GSHV-1 Diagnosis with Negative Swab & Low IgG

[Sisssty12]

Wife was having discomfort on her rectum, noticed a white bump/patch that was painful. She went to Dr who looked at the spot & didn’t consider HSV but prescribed steroid cream which seemed to make things worse. After a few days the area around her urethra became red/irritated then a bump/sore appeared on the lip of her vag that she described as something between a canker sore and a fever blister, then her genital area became red & inflamed & painful. We were not thinking HSV (long married). She went back to Dr who started thinking HSV & ran swab test of bump plus IgM & IgG tests. Everything was negative for HSV2, and for HSV1 the swab test was negative, but IgM was “positive” (IgM>1:40) and IgG was 1.89. The Dr determined she had GHSV1 & prescribed Valtrex. After 3-4 days things started to clear & pain started to cease, except the white patch on rectum remained but no longer painful.

My wife says she had “cold sores” when she was a kid but is unsure if they were canker or fever blisters. I’ve never had fever blisters or other HSV1 symptoms. We never even thought to get tested.

My wife is adamant she has been faithful, & I know I’ve been faithful & I’ve never had a reason to suspect her (she could be lying, but I don’t think so). Still, this is causing stress in our marriage, because this came from somewhere (assuming it’s GHSV1).

1-Dr said she could’ve gotten HSV1 years or decades ago without symptoms and it lay latent in her system unl now. Does GHSV-1 work that way (1st outbreak occurring years later and still severe)?

2-Dr said transmission can occur via hand (mouth to genitals), even from same person, suggesting my wife or I have OHSV1 without knowing it & inadvertently gave her GHSV1. Is this a thing?

3-Did Dr administer IgG test too soon (within 2-wks of symptoms)?

4-Given low IgG results & negative swab test could this be false positive?

5-What does IgM>1:40 mean?

6-If this isn’t GHSV1 what else could it be?

7-Is next step West Blot (we want closure)

[Terri Warren]

1-Dr said she could’ve gotten HSV1 years or decades ago without symptoms and it lay latent in her system unl now. Does GHSV-1 work that way (1st outbreak occurring years later and still severe)?
Yes, it surely can but the negative swab test of the lesions is confusing now.

2-Dr said transmission can occur via hand (mouth to genitals), even from same person, suggesting my wife or I have OHSV1 without knowing it & inadvertently gave her GHSV1. Is this a thing?
Not really, no

3-Did Dr administer IgG test too soon (within 2-wks of symptoms)?
The timing of the IgG test has nothing to do with the timing of symptoms, it has to do with timing of any occurrence that might have resulted in infection.

4-Given low IgG results & negative swab test could this be false positive?
It could be

5-What does IgM>1:40 mean?
It should never have been done – the CDC says never do IgM testing. It’s got a high rate of false positives – not wrong every time, but wrong very often.

6-If this isn’t GHSV1 what else could it be?
I don’t know.

7-Is next step West Blot (we want closure)
Well, before we do that, let me ask you a few questions.

Are you the giver of oral sex to your wife and if the answer is yes, when was the last time before she developed these symptoms?

Terri

[Sisssty12]

About 10 years ago my wife went thru breast cancer, double M, radiation, chemo, the works. Since then she does not enjoy receiving oral due to dryness, etc. It’s probably been 5 or more years since the last time I even tried with her.

[Sisssty12]

Wife reminded me that I did kiss up her leg to her inner thigh one nite in February (just after Valentines Day). I had forgotten that. She stopped me before I got “there”, but I did kiss her upper/inner thigh.

[Terri Warren]

The contact with her inner thigh isn’t what might transmit HSV to her genitals.
So at this point, we aren’t sure that she has HSV 1 at all – her index value is low. The western blot would simply tell us if she indeed has HSV 1 or not. It will not tell us the location of her infection. If she has genital HSV 1, she has had it a long time and it may not recur for a long time. This may be challenging to nail down. But the western blot would at least tell us if she has HSV 1 at all or not.

Terri

[Sisssty12]

So it’s possible this “outbreak” is not HSV1 but something else, but she has an old HSV1 infection?

Is there anything telling or unique about the order her symptoms appeared – white patch/bump on rectum, then a few days later inflamed/irritated urethra, then a few more days & bump/sore appears on lip & vagina becomes red/inflamed?

My wife is adamant that she has not been unfaithful, & I believe her, but we still would like confirmation of hsv1 even if it doesn’t really tell us much more.

FWIW, Here is more detailed test report (i was slightly off on igg for hsv1, but basically the same)

HSV Culture w/reflex to typing
Your value – see note
Culture negative for herpes simplex virus
Collected from vagina/vaginal specimen (SWAB)
ARUP Laboratories

Herpes simplex virus (HSV) 1 & 2 IGM Screen
Herpes simplex virus 1 IgM
Your value – Positive
Flag A
Herpes simplex virus 2 IgM
Your value – Negatve

HSV 1 IgM Titer
Your value 1:40
Standard <1:20

Components results
HSV 1 IgG type-Specific Ab
Your value – 1.84 Index
Standard <0.90 Index
Flag H
HSV 2 IgG type-Specific Ab
Your value – <0.90 Index
Standard <0.90 Index

Is it at least reasonable to conclude from tests that this is not HSV2

[Terri Warren]

Yes, it’s reasonable from these test to assume that she does not have HSV-2. And it is questionable whether she has HSV one or not. And you are correct, even if the HSV one antibody test is correctly positive, it does not tell us where that infection is. If you want a better confirmatory test it is the herpes western blot from the University of Washington. She can work with her own provider to get that test done or she can work with me. She should obtain the kit from the University of Washington by calling 206-685-6066.
I think it is fine to want to know if she has HSV one, but what would you do with the results? Have you been tested to know if you’re positive for HSV one? If you’re both positive nothing needs to happen here and since you’ve been together for a very long time, even if she is positive and you are not, does it really make a difference?

Terri

[Sisssty12]

Thanks for everything. At end of day this comes down to me believing her and I do. She’s asked me to get tested so I am. She has a followup visit in a month & is going to ask about Western blot. If they say no she’ll go thru you, she wants to know as much as I do.

Last question – She wants me to test, given I’ve had no symptoms should i just do standard igg or go straight to western blot?

[Sisssty12]

Bump, actually a few more questions.

If the swab test had been positive, would that along with somewhat harsh symptoms & a low positive IGG imply a recent infection (first OB), or is there just no way to know?

Wife wants me to test, given I’ve had no symptoms should I just do standard igg or go straight to western blot?

Does she need to wait 12-weeks to do western blot (it’s been +/- 7-weeks since symptoms first appeared)?

[Terri Warren]

The odds that you have HSV 1 are 1 in 2. About 50% of people in the US have HSV 1 and that increases with age. Or is she wanting you to do the blot for HSV 2?
If you and she want to do the blot, you can do it anytime – testing is not related to timing of symptoms, it is related to timing of last sexual encounter, and in this case, we are concerned about oral sex, not intercourse for HSV 1 and enough time has gone by for an accurate blot now.

Terri

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