HSV-1 Exposure and Testing

[Concerned1]

Hello, Terri,

I have never had an STD but a recent sexual encounter has given me cause for concern. Last spring, I began dating a woman: after some kissing/general foreplay, she requested we both get tested for STDs in order to have unprotected sex. (She was on birth control.) I went to a local clinic and got a finger prick/urine sample and examination, testing negative for everything they checked. (As you’re aware, herpes is not normally part of a standard STD screen.)

My partner showed me her paperwork, which appeared to consist of a blood draw. She was “positive” for HSV-1 and stated she only tested that way because of a cold sore. I had noticed a blemish on her lip around this time. Owing to my ignorance, I didn’t think much of the test result and we proceeded to have intercourse. Several weeks later, I came down with a flu-like illness that my physician diagnosed as strep throat due to a positive swab culture. The sore throat persisted for nearly two weeks and I felt ill for three, which sounds unlike strep.

Between then and now–roughly six months–I’ve gotten a blister on the corner of my mouth three or four times. It usually presents as a yellowish pocket, which then breaks and scabs over. It looks similar to a pimple and doesn’t appear to “cluster”–i.e., there’s just one. However, owing to my kissing a partner with a positive HSV-1 result and the subsequent illness, I’m pretty much convinced I got oral transmission. (I do recall her giving me oral sex, but I have no genital sores.) I don’t recall ever getting these sores before, and it recurs in the same spot. I now believe she insisted on an STD screen in part as a way of “confessing” her HSV-1 status to me.

I was just at my dentist yesterday and the hygienist didn’t think it was herpes, though it’s currently at a stage where it’s just red and irritated-looking, not raised. Because I live in New York, getting the Western Blot would be very difficult, so I plan on getting an IGG test shortly through STDtestexpress.

My questions: based on circumstances, is it reasonable to assume I have HSV-1? How confident can I be in the result of the IGG test? I see people dismissing this as “just cold sores,” but what is the accepted practice in having to disclose this to future partners? Thank you.

[Terri Warren]

You might have HSV 1, yes, but difficult to know for certain from your description. If you get it again, you should definitely go in and have someone swab test this sore using PCR preferably, to see. If the IgG is positive for HSV 1, you will know that you have it but you won’t know exactly how long you have had it. It could also be impetigo or angular chelitis, both of which can cause breaks in the skin in the corner of the mouth.

When you partner presented you with her blood work which indicated she was positive for HSV 1, didn’t you wonder about your own status since she had a test result for herpes and you didn’t? You could also have HSV 2 and not know it. Didn’t she ask about your HSV 1 and 2 status? I really doubt that someone would get an STD screening as a way of telling you that she gets cold sores – she could just tell you that she gets cold sores. A more likely explanation in my opinion is that she wanted to know about her own HSV 2 status and the lab routinely tests for both and she also wanted to know about your status, offering to get tested herself as a diplomatic way of asking you too to be tested.

I also think that the likelihood of having a positive strep test AND a new case of oral herpes at the same time is pretty unlikely, really. Your strep sounds like strep to me.

In my opinion, if a person has known history of either having cold sores (not canker sores) and/or is HSV 1 positive, it is a good idea to disclose to a new partner. Others may disagree. That’s what I would want to have happened to me when I was single so I apply that standard to others.

Terri

[Concerned1]

Thank you for responding, Terri. Truthfully, I did not really stop to consider my HSV-1 or HSV-2 status owing to the fact I had been totally asymptomatic until recently. I have also had only a handful of sexual partners in my lifetime.

Would it be wise to get a PCR test in addition to the IgG test? The Web lab I’m using doesn’t specifically call it IgG, but says it’s “the type-specific test recommended by the CDC.” If it’s negative, what is the margin for error/false negative? Would an STD clinic typically know what a PCR test is?

[Terri Warren]

You would want a PCR swab test only if you had a lesion to swab. It is NOT to be used in asymptomatic people and it is NOT to be used as a blood test. The PCR test is looking for virus itself, not antibody, and virus is not normally found in the blood of adults.

Yes, the test they are describing is the one you want. Do NOT get an IgM test – this is useless and confusing.

Terri

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