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Hi,
I am a man who had one-time unprotected oral (bidirectional) and vaginal sex with a woman with confirmed HSV 2 on 4.4.2015. She did not have any lesions at the time, is not on anti-viral medication, and we did not use any protection. I was seronegative for HSV 1&2 before this incident and want to determine whether I have contracted HSV.I noticed two scabs on the shaft of my penis (about the size of a pin-head each surrounded by redness but no itching/tingling/burning/pain at all) ~4 days after my exposure. I went to urgent care 7 days after my exposure and the doctor said it was likely genital herpes. He gave me 7 days of acyclovir 400mg (three times/day) and did a viral culture (PCR swab not available at this hospital), and an IgG antibody test for HSV 1&2.
All the tests came back negative (expected since I had no previous exposures and the lesions seemed too scabbed to provide any live virus). Despite having developed ~4 more similar looking tiny scabbed lesions in the same region (again no itching/tingling/burning/pain), at my follow up appointment a new doctor said she didn’t think it was herpes but she didn’t know what it was. From my reading I understand atypical herpes presentation is common (and so mild sometimes many people don’t realize it’s herpes) so I don’t understand why the doctor felt so sure that the lack of itching/tingling/burning/pain meant it wasn’t herpes. She ordered a PCR serum test which was also negative. I have continued with acyclovir (400 mg twice/day as prophylaxis). 33 days after exposure I had another negative IgG antibody test (HSV 1&2). Around 4.28.2015 all visible lesions had healed.
I have a new partner who is negative for HSV 1&2 and aware of my situation so I am very interested in determining my HSV status ASAP, but given my confirmed exposure was recent and I have been using anti-virals, I know most tests won’t be accurate yet. Just to be safe we are waiting to have sex or kiss (since both my lips and genitals were exposed I could be shedding orally and genitally) until this gets resolved.
My questions:
A. Based on other posts here I suspect you will suggest going off anti-virals to get an accurate blood test. While I understand this in theory, I am still curious about the practical application.
1. I believe you have previously said there is no peer reviewed research to back this up – is this still true?
2. In your clinical experience approximately how long does it take for people on anti-virals to seroconvert?
3. If I go off anti-virals now do you think it will take a full 4 months for me to seroconvert if I do have hsv 2? I am hoping it would be worth testing after 4-6 weeks so we don’t have to refrain from sexual activity for 4 more months (and my partner and I agree we do not want to be sexual unless I am on anti-virals since that greatly reduces risk of transmission over and above condom use). What is your opinion on this?B. I know there are many testing options available (multiple herpeSelect tests, biokit or other point of care tests, WB, etc.) and I am wondering since I don’t have current symptoms to swab, my exposure is still recent, and I am on anti-virals…
4. what test(s) you recommend for me at this point to get accurate results ASAP and why?
5. When should I get these test(s)?
6. Where can I get them (and how do I order them?)
7. Are there any at-home testing options you are aware of?
8. What do you know about the PCR serum test for non-CNS HSV? Would this be diagnostic in my case and if so at what point? I can’t find any reliable peer reviewed sources or anyone with clinical experience with it but my doctor does offer it.
9. In your clinical experience what does ‘asymptomatic genital herpes’ mean? Does my case qualify?C. If I get any more lesions I would like to do a PCR swab right away.
10. Do you know of any labs or clinics in/around Los Angeles that will do a PCR swab and how I get a test ordered there?
11. I have read on this forum that you send your patients home with PCR swab materials so they can do the swab as soon as they have symptoms and send it back to the lab. Do you offer this service remotely (Los Angeles, CA)? And if so how much does it cost per swab? If not, do you know of any clinics that offer this in California?Thanks so much for your time.
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A. Based on other posts here I suspect you will suggest going off anti-virals to get an accurate blood test. While I understand this in theory, I am still curious about the practical application.
1. I believe you have previously said there is no peer reviewed research to back this up – is this still true?Yes, this is still true as far as I know. The University of Washington now includes a statement on the western blot stating it may impact serconversion. Also, we have lots of experience with this now and I strongly believe it to be true.
2. In your clinical experience approximately how long does it take for people on anti-virals to seroconvert?We had a patient who had a primary infection (was unable to pay for the PCR at the time but had had sex with a man with known HSV 2, without a condom, 4 days prior and it was a classic presentation. She went on antivirals immediately and nine months later, still tested negative for HSV 2 antibody. Finally she agreed to come off and in 6 weeks, as I recall, she tested positive.
3. If I go off anti-virals now do you think it will take a full 4 months for me to seroconvert if I do have hsv 2? I am hoping it would be worth testing after 4-6 weeks so we don’t have to refrain from sexual activity for 4 more months (and my partner and I agree we do not want to be sexual unless I am on anti-virals since that greatly reduces risk of transmission over and above condom use). What is your opinion on this?
By 6 weeks from infection (and coming would be the same), 70% of people have made antibody, so most people don’t need to wait 4 months to serconvert. So testing at 6 weeks might be useful, but if negative, you just can’t be certain.
B. I know there are many testing options available (multiple herpeSelect tests, biokit or other point of care tests, WB, etc.) and I am wondering since I don’t have current symptoms to swab, my exposure is still recent, and I am on anti-virals…
4. what test(s) you recommend for me at this point to get accurate results ASAP and why?
The herpeselect would be fine – none is going to be accurate now due to the use of antivirals, howeer.
5. When should I get these test(s)?
see above
6. Where can I get them (and how do I order them?)
You can order them yourself online at many locations – I recommend healthcheckusa.com but there are many others.7. Are there any at-home testing options you are aware of?
no8. What do you know about the PCR serum test for non-CNS HSV? Would this be diagnostic in my case and if so at what point? I can’t find any reliable peer reviewed sources or anyone with clinical experience with it but my doctor does offer it.
Doing a PCR from blood is pointless and I have no idea why your doctor would order this. People with HSV rarely have virus in the blood outside of a bad first infection.
9. In your clinical experience what does ‘asymptomatic genital herpes’ mean? Does my case qualify?
This refers to people who have herpes but have no symptoms. I don’t know if you qualify because I don’t know if you have herpes or not.
C. If I get any more lesions I would like to do a PCR swab right away.
10. Do you know of any labs or clinics in/around Los Angeles that will do a PCR swab and how I get a test ordered there?
I don’t know of clinics in LA that offer this, but all the major laboratories do it now.
11. I have read on this forum that you send your patients home with PCR swab materials so they can do the swab as soon as they have symptoms and send it back to the lab. Do you offer this service remotely (Los Angeles, CA)? And if so how much does it cost per swab? If not, do you know of any clinics that offer this in California?Yes, we do offer this service remotely, and people all over the world use it. You would need to establish care as a patient at our clinic via a brief phone consultation and we could send you swabs.
Terri
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1. I would wait 3.5 months to be tested for a final result.
2. I have had trouble with the POC test – sometimes difficult to read, though not always. It is a color change dot, and our experience was that sometimes there was a very faint pink dot and we didn’t really know what to make of that. I would say a strong positive or negative would be easy to read and pretty accurate.Terri
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A. i was exposed to HSV-2 both genitally and orally but both outbreaks so far have appeared only genitally.
1. Is there any way to determine if I am infected orally as well? Is this something I should be concerned about?
There really isn’t a way to know for sure, but HSV 2 doesn’t like the mouth very much.
2. In your clinical experience, how commonly is hsv 2 contracted orally and genitally at the same time?
I would say in cases where I see true new HSV 2 infection about 5-10% have symptoms in both locations.
3. Do you know of any peer reviewed articles discussing genital to oral hsv 2 transmission risk? I understand the risk is quite low but am not sure what people are basing their estimates on and I want to know the risks so my partner can be informed before she gives me oral sex.I don’t know of any research about that. If you find it, let me know.
B. Assuming I have HSV-2 infection genitally only and avoid any sexual contact during visible outbreaks, what are the chances of transmission for the following activities (during the first year after infection / afterwards)?
1. Performing unprotected oral sex
0
2. Receiving unprotected oral sex
unknown but likely low
3. Receiving unprotected anallingus
unknown but likely really low
4. Performing vaginal sex with a condom
An average having sex twice a week for a year and the partner knows about the herpes:5. Performing anal sex with a condom
unknown
Terri -
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oh yes, it did. So the risk having sex twice per week with both couples knowing about the discordancy, using condoms while on antiviral therapy is 2-3% per year, on average. That means 2 or 3 women out of 100 will become infected on average, given this scenario.
Terri
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