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Interpretation of results
Hi doc. I'm a 30yo male with oral herpes from young. I had a concern on HSV2 and was wondering if you could help me with some interpretation.
The concern started from a penile rash in Jul which my dermatologist suspected herpes, but didn't diagnosed. I had similar penile rash for 4 or 5 times in this year all with balanitis. None of them looks like typical herpes (no blister, no break, no hurt, no scar). During a recent similar rash a dermatologist diagnosed as non-specific balanitis. My last sexual exposure was in Apr.
I did a series of tests:
1. Jul 4, 11 week (Trinity. Lab don't give index value)
HSV1: Igm -, Igg +
HSV2: Igm -, Igg +
2. Jul 13, 12 week (Euroimmun ELISA)
HSV 2: Igg +, 22.7 RU/mL
(neg: 0~16.0; equivocal: 16.0~22.0; pos: 22.0~)
3. Sep 1, 19 week (Trinity)
HSV1: Igm -, Igg +
HSV2: Igm -, Igg -
4. Sep 19, 21 week (Euroimmun ELISA)
HSV 2: Igg +, 45.2 RU/mL
5. Sep 28, 23 week (Euroimmun Western Blot. I am having difficulty getting a UW WB test, the closest I can have is a Euroimmun WB)
HSV1 pos
HSV2 boarderline
In detail, it shows:
gC-1 130 kDa (gC1): 108 pos
gG-1 60 kDa (gG1): 81 pos
gG-2 (gG2): 18 boarderline
Since Jul I've been on the lookout for herpes. I did about 4 or 5 swabs for DNA PCR whenever I found anything suspicious. All neg. I never found anything like typical herpes blisters.
Since my Euroimmun ELISA increased from Jul to Sep, my doctor said it could be a new infection. But the first Euroimmun test was already 12 week after exposure.
It seems my test results are not so consistent. The trinity test turned neg in Sep, and the western blot test was boarderline, but the index value of Euroimmun test increased. I really don't know how to interpret. In your opinion, is it likely I have HSV2? Do you recommend I pursue more tests?
Also after my last exposure in Apr I did have a few mutual masturbation including fingering. This is not a concern for HSV, right?
Thank you!
The concern started from a penile rash in Jul which my dermatologist suspected herpes, but didn't diagnosed. I had similar penile rash for 4 or 5 times in this year all with balanitis. None of them looks like typical herpes (no blister, no break, no hurt, no scar). During a recent similar rash a dermatologist diagnosed as non-specific balanitis. My last sexual exposure was in Apr.
I did a series of tests:
1. Jul 4, 11 week (Trinity. Lab don't give index value)
HSV1: Igm -, Igg +
HSV2: Igm -, Igg +
2. Jul 13, 12 week (Euroimmun ELISA)
HSV 2: Igg +, 22.7 RU/mL
(neg: 0~16.0; equivocal: 16.0~22.0; pos: 22.0~)
3. Sep 1, 19 week (Trinity)
HSV1: Igm -, Igg +
HSV2: Igm -, Igg -
4. Sep 19, 21 week (Euroimmun ELISA)
HSV 2: Igg +, 45.2 RU/mL
5. Sep 28, 23 week (Euroimmun Western Blot. I am having difficulty getting a UW WB test, the closest I can have is a Euroimmun WB)
HSV1 pos
HSV2 boarderline
In detail, it shows:
gC-1 130 kDa (gC1): 108 pos
gG-1 60 kDa (gG1): 81 pos
gG-2 (gG2): 18 boarderline
Since Jul I've been on the lookout for herpes. I did about 4 or 5 swabs for DNA PCR whenever I found anything suspicious. All neg. I never found anything like typical herpes blisters.
Since my Euroimmun ELISA increased from Jul to Sep, my doctor said it could be a new infection. But the first Euroimmun test was already 12 week after exposure.
It seems my test results are not so consistent. The trinity test turned neg in Sep, and the western blot test was boarderline, but the index value of Euroimmun test increased. I really don't know how to interpret. In your opinion, is it likely I have HSV2? Do you recommend I pursue more tests?
Also after my last exposure in Apr I did have a few mutual masturbation including fingering. This is not a concern for HSV, right?
Thank you!
MEDICAL PROFESSIONAL
"From your reply it sounds like there is a small possibility that I have HSV2. In your opinion, should I disclose this to my future partner?"
Given the uncertainties, probably it would be appropriate to disclose the possibility to your partner before starting on an ongoing, potentially commited relationship. For casual sex with a new partner, in which you should be using a condom anyway, I don't think it's necessary.
Oral HSV-2 infection is uncommon; HSV-2 doesn't infect oral tissues as readily as genital, and when it does, recurrent oubreaks and viral shedding appear to be uncommon. If you had acquired a new oral HSV-2 infection, you probably would have had an outbreak that was different -- more severe, more prolonged -- than your usual recurrent oral HSV-1 infection. However, you desire additional reassurance, it certainly would be possible to have a swab test for an HSV PCR on an oral herpes oubreak. If you do, you can definitely expect it to confirm HSV-1 and not HSV-2.
Given the uncertainties, probably it would be appropriate to disclose the possibility to your partner before starting on an ongoing, potentially commited relationship. For casual sex with a new partner, in which you should be using a condom anyway, I don't think it's necessary.
Oral HSV-2 infection is uncommon; HSV-2 doesn't infect oral tissues as readily as genital, and when it does, recurrent oubreaks and viral shedding appear to be uncommon. If you had acquired a new oral HSV-2 infection, you probably would have had an outbreak that was different -- more severe, more prolonged -- than your usual recurrent oral HSV-1 infection. However, you desire additional reassurance, it certainly would be possible to have a swab test for an HSV PCR on an oral herpes oubreak. If you do, you can definitely expect it to confirm HSV-1 and not HSV-2.
Thank you very much your answer doctor.
From your reply it sounds like there is a small possibility that I have HSV2. In your opinion, should I disclose this to my future partner?
May I also ask a question about oral HSV2 please? I had long-standing oral HSV1. Can I have both type orally? I know oral HSV2 is rare, but since I also had oral exposures before, I'm not sure if it could be a concern. If I have oral herpes outbreak in the future, is it necessary for me to get a swab test?
Thank you doctor!
From your reply it sounds like there is a small possibility that I have HSV2. In your opinion, should I disclose this to my future partner?
May I also ask a question about oral HSV2 please? I had long-standing oral HSV1. Can I have both type orally? I know oral HSV2 is rare, but since I also had oral exposures before, I'm not sure if it could be a concern. If I have oral herpes outbreak in the future, is it necessary for me to get a swab test?
Thank you doctor!
MEDICAL PROFESSIONAL
Noted before I replied above.
MEDICAL PROFESSIONAL
Welcome to the forum.
Unfortunately, I really cannot help very much. I am unfamiliar with the Euroimmun HSV test, or how to interpret a borderline test result. However, with most herpes blood tests, boderline results (especially for HSV-2) in fact are negative. And with the ELISA tests like Euroimmun, a rising value that nevertheless remains in the negative or low positive range generally doesn't mean anything. Further, as discussed previously with Dr. Hook and Terri Warren, your symptoms did not seem typical for herpes; you had negative lesion testing for HSV DNA; and it seems the lesions did not promply improve with anti-herpes therapy with valacyclovir.
Thus, the totality of evidence indicates that you are not infected with HSV-2 and do not have genital herpes. The only wrinkle is your dermatologist's original opinion. However, even the world's top herpes experts acknowledge their own visual diagnosis is often unreliable: such experts often miss herpes, and often suspect herpes when it is absent. Therefore, I suggest you trust the clinical evidence and the lab tests, and go forward with confidence you don't have it. Of course, if in the future you have new genital lesions suspicious for herpes (blisters/sores, etc), consider reexamination and another PCR (DNA) test. But I am confident that won't happen.
I hope this has helped. Best wishes-- HHH, MD
Unfortunately, I really cannot help very much. I am unfamiliar with the Euroimmun HSV test, or how to interpret a borderline test result. However, with most herpes blood tests, boderline results (especially for HSV-2) in fact are negative. And with the ELISA tests like Euroimmun, a rising value that nevertheless remains in the negative or low positive range generally doesn't mean anything. Further, as discussed previously with Dr. Hook and Terri Warren, your symptoms did not seem typical for herpes; you had negative lesion testing for HSV DNA; and it seems the lesions did not promply improve with anti-herpes therapy with valacyclovir.
Thus, the totality of evidence indicates that you are not infected with HSV-2 and do not have genital herpes. The only wrinkle is your dermatologist's original opinion. However, even the world's top herpes experts acknowledge their own visual diagnosis is often unreliable: such experts often miss herpes, and often suspect herpes when it is absent. Therefore, I suggest you trust the clinical evidence and the lab tests, and go forward with confidence you don't have it. Of course, if in the future you have new genital lesions suspicious for herpes (blisters/sores, etc), consider reexamination and another PCR (DNA) test. But I am confident that won't happen.
I hope this has helped. Best wishes-- HHH, MD
Oh I had some interactions with Doc Hook and Doc Terri in Jul before the latest tests. The links are here for your ref:
http://www.medhelp.org/posts/STDs/Confused-about-HSV/show/1971551#post_9259520
http://www.medhelp.org/posts/Herpes/Could-it-be-HSV2/show/1981819#post_9322307
I'm sorry for my long post. It is really frustrating not having a definitive result after so long time, and I was hoping you could help me and shed some light on this issue. Thank you doctor.
http://www.medhelp.org/posts/STDs/Confused-about-HSV/show/1971551#post_9259520
http://www.medhelp.org/posts/Herpes/Could-it-be-HSV2/show/1981819#post_9322307
I'm sorry for my long post. It is really frustrating not having a definitive result after so long time, and I was hoping you could help me and shed some light on this issue. Thank you doctor.
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
