Exposure and results

[Hsv123]

Hi Terri,

Thank you so much for offering this support! I am a medical student and I see this forum as a better resource than any pertaining to HSV!

I will attempt to be brief in explaining my exposure, subsequent symptoms, and question but I’m afraid I will fail.

I had 2 instances over 3 days of unprotected penetrative sex with a girl who admitted to having multiple recent sexual partners. She had a full panel test the day after our first encounter. Of note:
HSV-1 IGG: <.91 (-)
HSV-2 IGG: 1.08 (equiv)

I felt flu-like symptoms 1 week after last encounter with persistent burning in thigh and between inguinal folds that subsided after 1.5 weeks. I had potential atypical lesions which were not painful. With these symptoms I received a positive strep test and swab of lesions which came back negative (RN described them as very atypical of HSV and unlikely related).

Six weeks after exposure I again developed flu like symptoms, fatigue, similar nerve pain and and full body rash. No painful genital lesions. Worried about HIV primary I got testing:

HIV RNA: (-)
HIV 4th gen: (-)
EBV: IGM and IGG titers (+) high confirming recent infection. (And possibly related to previous partner’s equivocal?)

At 55 days post exposure I had HSV serology performed:

HSV 2 IGG: <.90 (-)

I am still having intermittent nerve pain in left thigh/inguinal region and mons pubis that occasionally radiates down left leg. After the mono diagnosis, I am tempted to attribute this to EBV nerve pain. (I also have a small painless red bump on mons pubis – likely ingrown hair.)

Finally to my question:
After atoning for my last indiscretion, I have started seeing a very nice nurse who I do not want to put at undue risk of HSV acquisition. Considering my hx, and clinical picture would you suggest further testing? I need help weighing the risk of IGG false positive with potential early false negative.

Thank you again for setting up such a great resource. I eagerly await your reply.

-HSV123

[Terri Warren]

I am assuming the HSV results that you posted were hers, not yours?
Do you know anything about the timing of her sexual encounters prior to you? If she had recently had another partner with unprotected sex, the equivocal could represent a new infection or it could just represent a negative, as most equivocal results do.
I’m not sure about the accuracy of the EBV IgM test. For HSV, the IgM is most often a false positive, so I’m 100% clear that you have a brand new infection given that your IgG is also positive. That’s not making much sense to me.
If you want to take an IgG test you can, with your eyes wide open to the possibility of a false positive, requiring a western blot for confirmation. You could also have sex with this new person IF you use condoms with every intercourse and they stay intact. Condoms reduce transmission from infected males to uninfected females by 96%

Terri

[Hsv123]

Terri,

Thank you kindly for your response. To make things clearer:

The initial HSV-IGG of 1.08 was from the girl I had sex with. I believe she was recently with other partners, so this could represent a recent infection.

The latter HSV-IGG of <.90 was from me (at 55 days post exposure).

A side note: THE EBV titers were also mine. The titers and mono spot was reactive which definitely showed a recent mono infection (and was what resulted in my full body rash).

The question at hand: Should I perform a second IGG serology for myself at 10 weeks, 12 weeks…in light of hx and possibility of false pos.

Thank you again,
HSV123

[Terri Warren]

Ok, thanks for the clarification of a positive mono spot test.
Yes, you could do another IgG at 10 weeks. I think if that’s negative, you likely don’t have HSV 2. The IgG test for HSV 2 picks up 92% of infections compared to the gold standard western blot. But be so aware of the potential for false positives! Reach out to me as needed.
Terri

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