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Question For Handsfield. A newer infection or not?
Quick synopsis:
8/2008 Tested negative for HSVI and HSVII using Herpeselect
8/2009 Tested Low positive for HSVII (1.18) Herpeselect
9/2009 Tested Negative BioKit for HSVII
9/2009 First "OB" on left buttock lasted 1.5 months with heavy flu-like symptoms
11/2009 Second "OB" in same area lasted about the same amount of time
12/2009 Tested strong positive for HSVII in the 5.0 range. Always negative for HSVI
1.) Does this testing record indicate a newer infection?
2.) Do I need further testing?
3.) From 2005-2007 I was with a partner who assumed he had herpes due to a reoccuring lesion on his penis. He was never confirmed positive to my knowledge. Is there anyway I could have contracted Herpes from this partner and not tested positive for two years? BTW, I was tested a couple of months after him and again in 2008, both tests coming back negative.
4.) From 8/2008-6/2009 I was only with one partner. After we broke up I got tested. This is when I first got a low positive for HSVII, followed by two OB's and a strong positive. Is he the most likely carrier of the initial Herpes infection?
Some additional questions about HSVII outbreaks on buttocks.
1.) I get the OB's on my left buttcheek. Is it most likely that I will only have OB's in this spot?
2.) When one is a carrier of HSVII and OB's occur on buttocks, is one just as likely to transmit the infection via the vagina/anus and asymptomatic shedding as one whose OB's occur on gentials?
8/2008 Tested negative for HSVI and HSVII using Herpeselect
8/2009 Tested Low positive for HSVII (1.18) Herpeselect
9/2009 Tested Negative BioKit for HSVII
9/2009 First "OB" on left buttock lasted 1.5 months with heavy flu-like symptoms
11/2009 Second "OB" in same area lasted about the same amount of time
12/2009 Tested strong positive for HSVII in the 5.0 range. Always negative for HSVI
1.) Does this testing record indicate a newer infection?
2.) Do I need further testing?
3.) From 2005-2007 I was with a partner who assumed he had herpes due to a reoccuring lesion on his penis. He was never confirmed positive to my knowledge. Is there anyway I could have contracted Herpes from this partner and not tested positive for two years? BTW, I was tested a couple of months after him and again in 2008, both tests coming back negative.
4.) From 8/2008-6/2009 I was only with one partner. After we broke up I got tested. This is when I first got a low positive for HSVII, followed by two OB's and a strong positive. Is he the most likely carrier of the initial Herpes infection?
Some additional questions about HSVII outbreaks on buttocks.
1.) I get the OB's on my left buttcheek. Is it most likely that I will only have OB's in this spot?
2.) When one is a carrier of HSVII and OB's occur on buttocks, is one just as likely to transmit the infection via the vagina/anus and asymptomatic shedding as one whose OB's occur on gentials?
Thanks Dr. Handsfield. I understand MedHelp's position better now on the three question policy.
If I had HIV I'd be burning up the interwebs too!
I thought that that was the answer you'd give me. I'm 95% sure that if I have HSVII (most likely that I do), it was transmitted to me by my last partner who claims to have been tested and claims to be negative. I, personally don't believe this, due to my meticulous testing repetiore.
I will recommend that he get tested again, even though I have a feeling that he knows his status and just doesn't want to believe it or hasn't been tested properly.
If I had HIV I'd be burning up the interwebs too!
I thought that that was the answer you'd give me. I'm 95% sure that if I have HSVII (most likely that I do), it was transmitted to me by my last partner who claims to have been tested and claims to be negative. I, personally don't believe this, due to my meticulous testing repetiore.
I will recommend that he get tested again, even though I have a feeling that he knows his status and just doesn't want to believe it or hasn't been tested properly.
MEDICAL PROFESSIONAL
If you have HSV-2, it is recently acquired. Either your initial low-positive result was the first evidence, in which case you probably were infected in roughtly the month before the test; or you had a previous false positive result and, by bad luck, caught the infection sometime between the first and latest test result. More precision can only come from your best judgment of potential exposures.
My normal advice to people with newly diagnosed genital herpes is to not take suppressive therapy for the first several months. That's the only way to get a clear understanding of the course of recurrent outbreaks -- frequency, location, duration. This isn't hard and fast, and if you are likely to be having sex with uninfected partner(s), treatment might be wise. But if transmission isn't a high risk at this time, consider stopping the drug -- in part to allow a recurrence for confirmatory testing.
The MedHelp policy also is intended to reduce repeated anxiety-driven. Without it, I guarantee this and the HIV forum would be overloaded with threads with little or no educational value, not to mention being boooorrrriiinnnngggg for the moderators. That's not your style, which is another reason I was tolerant.
My normal advice to people with newly diagnosed genital herpes is to not take suppressive therapy for the first several months. That's the only way to get a clear understanding of the course of recurrent outbreaks -- frequency, location, duration. This isn't hard and fast, and if you are likely to be having sex with uninfected partner(s), treatment might be wise. But if transmission isn't a high risk at this time, consider stopping the drug -- in part to allow a recurrence for confirmatory testing.
The MedHelp policy also is intended to reduce repeated anxiety-driven. Without it, I guarantee this and the HIV forum would be overloaded with threads with little or no educational value, not to mention being boooorrrriiinnnngggg for the moderators. That's not your style, which is another reason I was tolerant.
Well, for the purposes of speculation only, let's assume that I'm am for sure HSVII positive.
**My main question is, if I am indeed positive, do my rising antibody levels indicate a newer infection?**
I will definitely pursue a WB test. Can I order this through my dermatologist?
I'm unsure if I will have another outbreak as I am on Valtrex, but if I do, I will take your advice and get it swabbed.
Sorry for the more than three questions, I was unaware of this policy. Also, I think it's strange to have this policy so "other people can get their questions in" when I am paying for the service. :)
Thanks for you and Dr. Hook's help.
**My main question is, if I am indeed positive, do my rising antibody levels indicate a newer infection?**
I will definitely pursue a WB test. Can I order this through my dermatologist?
I'm unsure if I will have another outbreak as I am on Valtrex, but if I do, I will take your advice and get it swabbed.
Sorry for the more than three questions, I was unaware of this policy. Also, I think it's strange to have this policy so "other people can get their questions in" when I am paying for the service. :)
Thanks for you and Dr. Hook's help.
MEDICAL PROFESSIONAL
FYI, Dr. Hook and I take questions interchangeably, without regard to specific requests. It is only by chance that I'm answering and not Dr. Hook.
I reviewed your previous threads with Dr. Hook and agree with the advice he gave you at that time. However, the situation appears to have changed, with your most recent HerpeSelect result now definitely positive. Such results rarely are false, so maybe your buttock lesions are due to herpes after all.
Because of the atypical features, you need another confirmatory test before concluding that you are or are not infected with HSV-2. Next time you have a recurrence of the buttock rash, see a provider within 1-2 days for testing for HSV-2 from the rash. If positive it will nail the diagnosis; if negative it won't help one way or the other. Also, you should have another confirmatory blood test, this time a Western blot, the ultimate gold standard for HSV antibody testing. WB is done primarily at the University of Washington laboratory in Seattle; the lab your doctor uses will know how to send a specimen to the UW lab.
To the specific questions
1) If herpes is the cause of the buttock lesions, most likely all future recurrences will be in more or less the same area and not elsewhere.
2) People often have cervica/vaginal viral shedding in addition to the sites of symptomatic outbreaks. I don't know whether this has been carefully studied for more distant recurrences, e.g. buttocks. If HSV-2 is eventually confirmed, it would be safest for you to assume that there is a potential for transmission by vaginal (or anal) sex, even without exposure of your partner to the buttock lesions.
I suggest we not speculate further until the diagnosis is confirmed or refuted, as suggested above.
Finally, please note that MedHelp permits a maximum of 2 questions every 6 months on the professionally moderated forums (see Terms and Conditions). This is your third, and normally it would have been deleted without reply. The new information you provide does change the game somewhat, so I let it stand. But this thread will have to be your last until next August at the soonest. (Not all questions can be accommodated, and the rule is designed to assure that others with new questions have the chance to fit them in. I hope you understand.)
Regards-- HHH, MD
I reviewed your previous threads with Dr. Hook and agree with the advice he gave you at that time. However, the situation appears to have changed, with your most recent HerpeSelect result now definitely positive. Such results rarely are false, so maybe your buttock lesions are due to herpes after all.
Because of the atypical features, you need another confirmatory test before concluding that you are or are not infected with HSV-2. Next time you have a recurrence of the buttock rash, see a provider within 1-2 days for testing for HSV-2 from the rash. If positive it will nail the diagnosis; if negative it won't help one way or the other. Also, you should have another confirmatory blood test, this time a Western blot, the ultimate gold standard for HSV antibody testing. WB is done primarily at the University of Washington laboratory in Seattle; the lab your doctor uses will know how to send a specimen to the UW lab.
To the specific questions
1) If herpes is the cause of the buttock lesions, most likely all future recurrences will be in more or less the same area and not elsewhere.
2) People often have cervica/vaginal viral shedding in addition to the sites of symptomatic outbreaks. I don't know whether this has been carefully studied for more distant recurrences, e.g. buttocks. If HSV-2 is eventually confirmed, it would be safest for you to assume that there is a potential for transmission by vaginal (or anal) sex, even without exposure of your partner to the buttock lesions.
I suggest we not speculate further until the diagnosis is confirmed or refuted, as suggested above.
Finally, please note that MedHelp permits a maximum of 2 questions every 6 months on the professionally moderated forums (see Terms and Conditions). This is your third, and normally it would have been deleted without reply. The new information you provide does change the game somewhat, so I let it stand. But this thread will have to be your last until next August at the soonest. (Not all questions can be accommodated, and the rule is designed to assure that others with new questions have the chance to fit them in. I hope you understand.)
Regards-- HHH, MD
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.
