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Herpes Testing Confusion
I have been in a long monogomous marriage, and engaged in stupid drunken behavior. I had protected vaginal sex with a stripper (when she got off me the condom had moved half way up my shaft), and I performed cunnilingus on this CSW.
The only symptoms I developed were a rash around my mouth and chin, chapped lips, and a metalic taste in my mouth. The rash tingled and burned at times. This developed at about 3 weeks after incident. Both primary provider and dematoligist did not suspect herpes. No ulcers or fluid filled pimples.
At 4 weeks after episode, I had a full STD panel done by testing company.
HSV 2 IGM positive 2.87
HSV2 IGG positive 1.87
All other tests for were negative including HSV 1.
At 5 weeks I met with primary care provider and tested again for HSV2 only.
IGG negative <.90
At 15 weeks, I tested again to make sure, and the results were as follows:
HSV 2 in range at 2.09
I have also had two PCR tests done on my mouth and penis though both providers thought there was no reason to, both were negative.
My questions are as follows:
I have read on this site many times that cunnilingus is safer sex, so if that is so, than I would consider the rest of my exposure is lower risk. And, could I have Herpes on my face. It would seem that HSV 2 could infect the skin anywhere? Please confirm that hypothesis.
Does the exposure on my penis represent significant risk, and if I contracted HSV at the lower end of the shaft, isn't that where symptons would occur?
I am seeing my doctor today and will request to have WB test done given your confidence in that test. In the meantime, can you provide me with your expert opinions about the validity of the tests I have taken, and the probability that I have been infected.
My anxiety level even after 16 weeks is so high, it is hard for me to concentrate. I know I was weak and stupid, but this was a one time venture.
Please help me sort this out.
Thank you.
The only symptoms I developed were a rash around my mouth and chin, chapped lips, and a metalic taste in my mouth. The rash tingled and burned at times. This developed at about 3 weeks after incident. Both primary provider and dematoligist did not suspect herpes. No ulcers or fluid filled pimples.
At 4 weeks after episode, I had a full STD panel done by testing company.
HSV 2 IGM positive 2.87
HSV2 IGG positive 1.87
All other tests for were negative including HSV 1.
At 5 weeks I met with primary care provider and tested again for HSV2 only.
IGG negative <.90
At 15 weeks, I tested again to make sure, and the results were as follows:
HSV 2 in range at 2.09
I have also had two PCR tests done on my mouth and penis though both providers thought there was no reason to, both were negative.
My questions are as follows:
I have read on this site many times that cunnilingus is safer sex, so if that is so, than I would consider the rest of my exposure is lower risk. And, could I have Herpes on my face. It would seem that HSV 2 could infect the skin anywhere? Please confirm that hypothesis.
Does the exposure on my penis represent significant risk, and if I contracted HSV at the lower end of the shaft, isn't that where symptons would occur?
I am seeing my doctor today and will request to have WB test done given your confidence in that test. In the meantime, can you provide me with your expert opinions about the validity of the tests I have taken, and the probability that I have been infected.
My anxiety level even after 16 weeks is so high, it is hard for me to concentrate. I know I was weak and stupid, but this was a one time venture.
Please help me sort this out.
Thank you.
MEDICAL PROFESSIONAL
Do you know what lab did your WB? University of Washington?
I discussed your test results with a couple of herpes expert colleagues. They agree with my advice above. A second indetermate WB result by UW, after 3+ months, generally means no HSV infection is present. If you have both that outcome and a negative BiokitUSA test, you can be very sure about it.
I discussed your test results with a couple of herpes expert colleagues. They agree with my advice above. A second indetermate WB result by UW, after 3+ months, generally means no HSV infection is present. If you have both that outcome and a negative BiokitUSA test, you can be very sure about it.
MEDICAL PROFESSIONAL
Welcome to the STD forum.
It is quite rare to catch herpes after any single new sexual encounter. In monogamous couples in which one person has HSV-2, who have unprotected sex 2-3 times a week, transmission to the other partner occurs in only 1 in 20 couples per year; after 10 years, only half the partners have acquired HSV-2. That tells you how low the chance is for any particular exposure. And you don't know that the stripper has HSV-2 (most commercial sex workers don't) and you used a condom -- which isn't perfect, but reduces the transmission risk by 70-90%. That the condom only partly covered the penis may slightly lower that figure, but not by much. And the mouth is less susceptible to HSV-2, so infection by oral sex on an infected woman is rare.
Your symptoms were not highly suggestive of herpes. The symptoms and signs can be quite variable, so it probably is possible. But with two physicians -- including a dermatologist -- believing the facial rash was not herpes, that also is my opinion. The rash probably was unrelated to the sexual exposure.
Given those facts, had you come to my clinic we would have recommended against being tested for herpes, because the tests are not perfect -- as you have learned. The HSV IgM test is very bad, often giving false postive results; STD experts never use the HSV IgM test, but some doctors order it, not knowing it is unreliable. However, you have now had conflicting results on the proper kind of test, the IgG type specific test. Although an ELISA ratio of 2.09 is technically positive, up to half the time results in that range are false. Given the low risk of the sexual exposure and lack of genital symptoms, my bet is that you don't have it.
You are doing the right thing to have a Western blot test; that's how to sort this out. I'm predicting it will be negative for HSV-2. If positive, it won't necessarily mean you caught it during the sexual exposure described. You might have been infected for years -- with a false negative result with the first IgG test.
Let me know what the WB shows and we'll take it from there. Good luck--
HHH, MD
It is quite rare to catch herpes after any single new sexual encounter. In monogamous couples in which one person has HSV-2, who have unprotected sex 2-3 times a week, transmission to the other partner occurs in only 1 in 20 couples per year; after 10 years, only half the partners have acquired HSV-2. That tells you how low the chance is for any particular exposure. And you don't know that the stripper has HSV-2 (most commercial sex workers don't) and you used a condom -- which isn't perfect, but reduces the transmission risk by 70-90%. That the condom only partly covered the penis may slightly lower that figure, but not by much. And the mouth is less susceptible to HSV-2, so infection by oral sex on an infected woman is rare.
Your symptoms were not highly suggestive of herpes. The symptoms and signs can be quite variable, so it probably is possible. But with two physicians -- including a dermatologist -- believing the facial rash was not herpes, that also is my opinion. The rash probably was unrelated to the sexual exposure.
Given those facts, had you come to my clinic we would have recommended against being tested for herpes, because the tests are not perfect -- as you have learned. The HSV IgM test is very bad, often giving false postive results; STD experts never use the HSV IgM test, but some doctors order it, not knowing it is unreliable. However, you have now had conflicting results on the proper kind of test, the IgG type specific test. Although an ELISA ratio of 2.09 is technically positive, up to half the time results in that range are false. Given the low risk of the sexual exposure and lack of genital symptoms, my bet is that you don't have it.
You are doing the right thing to have a Western blot test; that's how to sort this out. I'm predicting it will be negative for HSV-2. If positive, it won't necessarily mean you caught it during the sexual exposure described. You might have been infected for years -- with a false negative result with the first IgG test.
Let me know what the WB shows and we'll take it from there. Good luck--
HHH, MD
A related discussion, Herpes Testing Confusion was started.
MEDICAL PROFESSIONAL
Welcome back. Too bad about the indeterminate result on Western blot. There seems to be a communication problem between your doctor and the WB lab technician. Indeterminate results happen "all the time" only in the sense that a lab doing tens of thousands of tests every year is bound to see indeterminate results fairly frequently. But only a tiny fraction of WB results are actually indeterminate.
Most people in your situation do not have HSV-2, and I continue to believe that most likely you aren't infected. There are a couple of ways to sort this out further. First, wait another few weeks and have another Western blot; most of the time, a second one gives more clear results. Second, find a doctor or clinic to do a BiokitUSA test. Research has shown it to often be helpful in sorting out uncertain HSV-2 test results. If Biokit is positive, you probably have HSV-2; if not, it will be very reassuring.
Most people in your situation do not have HSV-2, and I continue to believe that most likely you aren't infected. There are a couple of ways to sort this out further. First, wait another few weeks and have another Western blot; most of the time, a second one gives more clear results. Second, find a doctor or clinic to do a BiokitUSA test. Research has shown it to often be helpful in sorting out uncertain HSV-2 test results. If Biokit is positive, you probably have HSV-2; if not, it will be very reassuring.
Doctor,
The WB came back indeterminate. My doctor spoke with a technician at WB who said that this happens all the time, and did not recommend further testing.
I am tired of this. Do you have a perspective?
The WB came back indeterminate. My doctor spoke with a technician at WB who said that this happens all the time, and did not recommend further testing.
I am tired of this. Do you have a perspective?
MEDICAL PROFESSIONAL
Thanks for the additional information. That makes is even less likely your WB will be positive. Let me know when that result is available.
Lots of viruses cause infection more readily at some anatomic sites than others. Of the ~100 types of human papillomavirus (HPV), only about 30 readily infect the genitals; and the non-genital types rarely show up in the genital area. Sexually transmitted chlamydial infections uncommonly infect the mouth and throat -- much less frequently than gonorrhea, for example.
So it is with HSV-2, which doesn't "take" very well at the mouth. And although HSV-1 more readily infects the genital area, most people with genital HSV-1 have far fewer recurrent outbreaks and asymptomatic shedding than those with HSV-2. The biological reasons for such differences are not well understood.
Lots of viruses cause infection more readily at some anatomic sites than others. Of the ~100 types of human papillomavirus (HPV), only about 30 readily infect the genitals; and the non-genital types rarely show up in the genital area. Sexually transmitted chlamydial infections uncommonly infect the mouth and throat -- much less frequently than gonorrhea, for example.
So it is with HSV-2, which doesn't "take" very well at the mouth. And although HSV-1 more readily infects the genital area, most people with genital HSV-1 have far fewer recurrent outbreaks and asymptomatic shedding than those with HSV-2. The biological reasons for such differences are not well understood.
While I am working on getting the WB, I have new information.
It appears that I was tested with a combo Igg test at 15 weeks as well and that was negative, but the type specific for HSV 2 was low positive, below 2.5.
Therefore, my results seem to be two negative HSV I/II igg tests at 5 and 15 weeks. And low positive type specific HSV 2 tests both near or below the 2.0 area.
If HSV 2 is a skin disease, why is it so rare to contract around the mouth if that area is contact with the disease. I understand that the inside of the mouth may be a different story.
It appears that I was tested with a combo Igg test at 15 weeks as well and that was negative, but the type specific for HSV 2 was low positive, below 2.5.
Therefore, my results seem to be two negative HSV I/II igg tests at 5 and 15 weeks. And low positive type specific HSV 2 tests both near or below the 2.0 area.
If HSV 2 is a skin disease, why is it so rare to contract around the mouth if that area is contact with the disease. I understand that the inside of the mouth may be a different story.
Dr. Handsfield,
Thank you for your help. I will let you know if or when I get the WB test done.
Thank you for your help. I will let you know if or when I get the WB test done.
You are reading content posted in the STDs Forum
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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.
