Confusion in the Midwest

[doubled]

Hi Terri:

I am a 42 year old African-American woman. I have been married for 9.5 years. At the end of December 2014, I began a sexual relationship with another man. We had oral sex (unprotected) and vaginal sex (protected) perhaps twice a month until the end of March. During that time, I did not notice any strange symptoms. After I ended the affair, I began to itch in various spots. On my knees, my feet, my buttocks, my arms, hands, armpits, around my mouth, face, and nose. I have high blood pressure and diabetes and am taking many meds. I was unsure if the itching was caused by the various medications or by my illnesses. I also developed a fine rash in my decolletage area, on my neck, ears, and two spots that resembled canker sores in my mouth. My PCP prescribed Ketaconazol and Magic Mouthwash. The two spots in my mouth disappeared after a few days. During this time, I avoided sex with my husband.

Approximately 4.5 weeks after the last encounter with the other man, I requested an HSV exam. I tested negative for HSV I and II. I then had unprotected sex with my husband. I learned later that I was given an IGM exam. While doing research on the internet, I read that the IGM test is basically useless. I continued to have these weird itching occurrences. I checked my vagina regularly and did not notice anything unusual like sores or lesions. In Mid-May, I developed a slight sore throat and what appeared to be a rash in the back of my throat. I saw my dentist and was told it appeared that I was having an allergic reaction, I was prescribed Niacin mouthwash. I also saw an allergist because I continued to itch. He tested me for known allergens and said I did not appear to be highly allergic to anything. He also ordered several blood tests, including an immunoglobulin test, which I know included a test for IGG and IGM. My levels were normal.

I took an HSV IGG test 11 weeks after sex with the other guy. Results:

HSVI – 8.0 (Positive) – I do not recall having a cold sore ever.
HSVII – <90 (Negative)

After receiving the positive result, I told my husband about the affair. He was then tested 8 weeks after we had sex. His results are as follows:

HSVI – <90 (Negative)
HSVII – 3.6 (Positive)

We are both confused by the results. He advised me that he has not had sex with anyone since we got married. He was tested for HSV for the 1st time now. Here are our questions:

1. Is it possible that I am also positive for HSVII and my HSVI status is preventing HSVII from showing positive? Would you recommend that I retest for HSVII with the Western Blot? How do we arrange this?
2 Since my husband’s HSVII status is right above the regular 3.5 threshold for false positives, do you recommend that he retest with a Western Blot for HSVI and HSVII? He has not had any symptoms.
3. I know that HSVI is usually oral and II is usually genital. Can we determine where we are infected?

Thank you in advance.

[Terri Warren]

1. Is it possible that I am also positive for HSVII and my HSVI status is preventing HSVII from showing positive? Would you recommend that I retest for HSVII with the Western Blot? How do we arrange this?

The screening test is actually pretty good at picking up HSV 2 but if you want a western blot for confirmation, you can call the clinic and we can arrange that for you.

2 Since my husband’s HSVII status is right above the regular 3.5 threshold for false positives, do you recommend that he retest with a Western Blot for HSVI and HSVII? He has not had any symptoms.

Good question. Yes, I noted that it was just about 3.5. Let me ask you this: would you as a couple do anything differently if he was HSV 2 negative vs. positive? That is, would you do thing to avoid you getting infected if indeed you are not infected? If the answer is yes, you would do things differently, then I would advise a western blot. He is just on the little cusp. I think statistically he will be positive on the western blot but it is interesting that you have not yet become infected with him being unaware that he is infected.

3. I know that HSVI is usually oral and II is usually genital. Can we determine where we are infected?

You can’t determine where you are infected with having a positive lesion swab test from either the mouth or the genital area (waist to mid thigh). However, if he is HSV 2 positive, I would make the assumption that he is genitally infected because for the vast majority of people who are HSV 2 positive, we can recover virus from the genital tract.

Terri

[doubled]

Hi Terri. Thank you for your response. Just a few more questions:

1. Would you recommend that I wait until 16 weeks after my last sexual encounter with the other guy to retest using WB? That would be mid-July. Or, should I wait until 16 weeks after last having sex with my husband to test? That would be the end of August.
2. Also, should my husband wait until 16 weeks after the last time we had sex to confirm his results with WB? Or, do you recommend that he test with the WB now since he already received a possible positive diagnosis?
3. To request the WB, should we contact your office? We have a Quest Lab near us that can draw blood. I’ve read your responses to prior posts, but I want to make sure I understand how this works.
4. Lastly, my husband doesn’t know if his possible HSV2 is genital or oral. And I don’t know the location of my HSV1. I realize that most cases of HSV1 are oral and most cases of 2 are genital. However, if he has HSV2 orally and I have HSVI orally, can I also contract HSV2 orally? I’m wondering the same if the location of my HSV1 is genital? Can I contract HSV 2 from him genitally?

Thanks in advance, Terri.

[Terri Warren]

1. Would you recommend that I wait until 16 weeks after my last sexual encounter with the other guy to retest using WB? That would be mid-July. Or, should I wait until 16 weeks after last having sex with my husband to test? That would be the end of August.

I would wait 16 weeks after your last contact with the other person. I’m assuming your sexual relationship with your husband is ongoing to it won’t be useful to base your test timing on sex with your husband.

2. Also, should my husband wait until 16 weeks after the last time we had sex to confirm his results with WB? Or, do you recommend that he test with the WB now since he already received a possible positive diagnosis?

Now

3. To request the WB, should we contact your office? We have a Quest Lab near us that can draw blood. I’ve read your responses to prior posts, but I want to make sure I understand how this works.

Yes, you contact our office to set up a phone consult at which time we will arrange for the western blot at a Quest lab near you. Only I can arrange this through Quest in the US right now.

4. Lastly, my husband doesn’t know if his possible HSV2 is genital or oral. And I don’t know the location of my HSV1. I realize that most cases of HSV1 are oral and most cases of 2 are genital. However, if he has HSV2 orally and I have HSVI orally, can I also contract HSV2 orally? I’m wondering the same if the location of my HSV1 is genital? Can I contract HSV 2 from him genitally?

We can’t know where your oral infection is without a lesion somewhere. His HSV 2 is 95% likely to be genital.

Terri

[Author]

Posts