after that. I few days later I developed some small red spots and itching on my penis. I am uncircumcised and assumed that it was candidas infection and that it would go away on its own. Several weeks (6-8) later the spots had come and gone a few times but I then suddenly developed a sharp pain during ejaculation. The next day I masterbated again and the pain was there again followed by severe pain during urination. I went to the urgent care the next day (end of March) and the doc said it looked like herpes, I thought impossible and told him about my GF's recent yeast infection and he prescribed some cream. that helped with the spots but the burning persisted. A few days later I received the results and was very dismayed to learn that I had contracted herpes of some kind and possibly both based on my test results. When I got my results I discussed them with my GF and she accused me of having infected her with herpes. Having now tested negative on the IgG I am pretty certain that she is actually the culprit of our, most likely, mutual genital herpes infection. I don't claim compete innocence, only that she is the source of the original disease. The exact sequence of events that led to my infection will never be known, because it is possible she infected me with HSV-1 orally and then I passed it to her genitally when I preformed oral sex on her which was then passed to me genitally.

I am hopeful that this is nothing more than GHSV-1 and that I don't have many more recurrent outbreaks. Are GHSV-1 outbreaks more frequent in uncircumcised men? Because I have had I am guessing two in the last month or one long one since January. I am hoping I don't see another one for awhile. At this point I think the only thing I can do is wait until like August and get another blood test done.

Thanks again for your advice and support!
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Avatar universal
Based on symptoms I wouldn't have thought that either your or your partner has herpes. Your timeline is partly helpful, but without the most important information. What were the dates and details of all your HSV tests, positive and negative; and the results, dates, details of all tests your apparently infected partner has had? Was your positive culture from your urethra, or from lesions on your penis? What sexual practices did you have during the time you and/or she became infected:  vaginal, presumably. Oral sex on you? Oral by you on her?
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Avatar universal
Here are the details of the tests:
I first developed symptoms around the end of January/beginning of February
I went to urgent care on 3/30

HSV-1 Culture - Postive (Typing was confirmed by monoclonal antibody microscopic immunofluorescence. )
HSV-2 Culture- Negative
HSV 1/2 IgM- Negative
HSV-1 IgG- Negative
HSV-2 - IgG - 2.23 Positive (The test ordered for the IgG was HSV 1 and 2- Specific Ab, IgG.)

I was prescribed a 10 day 3 pill a day 250mg Famvir antiviral

Then on 4/14 I noticed a new spot and went in to the Urologist on 4/16 to get blood work and a swab done. I was prescribed a 5 day twice a day avoclir 800mg. I got those results today by email. I am waiting for my doctor to release my results and I spoke with a PA at his office who couldn't find my culture results. This is what the email said "...PA wanted to let you know that you IgG was negative [both HSV-1 and HSV-2] and your IgM was positive. Swab for HSV 1 was detected and swab for HSV 2 was weakly detected.." I have no idea what a weakly detected swab culture means. I am still waiting for the exact results. The IgM was positive for HSV-2- but I am ignoring that as inconclusive. The nurse I spoke to told me that was a weak positive also (HSV-2 IgM).

My break outs have been on the head of my penis. There has never been a liquid filled blisters or any scabbing over, simply a red spot circular in shape, more the first time and only one this time. I had no burring during urination or ejaculation this time. Both times the swab was taken from the spots on the head of my penis, neither swab was taken from inside of my urethra. Prior to the symptoms we both practiced oral sex on one another and vaginal intercourse, there was also mutual digital anal penetration. I have no idea of the dates, details, or results of any of her supposed tests. I trusted her at her word.





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Avatar universal
Sorry to post this twice but the first time I wasn't logged in and it doesn't look as though it flagged you with my response and I don't know how to delete a post....

Here are the details of the tests:
I first developed symptoms around the end of January/beginning of February
I went to urgent care on 3/30

HSV-1 Culture - Postive (Typing was confirmed by monoclonal antibody microscopic immunofluorescence. )
HSV-2 Culture- Negative
HSV 1/2 IgM- Negative
HSV-1 IgG- Negative
HSV-2 - IgG - 2.23 Positive (The test ordered for the IgG was HSV 1 and 2- Specific Ab, IgG.)

I was prescribed a 10 day 3 pill a day 250mg Famvir antiviral

Then on 4/14 I noticed a new spot and went in to the Urologist on 4/16 to get blood work and a swab done. I was prescribed a 5 day twice a day avoclir 800mg. I got those results today by email. I am waiting for my doctor to release my results and I spoke with a PA at his office who couldn't find my culture results. This is what the email said "...PA wanted to let you know that you IgG was negative [both HSV-1 and HSV-2] and your IgM was positive. Swab for HSV 1 was detected and swab for HSV 2 was weakly detected.." I have no idea what a weakly detected swab culture means. I am still waiting for the exact results. The IgM was positive for HSV-2- but I am ignoring that as inconclusive. The nurse I spoke to told me that was a weak positive also (HSV-2 IgM).

My break outs have been on the head of my penis. There has never been a liquid filled blisters or any scabbing over, simply a red spot circular in shape, more the first time and only one this time. I had no burring during urination or ejaculation this time. Both times the swab was taken from the spots on the head of my penis, neither swab was taken from inside of my urethra. Prior to the symptoms we both practiced oral sex on one another and vaginal intercourse, there was also mutual digital anal penetration. I have no idea of the dates, details, or results of any of her supposed tests. I trusted her at her word.
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Avatar universal
UPDATE:
I just spoke with my doctor and the lab seems to have lost my swab. Hence the positive HSV-1 and weak positive HSV-2  on my swab results that I reported earlier was incorrect as relayed to me. I also received my actual results:

Herpes Simples Type 1&2, Herpes Titter:
HSV- 1 IgG - Negative
HSV- 2 IgG - Negative

Herpes Simplex Type 1&2 IgM, Herpes IgM:
Herpes Type 1&2- Positive 1.47
"The following results were obtained with the Diamedix
immunosimplicity Is-HSV1 and 2 IgM EIA Test System.
The magnitude of the measured result, above the cut-off,
is not indicative of the total amount of antibody present.
The magnitude of the reported IgM level cannot be correlated
to an end-point titer."

HSV-1 IgM Antibodies IFA
Detected

HSV-2 IgM Antibodies IFA
Weakly Detected


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Avatar universal
OK, if I now correctly understand, you never had a positive swab test, for either HSV1 or HSV2.

In theory, your positive HSV1 IgM test indicates a recently acquired (within 3 months) HSV1 infection. However, the HSV IgM tests are notoriously unreliable.  CDC's STD guidelines in 2010 discouraged HSV IgM testing, and the soon to be released 2015 guidelines are expected to have an even strong statement, along the lines of "useless, never do it".

However, your positive HSV2 IgG test is suspicious, but I'm still not clear on the timing. Here's what I want in a final clarification. Just complete this information, nothing else:

DATE OF ONSET YOUR FIRST POSSIBLE HERPES SYMPTOMS:

DATES AND RESULTS OF ALL YOUR IGM TESTS:

DATES AND RESULTS OF ALL YOUR IGG TESTS:

DATES AND RESULTS OF ALL TESTS OF EITHER TYPE DONE ON YOUR PARTNER:

DATE OF ONSET OF POSSIBLE HERPES SYMPTOMS IN YOUR PARTNER:
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Avatar universal
DATE OF ONSET YOUR FIRST POSSIBLE HERPES SYMPTOMS:

End of January 2015 - head of penis was itchy and then small red spots (no liquid filled blisters or scabbing)

End of March 2015- Developed burning during ejaculation followed by burning during urination a day later, persisted until I was several days into a 3-pill a day antiviral regimen

April 14th I noticed a single small red spot on the head of my penis

DATES AND RESULTS OF ALL YOUR IGM TESTS:

3/30/15
HSV IgM 1/2 Combination - Negative

4/16/15
HSV IgM 1/2 Combination - Positive 1.47

HSV-1 IgM IFA   Detected

HSV-2 IgM IFA   Weakly Detected


DATES AND RESULTS OF ALL YOUR IGG TESTS:

3/30
HSV-1 IgG Ab Type Specific - Negative

HSV-2 IgG Ab Type Specific - 2.23 Positive

4/16/15
HSV-1 IgG - Negative
HSV-2 IgG - Negative

DATES AND RESULTS OF ALL CULTURE TESTS:
3/30
HSV Culture and Typing - Positive for HSV-1 Typing was confirmed by monoclonal antibody microscope immunofluorescence

4/16
Had another swab taken but the doctor/nurses/lab lost the swab, have no idea if I'll ever get the results

DATES AND RESULTS OF ALL TESTS OF EITHER TYPE DONE ON YOUR PARTNER:
I have no idea about any tests/dates/results

DATE OF ONSET OF POSSIBLE HERPES SYMPTOMS IN YOUR PARTNER:
She complained of itching and burring during urination days to a week before I developed itching and subsequent spot formation
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Avatar universal
*Sigh*  Now I'm really confused. Earlier today you wrote "I just spoke with my doctor and the lab seems to have lost my swab. Hence the positive HSV-1 and weak positive HSV-2  on my swab results that I reported earlier was incorrect as relayed to me." But now you report s positive culture and typing for HSV1 on March 30. Which is it?
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Avatar universal
Sorry I know this is confusing. I hope this clears it up

It is both.

These are the test results on 3/30:
Blood:
HSV IgM Combination 1/2 - negative
HSV-1 IgG Ab Specific - Negative
HSV-2 IgG Ab Specific - Positive 2.23

Culture:
HSV Culture and Typing - Positive for HSV-1 Typing was confirmed by monoclonal antibody microscope immunofluorescence

Based on these results the urgent care doctor on 3/30 told me that I was infected with both HSV 1 & 2 and that I was having a current outbreak of HSV-1 Genital Herpes. He said that the HSV-2 infection was old and the HSV-1 infection was new. I did a bunch of research and was suspicious of the diagnosis based on the low positive and having never had symptoms or any known exposure to HSV-2.

These are the test results from 4/16
Then I developed more symptoms (a single red spot) and because I was suspicious of the low positive on the original IgG test I went to a urologist on 4/16. I had a swab taken and blood work done. Yesterday I received an email that specifically told me that the swab test detected HSV-1 and weakly detected HSV-2 and that the IgG was negative for both HSV 1/2. I asked to see the results and when I got them this morning I realized that they mistook the HSV IgM IFA (which is compulsorily ordered upon a positive IgM combination blood test to confirm type specific antibodies) for the culture swab results. I asked them about this and thats when they told me that they lost the swab. These are my results that I did get:

Blood:
HSV IgM Combination 1/2 - Positive 1.47
HSV-1 IgM IFA - Detected
HSV-2 IgM IFA - Weakly Detected

HSV-1 IgG - Negative
HSV-2 IgG - Negative

Culture
Lost in transit it to the lab


I was hoping to definitively rule out an HSV-2 infection and I feel more confident in that conclusion at this point but the only way to be certain is to have blood work done again in 3-4 months. I am thinking of doing a western blot test so that I can be certain of what I am dealing with. The only other think I am curious about is whether there are any studies out there that compare the recurrence rate of GHSV-1/2 in circumcised and uncircumcised men. I am not circumcised and I feel that this fact made me more vulnerable to an HSV-1 infection then my sniped brethren. Also if recurrence rates are higher among uncircumcised men I would likely go on suppressive therapy.
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Avatar universal
OK, I think we finally have enough to make some pretty definitive conclusions.

You have genital HSV1, as proved by the initial (March 30) positive culture. Based on the initial blood test result (HSV2 IgG 2.23), I would have worried that it was really HSV2, with a lab error in distinguishing the two types by culture. However, your later negative HSV2 IgG results show the first result was falsely positive.

Why has your HSV1 IgG test remained negative? Maybe because of treatment. Acyclovir and related drugs can interfere with antibody production, at least for a while and sometimes indefinitely. In addition, a few people with HSV1 (probably around 5-10%) never develop measurable antibody. Additional testing isn't necessary except maybe for curiosity. Your positive culture is conclusive, and whether or not you ever have a positive IgG test won't change anything.

How and when were you infected? Not certain. Since your intitial symptoms were relatively mild, it might have been a recurrent outbreak of a longstanding infection, previously asymptomatic. Or it could have been a new infection acquired by oral sex performed on you in the 1-2 weeks before onset of your initial herpes symptoms. Your partner's genital infection probably was yeast, as diagnosed at the time, and not herpes. It is possible but less likely that she has genital HSV1. She could have an IgG blood test, but if positive for HSV1, it will say nothing about where she is infected (genital or oral) or how long she has had it.

Most likely you do not need suppressive treatment. If you are still taking acylocivr, stop it and see what happens. Without treatment, most genital HSV1 recurs less than once a year, and 40% of people have no recurrent outbreaks at all. Being uncircumcised probably increases the risk of catching HSV (either type) if exposed, but isn't known to change the frequency of recurrent outbreaks.

Does that finally help clarify things? If any doubt remains, I would advise you seek a final consultation with an infectious diseases specialist, preferably one with particular understanding of herpes and other STDs. (Your local health department STD clinic might be a source, or they may be ab le to suggest someone nearby.) If you do this, I recommend you print out this thread and bring it with you as a framework for discussion. I'm pretty sure s/he would agree with my analysis and advice.

Good luck!
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Avatar universal
Thank you so much for taking the time to read over my situation and take the time to ferret out the details. I agree with your synopsis of my current HSV situation and believe I only have GHSV-1. I am not currently taking any antivirals and am hoping I do not see any recurrent out breaks in the future. The only thing you didn't address was the IgM results from my last test (4/16), these results are the only reason I am even considering getting tested again in 3-4 months. Should I at all be worried about the weakly detected HSV 2 IgM indicates an HSV-2 infection?
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Avatar universal
I've already said how unreliable HSV IgM testing is. In addition, the IgM tests are not type specific. Even though the report suggests HSV2, if any IgM antibody actually is present, it is equally likely to be HSV1 antibody.
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Avatar universal
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