HSV-1 Confusion

[NoMansLand]

Dear Terri,

First of all, thank you for such an informative service. My situation is as follows:

I’m a 29 yo male. I had unprotected oral sex (both gave & received) on multiple occasions in Jan 2015, Aug 2015 and Nov 2015. Did not have intercourse.

I took a complete STD scan (via one those online services) in Feb 2015 and it came back normal. I took another such test the last week of Nov 2015 and everything was negative with the exception of HSV1, which had a value of 1.46. To be exact, the results read as follows:

HSV 1/2 IGG, Type Specific AB HerpeSelect
HSV 1 – 1.46 H
HSV 2 – 0.17

In terms of symptoms, I can’t see any bumps, sores, ulcers or lesions in my oral or genital areas. I have intermittent tingling & itching sensations in my genital area that have been going on for a few weeks (coinciding with my test results) but they usually last only a few seconds and happen a few times throughout the day (usually when I am not busy or pre-occupied with something else). I suspect they are anxiety related. It has now been a full 32 days since I had any kind of a sexual encounter. I don’t remember getting cold sores as a child, but I may have. About once a year or every 2 years, I get a red bump in my upper lip in the same spot – it is usually tender and somewhat painful, but doesn’t contain any puss and goes away on its own after 72-96 hours.

My questions:

1. Do you ever see false positives for HSV 1? I read on your forum that false positives for HSV 2 happen on occasion, but wasn’t sure about HSV 1.
2. If one is recently infected with HSV 1 (either orally or genitally) – is there usually always an outbreak of some sort or can one be totally asymptomatic?
3. How long do these feelings of tingling, itchiness etc last before an outbreak? Considering the length of time I have felt them without any kind of an outbreak, could they be psychosomatic?
4. The red spot I described above – is that a cold sore or more like a pimple?

Thanks so much.

NML

[NoMansLand]

And one more thing I forgot to ask: can this higher HSV1 result be due to another issue such as a recent flu shot, exposure to EBV or HPV virus or something else?

[Terri Warren]

1. Do you ever see false positives for HSV 1? I read on your forum that false positives for HSV 2 happen on occasion, but wasn’t sure about HSV 1.

Yes, we have seen false positives on HSV 1. However, the range for the possibility of false positives for HSV 1 appears to end lower – virtually everyone in our study of ELISA compared to western blot confirmed when their HSV 1 value was above 3.0 vs. higher for HSV 2.

2. If one is recently infected with HSV 1 (either orally or genitally) – is there usually always an outbreak of some sort or can one be totally asymptomatic?

It can be totally asymptomatic. In your case, the thing you get on your lip does sound like it could be a cold sore. At this point, you could do a couple of things – you could certainly get a PCR swab test of any red lesion that shows up on your lip and/or you could get a herpes western blot to confirm your HSV 1 status.

3. How long do these feelings of tingling, itchiness etc last before an outbreak? Considering the length of time I have felt them without any kind of an outbreak, could they be psychosomatic?

Well, it could just be overobserving – for most people the prodrome of herpes does not go away so quickly. Prodrome happens before an outbreak, and it usually lasts for a day or two.

4. The red spot I described above – is that a cold sore or more like a pimple?

See above – I would lean toward cold sore if your western blot is positive.

We don’t know exactly what causes false positives – it could be some other virus – we just don’t know.

Terri

[NoMansLand]

Hi Terri,

Best wishes to you and your team for the new year.

Id like to follow up on my earlier post as I believe I have 2 follow up questions remaining. I got another STD panel done two wks ago (about a month after the test that came back positive) and this time my results came back negative for both HSV 1 & 2. There were no numerical values on the lab results, just the indication <0.91.

FYI,the first test (which came back poz) was conducted by Quest and the second LabCorp.

I continue to have no visual symptoms of redness, sores, etc either orally or genitally. So:

1. Which do you think is a more likely scenario? That the Quest test came back with a false poz (recall that my value was 1.46) or the LabCorp test missed the HSV infection?

2. Should I take another Quest administered test in a month or so?

3. Should I confirm with Western Blot?

Thanks so much Terri.

[Terri Warren]

I would feel pretty confident about the HSV 2 result if there has been no intercourse, but the HSV 1 result could be incorrect as the screening test misses one of four infections with HSV 1. I wouldn’t venture a guess about which is correct.

I don’t think I would bother with another screening test if you really want to know what your HSV 1 status is. You could continue to get mixed results. If you were our patient at the clinic, and you really wanted to know about your HSV 1 status, I would recommend that you get a western blot 16 weeks after the last concerning encounter. That is far more accurate for HSV 1. Remember that over half the US population has HSV 1 so you may not need to worry quite so much about this.

Terri

[Author]

Posts