Concerned to Know my Status

[ConcernedToKnowMyStatus]

Thanks in advance, Terri. First background, then questions.

July 4th of 2022 I had protected sex, gave and received unprotected oral, and shortly thereafter had confirmed HPV symptoms. About 3 weeks later, I developed UTI-like symptoms (need to urinate, sensed irritation at the tip of penis), and was concerned it was herpes-induced urethritis. A doctor told me everything looked fine on that front, but I got IgG blood-tests (1 month from encounter) to be sure and they were negative for HSV1&2.

This past Saturday (June 17th) and Monday (June 19th), I had my first sexual encounters (single partner) since July 4th of 2022. By Monday, I felt extremely fatigued. Shortly thereafter my inguinal lymph nodes on that side (which, I add, had already been swollen for the past year) became even more enlarged, staying that way for several days. (They themselves were never tender, but they caused pain when I sat or stood in certain positions.) Then I noticed a small number of scattered, faint, painless red marks in parts of my pubic area and near the base of my penis, one of which looked pimple- or blister-like. I saw a dermatologist a day later, but that mark had ‘popped’ and become just a faded red mark by then. The dermatologist said it looked like a blister in the pictures I showed her, but – when I explained it wasn’t painful or sensitive – concluded it “definitely” wasn’t herpes. Overlapping this period I developed the same UTI-like symptoms again, with faint redness in the tip. These were prominent for a day, faint the next day, and then not there at all.

Yesterday morning I got another herpes antibody blood test. Now questions:

1 – Am I right to think that this is probably herpes?
2 – I worry this was a recurrence of a July 4th-acquired infection triggered by the sex on Saturday. If so, how likely is it that I passed this to my new partner (assuming she was uninfected before)? We had sex w/ condoms twice on Saturday, once on Monday. She has yet to notice symptoms

[ConcernedToKnowMyStatus]

Hi Terri,

Adding some follow-up info and questions.

My second antibody test came back negative for both IgG and IgM for both strains.

3 – I’m wondering how good the IgG result is as evidence that I don’t have an old infection (i.e. older than my most recent June 17th & 19th encounters, which were my first encounters since roughly a year prior). (I’m assuming given what I’ve read that the IgM result isn’t very good evidence of anything. Is that right?) I’m wondering this especially in light of your handbook’s claim that “the other problem with the IgG test is that it misses about 30% of HSV-1 infections.”

4 – Relatedly, I am wondering if it’s understood why the IgG test suffers this HSV-1-sensitivity problem when it comes to HSV-1 infections. Is it a problem purely on the side of the test, such that it might make sense for me to have another IgG test performed in the hopes of adding further evidential support on top of this most recent result? Or do the cases where the test fails to detect the HSV-1 tend to be cases where the individual’s HSV-1 (or immune system, or whatever) happens to be behaving differently in a way that makes it harder to detect the infection? If that were true, I imagine running another IgG test wouldn’t supply much by way of additional evidence.

5 – Relatedly, is this HSV-1-sensitivity problem on the part of the IgG test something that improves over time, such that I might regard my test as being at all more trust-worthy given that it’s been roughly a year since the encounter I’m concerned to rule out as a point of infection?

More miscellaneous information: My first message neglected to mention that the recent three encounters were condom-protected; not that this would seem to matter greatly, given that the red marks I encountered were in non-condom-protected areas.

Thank you again Terri. Best.

[Terri Warren]

1 – Am I right to think that this is probably herpes?
No, not at all

2 – I worry this was a recurrence of a July 4th-acquired infection triggered by the sex on Saturday. If so, how likely is it that I passed this to my new partner (assuming she was uninfected before)? We had sex w/ condoms twice on Saturday, once on Monday. She has yet to notice symptoms
The condoms will reduce transmission by 96% so even if you have herpes, which I doubt.

Terri

[Terri Warren]

3 – I’m wondering how good the IgG result is as evidence that I don’t have an old infection (i.e. older than my most recent June 17th & 19th encounters, which were my first encounters since roughly a year prior). (I’m assuming given what I’ve read that the IgM result isn’t very good evidence of anything. Is that right?) I’m wondering this especially in light of your handbook’s claim that “the other problem with the IgG test is that it misses about 30% of HSV-1 infections.”
The IgG test picks up 92% of HSV 2 and you symptoms don’t sound herpetic to me

4 – Relatedly, I am wondering if it’s understood why the IgG test suffers this HSV-1-sensitivity problem when it comes to HSV-1 infections. Is it a problem purely on the side of the test, such that it might make sense for me to have another IgG test performed in the hopes of adding further evidential support on top of this most recent result? Or do the cases where the test fails to detect the HSV-1 tend to be cases where the individual’s HSV-1 (or immune system, or whatever) happens to be behaving differently in a way that makes it harder to detect the infection? If that were true, I imagine running another IgG test wouldn’t supply much by way of additional evidence.
Once the test misses an infection, I see it missing it repeatedly

5 – Relatedly, is this HSV-1-sensitivity problem on the part of the IgG test something that improves over time, such that I might regard my test as being at all more trust-worthy given that it’s been roughly a year since the encounter I’m concerned to rule out as a point of infection?
Nope, it doesn’t get better over time

Terri

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