February 13, 2015 at 1:47 am #3725
Dear Nurse Warren,
I am a 24 year old heterosexual female, and I’ve been having trouble sorting out my herpes diagnostic situation over the past three months and was hoping you could offer me some advice on interpreting my results.
On November 14, 2014, I had one sexual encounter with a new partner, wherein he performed unprotected oral sex on me twice and we engaged in protected penetrative sex. I had asked him whether he had a clean bill of health before we were intimate, and he assured me he did. (At the time, I didn’t realize routine STI panels do not screen for herpes.) He was my third sexual partner, and my first sexual partner in about a year and a half. A week after this encounter, we decided not to see each other any more.
(At this point, I should note that I around the same time I was first intimate with this partner, I recently joined a new gym and enjoyed taking advantage of its steam room, shampoo and soap, and towel service.) A few days after the encounter with this partner, however, I became very sick: I was achy, tired, and had a very sore throat. I wasn’t surprised that this had happened: I usually feel get sick after I am initially intimate with someone, and I knew that this partner had recently gotten over some form of the flu and a pharyngitis infection. I went to see an internist, who told me I had pus on my tonsils and an inflamed pharynx, and then prescribed me a 10 day course of amoxicillin. He also tested me for mono, which I had already contracted ten years ago and which came back negative. I’m prone to yeast infections, so I took natural herbs prescribed to me by a naturopath (who had previously diagnosed me with a minor candida infection from a stool test) during this treatment in the hope that I would ward off an infection. I’ve always had some minor, unobtrusive perianal itching that comes and goes, but during this period of time, I started experiencing more intense perianal itching—I would describe it as sort of a “wet” itch on the outside of my anus. Because I had experienced perianal itching before—both during and after yeast infections—I left it alone for a few weeks, during which time I recovered from the infection but contracted a flu-like virus for a few days. The itching persisted after three weeks, so I took two Diflucan four days apart. The Diflucan, which normally nips my vaginal yeast infections in the bud, did not do much to mitigate the perianal itching. Frustrated that the itching wouldn’t subside, on December 11, 2014, I went to see my gynecologist.
As my gynecologist examined me, she said she saw a small papercut-like lesion around my anus that might have been a herpes lesion. She cultured the lesion and it came back negative, but she ordered some blood tests to confirm. The results were as follows:
IgG for HSV 1: 0.6
IgG for HSV 2: 0.1
IgM HSV 1/2: 1.5
My doctor circled the IgM results and, based on the lesion she saw and my recent sexual encounter, diagnosed me with genital herpes and started me on a 3 day treatment of 500 mg of Valtrex. She told me that many people are unknowingly carries of the herpes virus and that it’s very likely that I contracted it from my most recent sexual partner, even if he had never experienced symptoms. She also told me that it wasn’t medically necessary to know which type I had contracted, but that I could return in two months’ time to retest for type specificity. Judging from my mild symptoms, she suspected that I had contracted GHSV1.
Naturally, I was shocked by the results. I did not have any small painful ulcers or pain urinating, and I was surprised that herpes could manifest as a small papercut-like lesion. I took two courses of the 3-day Valtrex treatment, which didn’t alleviate the itching. I also informed my partner that I had contracted genital herpes, and he promptly got tested. I don’t know which tests he requested, but he contacted me to let me know that his tests came back negative and that he had never experienced any of the symptoms associated with herpes.
I then did some research online and discovered that many specialists advise against using the Herpes IgM test for diagnostic purposes and that doctors should instead rely on type-specific IgG tests to make diagnoses. (I also found out that the normal course of treatment for an OB is 10 days of 500mg Valtrex.) At this point, I went home for the holidays, during which time the itching improved slightly but was still very bothersome. The itching had started to subside until I had a spa treatment, during which I sat in a damp swimsuit bottom for about an hour. After the treatment, the severity of the itching increased. I went to see a former gynecologist of mine about the itching and showed her the blood work from the gynecologist who had ordered the blood tests. As my former gyno was taking a look at the tests, she told me that she rarely runs blood tests on her patients who exhibit my symptoms and that blood tests are practically useless unless they’re type specific. She performed both a vaginal and rectal exam on me; my vagina showed small traces of yeast and my rectum was smooth with no fissures or hemorrhoids. She guessed that I had some form of diaper rash and prescribed me lidocaine and Nystatin cream, which helped with the itching immensely.
However, I was still very confused and nervous about my original blood results, so yesterday on February 11, I went to a new doctor who ran only the type-specific IgG tests. I conveyed to her the story above, and she agreed that the IgM test was useless and instead suspected that I had developed some sort of fungal infection around my anus that was compounded by my gym visits, wearing thongs, and occasional diarrhea. The results are below:
IgG HSV1: 0.94
IgG HSV2: <0.91
Equivocal 0.91 – 1.09
My new doctor told me that I’m equivocal—neither positive nor negative—for HSV1 and negative for HSV2. She advised that I come back and re-run these tests in a month if I so choose.
I’m not sure, however, how I should proceed, or how to interpret my equivocal HSV1 results. Given my history, it seems that I am at an extremely low-risk for contracting herpes, but I’d like to have a more definitive sense of what’s going on with my body. Firstly, what do these results suggest to you? Would you guess, based on my history and the scenario above, that I have contracted HSV1? Would an HSV1 test be accurate if drawn 12 weeks after exposure? Would the increase in my HSV1 IgG value from 0.6 to 0.94 be accounted for by some kind of variance in the chemical reactivity of the test? Would it be worthwhile to pursue a Western Blot test in a month’s time, or should I return to my second doctor at that point and request another IgG? Should I forgo re-testing all together and presume I’m negative? If I choose to forgo testing, am I putting future partners at risk of contracting the virus? If I pursue further testing and it turns out that I am indeed HSV1 positive, is it, in your opinion, medically necessary to inform future partners that I am a carrier of the virus? Maybe most importantly, what would you advise that a young woman like me do in this situation? This has certainly been a very trying experience and I’d like to be rid of this whole process for good, but of course I want to do right by my body and those of my future partners.
Thanks so much for your time; I can’t tell you how much I appreciate it.
- This topic was modified 6 years, 5 months ago by Confused1234.
February 13, 2015 at 1:49 am #3726
Sorry, I should mention that my former gynecologist—the one back home—noted several small tears around my anus, which is how she diagnosed me with “diaper rash.”
February 13, 2015 at 4:16 pm #3729
I think first you need to know for certain if you have HSV 1 infection or not. The western blot would be the best way to determine this, yes. If I am doing my math correctly, it has been three months since the encounter in November so you might want to wait just a bit longer. Remember that more than half the US population between 14 and 49 has HSV 1 infection so it is very common.
What even the western blot cannot tell you is where you are infected. If you want to know exactly where the infection is, you need to have a lesion that tests swab test positive. There is nothing in your post that makes me certain that what you experienced was a primary outbreak of HSV 1 genitally, no. Is it possible, yes.
The IgM antibody test is NOT useful and has many false positives that confuse the situation greatly. Please ignore it.
I’m wondering if you perhaps you should investigate a fungal infection with an organism not easily treated with Diflucan.
How is the itching now?
February 13, 2015 at 5:05 pm #3731
A quick follow up question: How accurate is an IgG test for HSV1 three months after exposure? In your experience, do HSV-1 IgG index values often increase from three to four months? If I do test positive for HSV-1, is there a consensus among the medical community about informing future partners, particularly if I don’t know where I have the virus?
I live in New York, so obtaining the Western Blot test might be difficult. In a month’s time–which will be about 16 weeks from exposure–I’ll be home in Florida and can run the test then. Have you experienced any problems with Western Blot tests sent in from Florida? To order the Western Blot test, should I call 503-226-6678?
The itching has subsided for the most part, but I do experience short periods of noticeable itchiness. Like you, I also wonder whether I should investigate the possibility of a Diflucan-resistant fungal infection, but I’m not sure where to turn to for advice. My gynecologist insists on prescribing me more Diflucan–do you have any recommendations for alternative resources?
Thanks again for all your help.
February 14, 2015 at 2:43 am #3734
In less than a week, we will be able to help you with the western blot, living in New York, but it will be cheaper to do in Florida. Yes, that is the phone number.
In terms of the fungal infection: It is possible to obtain a culture for the yeast and determine if it is a sensitive strain. We do order that for our patients so I know it exists. I think you should talk with your doctor about that. You symptoms sound so yeasty!
There is no consensus about disclosing HSV 1 to partners really. I’ve heard the whole range of responses from my colleagues. What do you think would be best?
February 28, 2015 at 9:34 pm #5265
Hi Nurse Warren,
I’ve ordered the Western Blot test, which I will take in a month. I had tried to put this out of my head until then, but for the past week I’ve been sick with a cold, and today I noticed a small cut in the same area that my doctor had swabbed back in December. I can’t tell whether this is an outbreak or a small tear from a yeast infection. I have been feeling under the weather and a bit itchy since my cold started, and my diet has been especially poor over the past two weeks, so I’m wondering if this is a symptom of a yeast infection or another OB. In HSV positive individuals, do lesions usually occur in the same place during outbreaks? In your experience, do many people have outbreaks that consist of a single tear or paper cut-like lesion?
A few more questions: in your experience, have people often tested positive for HSV even if their partners have tested negative? My partner tested negative, so I’m having trouble reconciling his negative diagnosis with my potential positive one. And is it possible to arrange to have the Western Blot done in Florida? Like I said, I have the test scheduled a month from now, which will be 18 weeks after exposure. I’ll be in Florida in two weeks—which will be 16 weeks post-exposure—and would love to test earlier, if possible.
Thanks so much!
March 1, 2015 at 5:07 am #5268
Often herpes lesions are in the same location, but sometime they aren’t. Sometimes they appear as a paper cut but herpes lesions, in my experience, tend to be a bit rounder than a cut. or least oval.
sometimes people of course are positive and their partners are negative, yes of course. People can be in discordant relationships for years!
We can arrange the test in Florida, yes. You would need to call Rene in our office on Monday to arrange that if you want to do it. She can give you all the details.
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