hsv II testing tomorrow – hopefully

[Jessie]

Hi Terri, I have a few areas of concern: 1) I received hsv igg II testing 13.5 weeks after a one time sexual exposure with a condom about two years ago which returned negative at 0.11. Should this give me confidence as it didn’t quite hit the 16 week mark? A year after this incident, I had sex with a new partner who took off the condom without my consent and had sex three additional times with the same partner using a condom. He received igg 2 testing at this time and was negative (I looked at the results myself), and said that he had no other partners during that time or 5 months prior to testing. Whether to trust his timeline is questionable. About 5 days after the condom-removed sex, allergy season hit and i had a headache and a swollen throat which I immediately thought was hsv II primary infection. I took my temperature everyday for awhile, and it never spiked. 2) All together, I’ve tested negative 3 times via igg 2 testing over the years. I’ve had 11 sex partners. This number of sex partners scares me. 3) I’ve had cervicitis in the past, long before the two sex partners above, with cervical bleeding during intercourse with hsv II ruled out by blood testing and other sti and hpv ruled out. Does herpes ever present as simply cervicitis with no other signs and symptoms as a primary infection? Should I still think that this cervicitis was caused by herpes? I’ve read differential diagnoses that state that if hpv or bacterial sti infection is not causing cervical inflammation check for hsv even if no herpes lesions are noted. Also, I am positive for hsv 1 oral as I’ve had cold sores so that mostly rules out hsv 1 genitally. 4) I have a significant number of fordyce spots which make it difficult to determine what a good bump or a bad bump looks like on labias. Recently, I had what looked like folliculitis. It was a single white-pus filled bump which I popped with no pain, no redness, no burning or discomfort on the hairline of my labia majora. It left no mark, ulcer, or crust behind. I shave my pubic hair and have been taking spinning classes. I am hoping that this is the cause of folliculitis and that it does not indicate herpes. Well, there is the whole story. The most rational I ever become mentally is reducing my concerns to the two most legitimate which are that i was tested at 13.5 weeks and not 16 weeks making my test invalid and that this last sex partner’s test could be invalid because his timeline is not accurate and that he had other sex partners within the 5 months leading up to his testing. I want to go to the lab and get tested tomorrow, but I’m overcome by anxiety. Thank you.

[Jessie]

Oh, also, probably not too clear, my last hsv II testing was after all 10 partners. I tested at 13.5 weeks after sex with the 10th. The 11th is the partner with the negative test.

[Terri Warren]

I think the chances of you becoming positive after 13.5 weeks is really small – less than 10% for sure. We don’t need to worry about #11 because he has negative tests that you saw, correct?
You will be fine, I believe. Please check back with me if you have further question about your most recent test results.

Terri

[Jessie]

Hi Terri – things have gotten worse. I contacted number 11 and looked at results again. Now that I understand more, he had a hsv -2 inhibition elisa performed. it states that hsv – 2 gig inhibition was <90. The HSV-2 igg screening assay was repeated at Focus Diagnostics, and the result was not positive (i.e., the index was < 1.10) ; these, the inhibition study result could not be deterred. Interpretive criteria: inhibition <60 Negative and inhibition > or = 60 positive. What does this result mean? When I read it originally, I though this meant not positive but now am thinking that this is not true.

[Jessie]

As part of the inhibition assay, sera are re-tested in the routine HerpesSelect HSV-2 IgG ELISA (ie, an aliquot of the sample is diluted in specimen diluent rather than HSV-1 lysate or HSV-2 lysate); the resulting routine ELISA index value is <1.10 for a small percentage of sera. These sera are not considered positive for HSV-2 IgG, and thus the inhibition data can not be interpreted. A comment communicating this information is added to the report in place of a POSITIVE or NEGATIVE result.

Is this what happened?

[Terri Warren]

If the inhibition assay was unable to be done, then that is because the HSV 2 test was not positive, if I am reading your interpretation correctly. The HSV 2 ELISA has to be positive before the inhibition assay can be done. I don’t love the inhibition assay, honestly.

Yes, this is what happened.

Terri

[Jessie]

Is the inhibition assay unreliable? Was his second negative test unreliable? I wish I had known about all this when I originally looked at the test a year ago or that his doctor understood what this meant.That gives me a feeling of dread. He was tested again last week, and I went to get tested today.

Today, also I’m feeling my lymph nodes it my groin, and I can’t really tell, but maybe they are swollen. Would lymph nodes be swollen a year post infection? Do lymph nodes swell during recurrence?

[Terri Warren]

I have trouble with positive inhibition assays more often than negative ones. The inhibition assay that quest laboratory runs, is based partly on the screening test that is routinely offered. And we know that the screening test has some false positives. So my preference is to order the herpes Western blot as a confirmatory test which is completely different then either of these other two tests. I do not think this you a feeling of dread instead I think it should give you hope.

Lymph nodes in the groin can be swollen for any number of reasons including a simple hangnail on your toe. Some people have swelling of the lymph node with recurrences of herpes, yes, but we have no reason to believe that is true for you right now.

And Now have one question remaining on your second subscription. I believe you have five posts total now and I removed the one where you asked me if I saw your question. Please count for me and be sure my math is correct.

Terri

Terri

• This reply was modified 7 years, 7 months ago by Terri Warren.

[Jessie]

Hi Terri – #11’s retest came back today at 0.4. I know this is negative which gives me hope, but it’s not under 0.2 so is that concerning? I still have a day or two to wait for my test results.

[Jessie]

Also, I might add that so far he had one low positive and a subsequent negative, from the same blood draw, and then this year’s 0.4. He also has hsv-1 orally. Thanks

[Jessie]

Also, not taking any antivirals.

[Terri Warren]

Though he has a higher negative than we normally see, I think he is likely truly negative. If he really wants to know, he should get a western blot.

Jessie, this program counts posts and I can override it , but when you post lots of little things as above, it does make it slightly more complicated as I have to keep overriding the system to allow you to finish up your subscriptions. You’ve paid for 6 posts and done 8 but some are so short, I let it keep going. But now I think if you have more questions, you should renew if you want to and put all your thoughts into one as much as you can!

Terri

[Jessie]

Hi Terri – He thinks a negative is a negative. I’ve read differing opinions. That only under 0.2 is truly negative, and everything else is iffy. I think this means that above a 0.2 under 4 months from last intercourse could indicate someone is seroconverting. Is it as alarming to have 0.4 a year later? I’ve also read that 0.2, 0.5, 0.7 are all the same as long as they are negative with the condition that last intercourse was more than 4 to 6 months ago. I don’t think he would ever get a western blot, he doesn’t understand why I am freaked about about a low positive because he has had two subsequent negative tests. He also doesn’t understand why I think 0.4 is scary. He’s not really concerned about all this anyway which is good for him, and I don’t want to send anyone else into an anxiety tailspin. I am definitely very anxious about this. So, as I have a day more to wait for my results, could you tell me more about the index range and why all negatives are not created equal? Thank you for your response.

[Jessie]

Hi Terri – I know I am using one of my comments again, and that’s okay as I probably won’t have anymore questions. I also wanted to mention that he has never had any symptoms. I know these test results have to be interpreted in context. Thanks

[Terri Warren]

If his last contact with anyone was a year ago, I am far, far more confident about the 0.4. It’s when someone has a higher negative like this and has had any recent contact that I get more concerned. I think given this information about the year ago last contact, you should accept this negative and move on.

terri

[Jessie]

Terri! – my results are back, and they were negative 0.21. I am just posting in case anyone else in the future reads this and has a similar situation and would like to know the outcome. Thank you so much for your help and the work that you do!

[Terri Warren]

I’m very glad for you Jessie.

Terri

[Jessie]

Hi Terri – I have a question about my index value of 0.21. This index value is a year from last sexual encounter. I read this from a study by Dr. Rhoda A. Marrow: “The Focus ELISA detected an 8.7% (n 108; median index value, 2.39) HSV-2 seroprevalence among the 1,238 subjects. Of the 1,111 negative samples by Focus ELISA, the median index value was 0.27 (interquartile range, 0.16 to 0.50), with 72.5% of the samples having index values below 0.5.” This is the only study that I could find which gave a median of negative index values. It seems my score fits into this range, but I am becoming stuck on < 0.2 being truly negative. How often do you find that a 0.21 is positive by WB. Should I call your office for a consult? Thank you

[Jessie]

Also, do you know of or can you refer me to any other research articles that gives medians for negative index values?

[Terri Warren]

I don’t have any articles about the exact index values as I find them pretty meaningless if negative. If someone has had a relatively new exposure and their index value is .76, then I get a little concerned. I have no concerns at all about your .21 index value being negative. If you want a western blot for greater reassurance, we can order that for you but honestly, I think the chances of it coming up positive are really small. Do you think you can live with 0.21 as a true negative?

Terri

[Jessie]

Hi Terri – I think I have one more question left. In your experience when someone tests negative on herpeselect and positive on western blot is it most often because 1) patient hasn’t had enough time to seroconvert, 2) they are on antiviral therapy, 3) they have seroreconverted, or 4) because they just don’t make the antibody?

If they don’t make the antibody, is it because they have a hsv-2 strain that is glycoprotein g deficient or because there immune system just doesn’t make the antibody? I’ve read one swedish study that indicated that 0.2% of clinical isolates out of some 2,000 they found do not have the g protein, and this is the study that focus diagnostics sites. Do you know of any other study that has a percentage of g deficient hsv2?

[Terri Warren]

They test negative on the ELISA because the ELISA has problems picking up HSV 1, not because of the reasons you list. It is a test problem.

It isn’t about a glycoprotine G deficient strain, as far as we know. I am not clear about they the HSV 1 ELISA is a bad screening test – I just know that it is.

Terri

[Jessie]

Hi Terri, thanks for all your help again. when someone doesn’t seroconvert, is it the particular strain of virus that doesn’t show up in the blood tests? or is it on a person-by-person basis (ie could two people be infected with the exact same strain, with one seroconverting, and one not)?

[Jessie]

Hi again, I know I have already asked you this, but for clarification, how often have you seen someone test negative for hsv 2 on herpeselect a year from possible exposure and then test positive on western blot for hsv 2? Thanks

[Terri Warren]

Nine times in 33 years.

Terri

[Jessie]

Terri, this is really not good. I went to the emergency room last night as I thought I was having some disseminated hsv 2 outbreak. My hands and feet have been tingling, crawling, and hot for the past few days with a few diffuse red bumps spread over my hands. I thought it was mosquitoes or something. Yesterday, I realized my hands were clammy, swollen, and had developed a lacy rash (white and red), that the rash was also on my thighs, and my vagina. My vagina was swollen. I had a unusually amount of discharge and my vagina also seemed clammy. This all happened very quickly as I would have noticed it before as I have been compulsively checking my vagina for any changes. I saw one red spot on my hip, small, that definitely stung to touch and that has now healed over with a honey colored look. I had a few more red dots develop on my knees and on my ankle. Also on my hands I had very small pin prick sized dots that stung, as if they were open, to touch. All these spots had a very quick onset. I had the same dot on my right arm, and one on my chest, and on my abdomen. my cheeks feel hot and I have the same small dots and maybe almost cuts on both cheeks. My mouth is also tingling and hot with definite inflammation, an abrasion on the inside upper lip and the skin in various places of my lip looks like it wants to blister. My eyes feel inflamed, blood shot, and I had a white mucous coming from the corners. I have tinnitus and feel hot all over, no fever. My stomach hurts. The doctors refused to believe me. They thought I had a vitamin deficiency as I had told them I had lost a lot of weight over the past months (purposefully), hadn’t had my period one month. I told them this so that they would understand that I think I am immunodeficient. As you know my hsv 2 igg is 0.21 a year from last sexual encounter. They wouldn’t swab anything. I went to an urgent care this morning and just told them I was having a primary hsv 1 outbreak so they would at least give me some acyclovir. I think it is helping as nothing is getting worse so far. I don’t know what to do.

[Terri Warren]

Jessie, your symptoms do not sound like disseminated herpes to me (something I have never seen in an adult in 33 years either). Do you want to get a western blot to clarify your situation? Would you believe that?

Terri

[Jessie]

Hi Terri, thank you for responding to me, I don’t know what is happening to me, and it is really hard. I spoke with you and my western blot should hopefully be returned in a week or two.

[Terri Warren]

OK, Jessie, I’m sorry I try not to make connections between this forum and my phone consultations. Hopefully we will have news that will help you here.

Terri

[Jessie]

Hi Terri – my western blot was negative for hsv 1 and 2. I really want to believe this but I am left with no alternative explanation for what could cause the symptoms I have. When I had the symptoms, I couldn’t find anyone in new york city to do a pcr swap. Do you know any practitioners in new york city who are up to date on their knowledge of herpes or who offer pcr testing? I’ve called lots of obgyns.

When I was having all these symptoms when i went to the ER as described above with tingling in hands, feet, mouth, with diffuse red dots all over my body, and my lips and hands and vagina were inflamed, I now understand that disseminated herpes was an over reaction, but could it have been erythema multiforme. I’ve read that the lead cause of erythema multiforme is a herpes infection. It could have been spurred on my all my anxiety. None of this was from a vitamin or other deficiency as all my lab values were normal.

A few hours after this ER visit, I also noticed pustules in the area above my clitoris that I could cause to pop. However, they were not below the skin but definitely on the surface of the skin. They were spread out and had pus. They look just like fordyce spots put could pop. I don’t think this was bacterial or yeast however because it resolved on it’s own and was accompanied by all the other symptoms. Also, these pustules looked just like the one pustule I had after the oral and vaginal sex of last year. I never noticed these before this last sexual partner. I’ve also been tested for other sti’s and all were negative. I would move on from this but have no alternate explanation for what this could be? Any ideas?

[Terri Warren]

Honestly, I have no alternative explanation for your symptoms, but in my opinion, herpes is not causing them as all of your testing has been negative. EM is not diffuse red dots – it is target looking lesions on the body that are difficult to misdiagnosis. I feel like you are on the internet looking for explanations for your skin conditions and you are coming up with kind of far reaching possibilities. You’ve had the best possible test for herpes and are not believing it. Where you go from here I cannot say, but I have helped you as much as I can.. Further posts on this forum are not going to be helpful, Jessie. I believe we are finished her. My very best to you.

Terri

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