Confusing results and symptoms

[LookingForHelp123]

My bf & I had unprotected sex in Feb 2023. 2 days later I developed what looked like a yeast infection. Basic STI panel came back negative. My boyfriend experienced what he thought was hsv blisters 9 days after sex. We both did a full panel & he was negative. I was negative for HSV2 but positive for HSV1 IgG 22.60 (I’ve had cold sores since I was a child) & we had not had oral sex at this point. His PCP dx it as a bacterial infection. 3 weeks after a condom breaks, I develop itchy sores. The gyn was not concerned about herpes given our test results & I’m dx with BV. 6 weeks later he gets another outbreak with swollen groin lymph nodes, he tests positive for HSV2 IgG ~6.5.

May 2023- HSV1 IgG 20.70, HSV2 IgG 1.47; about 3 days prior to my test, I took 1000/mg Valtrex for 3 days
June 2023-HSV1 IgG 21.80, HSV2 IgG Negative; the day before I took this test, we had unprotected sex & a week later I had another sore pop up, My PCP orders a full STI panel. She prescribes me 1000mg Valtrex for 5 days if anything pops up again
July 2023- The following week I get a sore in that same spot & take the Valtrex for the full 5 days. I’m negative for everything, she ordered HSV 1/2 DNA PCR
August 2023-I ask for another IgG; HSV1 IgG 22.00, HSV2 IgG Negative
Late Sept 2023-Oct 2023-We have unprotected sex & 5 days later I get a reaction. It’s cultured 4 days later. I took Valtrex for 3 days, 1000mg/day & it didn’t do anything. My gyn swabs it. After showing a picture she is unable to diagnose based off appearance and symptoms. Those results come back negative for HSV1/HSV2

Could my history of Oral HSV1 be skewing the results of HSV2?
Would the use of Valtrex impact the results? Those are the only times I have taken it
Have you ever seen someone have a reaction like this with a positive partner and not have it be genital herpes?
Due to his negative result and then positive, followed by my repeat negatives can we assume he got this from his previous partner?
Any other advice/input?

[Terri Warren]

There are something here that are truly wrong OR you didn’t post a full picture OR I’m missing something. Each time a sore showed up, it should have been swab tested using PCR method. Doing blood tests alone in people who have sores is a big mistake. I see some of the later visits involved swabs, but I don’t see that for the earlier visits. This is especially true given your boyfriend has HSV 2, if the positive IgG the second time is accurate and with sores, it likely is.
I don’t think you’ve taken enough Valtrex to skew the result, no
Whether a former partner has a role in this depends on how long before having sex with you he had sex with someone else.
Your high HSV 1 could be rolling over into some cross reactivity with HSV 2, yes. Or the IgG is missing an HSV 2 infection in you.
PCR blood test is absolutely NOT what should be done. HSV is not in the blood of people, except very rarely in really sick people or newborns. I think your doctor was confused and when to use PCR (swabs) and when not to use PCR (like blood testing).

Terri

[LookingForHelp123]

Hi Terri,

Thank you for your response. I am worried there is something wrong that is not being caught with either him or myself. Unfortunately, where we live it is very hard to get a culture, both times with his outbreaks his PCP, private clinic and dermatologist never cultured it. This last time it happened to me, I called several urgent cares, local health district and my doctors, and most wanted to only do the blood test because they said they believe it’s more “accurate” and without being able to get in quickly I am afraid that my culture is incorrect or on the off chance it is correct, some underlying infection is being missed. My reactions have looked quite different from his, he had typical clusters at the base of his penis. Mine show as random sores in various locations, they also don’t have that tingly feeling I’m used to getting before a cold sore. His last encounter with his previous partner was in late November/early December. My previous partner was only a couple weeks prior to him.

-That is why I’m wondering if you have ever come across someone in a situation similar and had it turn out to be some kind of fungal or bacterial infection, even a different type of viral infection?
-Is there somewhere I can get a culture kit myself so if it happens again I can swab immediately?
-Should I wait until the one year mark and try another blood test to rule out an genital HSV2 infection?
-I’ve had some people mention that mine could be genital HSV1 but I was under the assumption that would be extremely rare given I’ve had oral HSV1 since I was around 4 or 5 years old. Is that correct?

[Terri Warren]

The blood test is notoriously poor. You said a couple of weeks since you last had sex with someone else. If you contracted HSV 2 but had not had enough time to have made antibody, it could be that you infected your current partner. You should do another IgG test in about 10 weeks. You could get a swab test kit and swab yourself if anything shows up in either of you. I think it would be extremely unlikely that you would now get HSV 1 genitally and he goes from negative to positive on the HSV 2 antibody test.

Terri

[Author]

Posts