Confused

[vaanwota]

Hi Terri. In July last year, I received unprotected oral sex (I’m male). 4 months later i noticed some sort of blister under the head of my penis. I went to my doctor who suspected it was herpes. He swabbed it, but the results came back negative. A week later I saw a urologist who suggested I had thrush and also suggested that I have igm tests for type 1 and type 2. Both of these tests also came back negative (both tests were taken more than 16 weeks after the risky exposure). She also prescribed fluconazole for thrush.

This is where my confusion started: I was relieved to have negative tests, however the urologist said that I should assume a positive result from the visual diagnosis, in spite of negative swab and igm tests. This left me in no mans land. I have spoken to a few herpes/sti experts since seeing the urologist, all who say that I should assume the negative test results were correct. I haven’t had any more blisters since the first outbreak, however I do seem to get regular discomfort in my urethra, especially after ejaculation. I have in the past suffered quite badly from thrush, and candidiasis after antibiotics and during last summer I had to have 3 courses of antibiotics for flu and and a chest infection. Since then I have been using fluconazole often to help with the thrush. This has helped, but it keeps returning – especially if I drink too much alcohol (which has been far more regular as a result of my constant anxiety about herpes).

I really don’t know what to think. Do I keep getting bouts of thrush? Is the urethra discomfort caused by herpetic urethritis? Should I get tested for herpes again? Was 16 weeks enough time for antibodies to show up? Should I try the western blot test? Am I being unbelievably over-anxious and should just accept the blood diagnosis and move on with my life?
Please give me any advice that you can?

[Terri Warren]

You had the wrong antibody test. You need an IgG antibody test, not an IgM test. That test has many problems with both false positives and false negative. Are you sure it was an IgM? If you get the IgG test and it is negative then I think you can have a bit more confidence. However, if you are particularly worried about HSV 1 from the oral sex (which is the biggest concern with receiving oral sex), then the western blot if more sensitive for HSV 1 than the IgG test.

Please ask more questions if you have them.

Terri

[vaanwota]

hi terri. I’ve just checked through my emails with the urologist and I had both IgG and IgM tests, both of which came back negative for type 1 and 2.

[Terri Warren]

So that’s great. However, even the IgG antibody test misses 1-2 out of 10 HSV 1 infections. So the western blot is better. but if the HSV 1 antibody test is positive on the western blot, you will not know if the infection is oral or genital.

Terri

[vaanwota]

So, given I’ve had negative swab, IgG and IgM tests, would you still recommend the Western Blot test in my case? How accurate is this test and how long does it take for the results to come back (I live in the UK and I don’t think there is anywhere here that does the test, so I’d need to send a blood sample to you)?
Does it test for type 1 and type 2?

[Terri Warren]

I think you are in touch with my office now for a western blot? If not, yes, it looks for both HSV 1 and HSV 2. You can send a blood sample to us and you can talk with Roger in our clinic about arranging that. If you are still concerned about HSV 1, the western blot is better than the screening test. I cannot give you the exact percentage of HSV 1 that the test picks up.

Terri

[vaanwota]

Thanks Terri. I have been in touch with your office. Many thanks for your advice and help.

[Terri Warren]

You’re welcome

Terri

[vaanwota]

Hi Terri
Since my last post on your website I had, what I thought might be another outbreak. Again, the symptoms were very confusing as they seemed very much like thrush (and since I am very susceptible to thrush, especially after drinking a lot of beer, I really wasn’t sure what to think). So I paid a visit to my doctor, who didn’t feel that there was enough of an outbreak to swab. So he suggested a PCR blood test, which he felt was the most accurate – especially in light of the fact that I’d previously tested negative to a PCR swab, and IGG and IGM antibody tests. The PCR blood test result came back today as negative, which I am very relieved about. Prior to having this test, Roger in your clinic very kindly arranged for the Western Blot kit to be sent to a clinic for me in the UK. The clinic called me last week to say that they had received it.

Do you still think that the Western Blot test is still necessary after 3 separate and different negative test results? (If not, I can go to the clinic and pay for the kit to be sent back to you)

How accurate is the PCR blood test?

The doctor I saw, who is also a dermatologist, also thought that the PCR swab test that I had last year is much much more accurate than the viral swab – and combined with the negative IgG result felt that it was unlikely that I had either type of herpes.

I really need closure. What do you think is best for me now? I feel like I need to get a grip and accept the negative diagnosis but all the months of uncertainty has played havoc with my emotional state.

Many thanks

[Terri Warren]

The PCR blood test is NOT recommended at all. Unfortunate that it was done.
Whether you do the western blot or not is up to you. If you feel like you can accept the results of your negative screening tests and move on, then don’t do it. If you can’t, then get the blot. It’s actually pretty straightforward.

Terri

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