HSV 2 Uncertainty

[Birka123]

Hello Dr. H,
I already have a post out there which Grace has kindly replied to, wanted your opinion.
I am a 26 y.o. healthy fem from the U.S. This past Feb I went to Israel and had protected sex with someone who I'm fairly certain has herpes. About 12 days post exp I started having some disturbing pain and genital irritation.  was still out of the country & couldn't get myself evaluated by the doctor; assumed it was a yeast infection. I kept having lots of shooting pain and a lot of swelling. I am fairly certain I had sores as well, as when I came back to U.S and inspected the area I saw what looked like 2 oozing paper cuts on each side of the labia. I was also experiencing new types of headaches & stiff neck & general malaise for few weeks. By the time I got an appt with my OBGYN the sores were gone but the pain was still severe. She ordered a Herpeselect Igg test at 3 weeks post exp (i know, early):
HSV 1 Igg - 4.89 (I had cold sores in the past); HSV 2 Igg - .13
No visual sign of infection. I have since been having constant pain and discomfort with recurring paper cuts and once developed a large painful lump in my butt cheek for 3 weeks. I never got a chance to have the sores cultured.
10 weeks post exp I went to my regular physician, same Igg:
HSV 1 Igg - 4.48; HSV 2 Igg - .13
13 weeks post exp got a whole work up of STDs, all neg. Candida neg. I went to a new OBGYN who ordered tests using Liaison:
HSV 1 Igg - 41.9; HSV 2 Igg - .08.
He has suggested  GHSV 1 and said I should get on Valtrex for a year, which I refused to do.  I still experience daily discomfort now with a lot of razor blade like cutting pain in my vulva, pain down my lower back and to my genitals, lots of localized tingling.

What's the likelihood of this being a new HSV-2? How likely is it for a non primary HSV infection to take longer than 13 wks to seroconvert? I read it usually takes up to 6 mo but what are the chances? How long do you think I should wait to retest?

Thanks

[Birka123]

Bump

[Birka123]

Doctor Hook,
Have a follow-up question. I read in your numerous posts to others that HSV Igg tests cannot always be trusted. I am not sure what it means but I tried to relate it to my case.

My situation from the last post to you is still unchanged. I had repeat Igg tests done subsequently at 16 weeks and a Biokit test done at 5 months post exposure, both negative. I also managed to get one of my sores cultured (if you could refer to it as a sore as it was so small my doctor took a long time to find it, so although it was fresh I don't think he could get a good sample from it), which also came back negative. Please note it was not a PCR so the chances of it being falsely negative are high.  I'm still experiencing the intermittent tingling, pain, lower back pain radiating to the groin/legs, genital irritation, etc but if I do get a paper cut sore with the symptoms they are becoming much smaller and less noticeable.

I'm not sure what to do at this point, and your comment on the trustworthiness of the ELiSA tests really gets me worried about false negatives.

Can you shed some light on what you mean by your words on the Igg reliability? Also, in your opinion, what should my plan of action be in pretty much all absence of "good" sores to be cultured, my last test being negative at 5 months post exposure, my ongoing symptoms, etc. My thinking is to get another Igg Herpeselect test now (6 months post exposure) and if negative follow up with a Western Blot. Would you add anything or disagree with any part of my post? Thank you.

[Edward W Hook, MD]

Both PCR and culture are methods for showing the virus is present. With culture the virus is grown from the specimen taken. With PCR biochemical methods are use to detect and amplify the DNA of the virus.  For a number of reasons including that specimens taken for culture can die in transport, PCR is more sensitive than culture. EWH

[Birka123]

Thanks for a prompt reply on a holiday weekend!
Can you explain the difference between PCR and culture? It's still essentially taking a sample of the sores, is it not, just more sensitive than actual culture?

[Edward W Hook, MD]

Welcome to the Forum.  I read your interaction with Grace and agree with the advice that you received.  Several thoughts which may be helpful:

1.  At this time there is no evidence that your lesions are genital herpes.  The pain pattern you describe is not typical (pain for weeks, pain without lesions, the extent of the pain all do not fit) and your HSV-2 blood tests are repeatedly negative.  By now most (but admittedly not all) people would have positive tests).
2.  You have antibodies for HSV-1 and get cold sores.  You have oral herpes. To attribute your symptoms to genital HSV-1 doesn't make sense given that infection in two sites is most unusual an since having already had HSV-1 before your encounter of concern, there was very, very little chance of getting HSV-1 again in a new location.
3.  If your doctor is willing, you may wish to arrange in advance for a PCR test (not culture) at your next outbreak.  Either with planning before hand or even taking the test swabs home with you  with plans to drop them off after you take the test yourself will help to get this done if your next occurrence happens at an inconvenient time.  After the specimen is taken, they can be kept in the refrigerator.  PCR is preferable to culture as it is more sensitive.  

I doubt that this is HSV.  Re-testing with the tests used to date, or a Western blot at 6 months should provide definitive information about HSV antibodies.  Hope this helps. EWH