HSV2 Positive PCR & Neg IgG at 5 weeks

[655321]

After about 1 week from my 1st sexual contact in 1.5 yrs I got a tiny, slightly itchy bump near my clitoris that showed up and healed in 4 dys. If you don’t count the 1 instance of oral I received 1.5 yrs ago, the last time I had intercourse was 4.5 yrs ago. PCR done 4 dys after the appearance of the bump resulted in a HSV2 + finding &IgG (completed within 3 wks of 1st exposure with this partner) was neg. for HSV1 & HSV2.

My partner has never had HSV2 symptoms but just got a positive IgG (for 1 & 2) about 5 wks after our first sexual contact.

I went for another IgG this week & results are still neg. for HSV1 & HSV2. Since I am only at 5 wks since my 1st symptom, I am assuming that means I simply have not seroconverted, right? I have not taken any antivirals & do plan to get another IgG at 12 wks. Here is where I’m struggling: In retrospect, I feel like I should have started using condoms ASAP (and had my partner start suppressive meds) after getting my + PCR until I actually got a + IgG. I really wanted the PCR to be a lab error & feel like perhaps I would still have the chance to avoid acquiring this had I just been smarter after my PCR. Is that just wishful thinking given the fact that I had a + PCR AND my partner is +? For someone trying to hard to do the “right thing” I sure feel like l messed up on how I could have responded and it’s making me feel terrible.

Also, at what point can I assume I do NOT have HSV2 orally? And at what point can I stop worrying about acquiring my own infection orally from my positive partner such as through giving oral or receiving oral & then being kissed right after? At this time we have stopped all oral until my HSV2 is more established but did engage in such a few times since my diagnosis and don’t know how long to wait before I can assume it is okay

Since my partner is also HSV1 + am I any less likely to acquire HSV1 orally AND/OR genitally given that I already have a genital HSV2 infection?

Thank you for your help

[Terri Warren]

I think you should believe your positive PCR, even though it’s hard, I know.
Once you have HSV 2, it is highly unlikely that you would obtain HSV 1.
Interesting that you are still negative for HSV 2, but it can take up to 12 weeks to establish an antibody response. If you have not had any oral lesions, I think it is highly unlikely that you have this orally. I think if you wait to give him oral sex another 6 weeks, you’re fine, antibody or no antibody.
The other possibility is that you’ve been infected for a while and the antibody test missed your infection – it misses 8% of HSV 2 infections. But with a positive partner, it seems more likely that you are recently infected although your first outbreak was pretty darn mild. The thing is, herpes virus behavior is all over the place in terms of severity of outbreaks.

Terri

[655321]

Thank you for the response!

When you said it is unlikely I would obtain HSV1 after being diagnosed with HSV2 did you mean both oral AND genital HSV1? Or just one or the other? Sees to me if you had genital HSV2 you would still be susceptible to oral HSV1 but it seems like you are saying I would have some degree of protection from both locations of HSV1 due to already having HSV2–is that accurate?

When you recommended waiting 6 more weeks before giving oral sex to my partner is that because my diagnosis would be 12 weeks old at that time? I want to make sure I wait the best amount of time before returning to oral sex. I was officially diagnosed via PCR on 6/19/18.

Is there any reason I should assume my partner’s positive IgG for HSV2 is a false positive? Do you recommend he do a Western Blot to confirm? I’m asking because I don’t want to assume he also has HSV2 and have unprotected sex with him if somehow he got this virus from me (we had both been assuming all along that I got it from him because he is quite a few years older, has slept with people with genital herpes and was already showing antibodies at 5 weeks since the first time we had sex while I remain negative).

Lastly, assuming my partner does have asymptomatic genital HSV2 should I be concerned about touching his genitals/giving a hand job? And if so, for how long would I not be safe to touch him? Obviously I would not touch myself anywhere on my body and would wash my hands afterward.

Is it safe for him to give me oral sex since he already theoretically has oral HSV1 and genital HSV2?

Thank you again-

[Terri Warren]

Yes, you have significant protection against both oral and genital HSV 1 infection
Yes, that’s 12 weeks and that’s plenty of time
I do believe, from what you have told me, that you did get it from him but he could get a western blot if he is not certain about this diagnosis.
It’s fine to touch his genitals and for him to give you oral sex.

Terri

[655321]

Thank you very much for your time—I really appreciate you and all that you do.

If any other queations come up I will purchase another round of questions.

Thanks again!

[Terri Warren]

Sounds good, take care.

Terri

[655321]

Hi Terri,

Wanted to follow up on this one. I am still waiting to hit the “12 week mark” from the date I first noticed the bump that led to my positive PCR. In the meantime, my partner just got another IgG test from a local lab a couple of days ago that actually gives index values. He got only the HSV2 IgG test since he knows he already has HSV1 and his value is 1.5

I would like him to get a Western Blot given his low positive and am wondering if perhaps his HSV1 which he definitely has a history of might be causing the low positive.

In the meantime I am so curious about my own results at 12 weeks and plan to do the same test that gives an index value instead of the one that just says positive/negative. I know I should believe the PCR but this is all just so odd and I have not had any other outbreaks in 10 weeks and my IgG is still negative.

Questions:

1. I have read the info about ordering the Western Blot but am still a little confused. There are no Any Test Now labs anywhere in the state where we live. Should we book an online consult to discuss how to do this given that there are no labs around?

2. Let’s say he does not actually have HSV2 but we know he has oral HSV1. Is he at risk of contracting HSV2 orally due to giving me oral sex? I know I’m somewhat protected from genital HSV1 given that I have genital HSV2 but I’m wondering if his oral HSV1 protects him from oral HSV2 at all…

3. Part of me wonders if perhaps my
PCR was accidentally noted as being positive for HSV2 when it was really HSV1. And then perhaps his HSV1 is what is giving a possible false positive on his IgG. The reason I wonder about that is because my symptoms were SO mild and he does have a history of HSV1 so somehow that would make more sense. Thoughts on that? Maybe I’m just overthinking…

4. Just confirming if my “12 week clock” for IgG testing should start with the first time I noticed the bump or another time?

Thank you so much for your time.

[Terri Warren]

I think a mis-typing of the virus is unlikely though I have seen it before. And he could have a false positive on his HSV 2 antibody test, yes. A western blot would probably be a good idea for him to clarify – the guidance on this is that anyone with an index value between 1.1 and 3.5 need a blot to confirm.
If you do actually have HSV 2, you will probably never ever contract HSV 1 if you don’t have it already (the IgG misses 30% of HSV 1).You could have mild HSV 2 symptoms because you actually do have HSV 1 already and the test missed it. Let’s see what your test shows at 12 weeks. It should be done 12 weeks from the time you noticed the bump,yes.

Terri

[655321]

Hello again,

Since my last post I had another IgG test at 11 weeks which came back negative for both HSV 1&2 (it was the kind of test that does not give index values). At 12 weeks I had yet another IgG done by Quest Labs (all previous tests were through Kaiser) so that I could obtain actual index values. The 12 week Quest IgG results were also negative for both HSV 1&2

To clarify, I have not ever taken any antivirals at all as I don’t have symptoms and don’t want to cause any false negatives on my blood tests. My partner also plans on doing the Western Blot given his low positive index value of 1.5 for HSV2 and the fact that his HSV1 might also be impacting his results.

I know it’s a stretch but I’d like to do a Western Blot, too, even though I had a positive HSV2 PCR. I have had no other HSV symptoms since the PCR (now almost 13 weeks) and I cannot help but wonder if this could have been a lab error.

By the time my partner and I will be able to get the Western Blot (it appears we will need to travel to another state to get it as there is no Any Lab Test Now location in our state) we will be at least at the 20 week mark and then I can just put it all to rest for good when I see what the Blot says. I am sure it is lottery winning odds but I just have to see it through to the bitter end before I can give in and 100% accept this diagnosis.

Here are my questions:

If by some wild chance my Western Blot came back as negative for HSV2 at 20+ weeks, would you actually consider me negative or does a positive PCR always trump the Western Blot?

I know the IgG stinks for HSV1 but what are your thoughts about mine still being negative for both HSV1 and HSV2 all the way up through week 12?

Is it worth doing another IgG with LabCorp at 16 weeks?

Is there a way to get the Western Blot without having to go to an Any Lab Test Now? I don’t understand how I would get it without some sort of lab assisting me.

Thank you again for your help and guidance!

[Terri Warren]

I think it is fine to obtain a western blot for clarity, your situation is so odd.
You don’t have to go to an anylabtestnow to get your blood drawn – you can get it drawn anywhere that will agree to do it and spin it. Do you know a provider who would draw it?

Terri

[655321]

Thanks Terri,

I think I will set up a consult with you through your website. I’m a little confused about the process of ordering the Blot and have no idea how to find a lab that would do it. Maybe you can be the ordering provider and then together we can figure out how I find a lab that does the draw for me? Would love to finally have all of this behind me, no matter what the final result ends up being. Thank you again.

[Terri Warren]

Yes, we can be your ordering provider and we will find a lab somewhere near you that can draw your blood.

This is your final post on this subscription. If you have more questions, feel free to renew

Terri

• This reply was modified 4 years, 4 months ago by Terri Warren.

[655321]

Hi Terri,

You may recall my scenario (I added this to my former questions from last year) as I’m your 10th person in 30+ years to have a negative Western Blot and positive PCR for HSV2. (I wasn’t taking antivirals and waited more than the appropriate amount of time to take the Blot).

Here we are almost a year after my initial outbreak and I have had 8 outbreaks total. What’s funny is after my first outbreak last June I did not take ANY antivirals and did not have another outbreak for 5 months. I thought I might be the lucky one with HSV2 that only hits a couple of times a year. Then suddenly I got another outbreak and despite beginning to take daily Valtrex after the second outbreak I have been plagued with an outbreak every other month since. It seems the daily suppressive Valtrex doesn’t help at all. Given such, I stopped taking it daily and still get outbreaks every other month. They are most definitely outbreaks and they always occur in the exact same spot.

Can I expect this to ever improve? Any ideas why the daily suppressive therapy might not be working? I am healthy and consistent with the Valtrex dosage and yet it just isn’t cutting the mustard. Will this likely improve with time since I’m still within the first 12 months of contracting HSV2? I prefer 1g of Valtrex a day (single dose) but have heard splitting into two doses might work better. If that doesn’t work I don’t know what to do. Thoughts?

Thank you-

[mconcerned1986]

Sorry to intervene, can you share if your partner tested positive or negative on WB?

I am having issues with itching and irritation in genital area and no sores after an encounter and my WB tested negative but still struggling with the itching. Thanks.

I won’t post further sorry Terri and @655321.

[Terri Warren]

I would suggest that you try 500 mg twice day instead and if that doesn’t work, try Famvir instead. And if that doesn’t work then I think you should have resistance testing done by gathering a swab for CULTURE, not PCR. It could be that there is some relationship between your not making antibody to HSV 2 and having this many outbreaks. Where do you live?

Terri

[655321]

Thanks Terri—I live in California. I can try the 2x/day dosing of Valtrex 500mg. A couple of months after my negative Western Blot (negative for HSV2) I got an outbreak that was positive for HSV2 again which is why I know it really is HSV2. It was driving me nuts that the IgG was not picking anything up but FINALLY the last one I had done back in December or so picked up the HSV2 antibodies and showed me as positive. So the last IgG did show me as being positive for HSV2. The Blot says I was positive for HSV1 but my IgG tests keep showing up negative for that (as they often do). Never had a cold sore to speak of but I understand the Blot has no false positives is that correct?

mconcerned1986–not sure how this would help your personal scenario but my partner was positive for HSV 1 and 2 per the Western Blot.

[655321]

Terri, I should also add that my “outbreaks” are generally SUPER mild and clear up in about 3-4 days with the Valtrex. I usually just get an itchy bump or two that you can barely notice except they are shiny/slightly weepy. They look nothing like the hideous photos you find online. So odd…Thanks again for your help.

[Terri Warren]

You’re welcome. I have a quick question – how long did you wait from infection to blot testing?

Terri

[655321]

Hi Terri,

I had not had intercourse in 4.5 years and then started sex with a new partner on on June 7th and June 12th. On June 14th I noticed a suspicious bump that tested positive for HSV2 by PCR. Never took ANY antivirals because I knew they could mess with future blood tests and the Blot. I waited slightly over 16 weeks from June 14th to get the Blot. My Blot said positive for HSV1 and negative for HSV2. After my initial diagnosis my partner got tested by IgG and was positive for both HSV 1 and 2 and later got the Blot which confirmed he was positive for HSV 1 and 2. My IgGs after my initial diagnosis remained negative for both for months until the IgG finally showed me as positive for HSV1 in January 2019.

Oddly…Shortly AFTER getting my Blot results I noticed another outbreak that was MUCH more obvious than the first. 3 weepy bumps that itched like hell and caused a good deal of swelling on that side but otherwise not painful. Got another positive HSV2 PCR at that time which suggests the Blot missed my HSV2 for whatever reason. Again, the Blot does say I have HSV1 but I’ve never had any oral sores or other sores vaginally.

All IgG tests remained negative from June until January 2019 when I finally tested positive by IgG for HSV 2 but I STILL show as negative for HSV 1 (I know that is common with IgG).

I definitely waited slightly more than 16 weeks suggested for the Blot and I swear on my life I never took ANY antivirals after that first outbreak in June leading up to the Blot. Not one. Got the Blot in October and didn’t get another outbreak until AFTER the Blot in November.

Again, I continue to get a mild outbreak about every other month. A real bummer to say the least.

Thank you again—so curious what you think…I will actually be in Seattle in July and could do another Blot no problem if you think that would make sense.

[Terri Warren]

oh, I think you will be positive on the blot if you retest if you were positive on the IgG. The UW explanation on the blot states that less than 1% of people will take longer than the 12 weeks to become positive – you are clearly in that group. You could retest for my interest but why spend the money?

Are you on suppression therapy now?

Terri

[655321]

Got it——maybe someday in the future I’ll do the Blot again just for the hell of it…

Didn’t start daily antivirals until November 9th 2018 and stopped them March 7th 2019 (I keep notes on all of this!). Last night I decided to start daily suppression again with the 500mg two times/day so I can determine if that curbs the every other month outbreaks.

1. How long should you be off of daily suppression to ensure the Blot is correct? It’s funny because I finally seroconverted on my IgG WHILE on daily suppression. I’m just a weirdo!

2. If it turns out the daily suppressive therapy does not curb my outbreaks does that mean it is also not reducing the risk of passing it on to others? I am no longer with the partner who I contracted this from and I am now worried that if I ever find a partner again I can’t even offer the consolation that antivirals reduce the risk of transmission for me. I guess we will cross that bridge when we get to it but I’m just curious.

Thank you for your speedy responses.

[Terri Warren]

I think if you are positive on the IgG test, it is likely you would also be positive now on the blot.
Antivirals reduce viral shedding by about 70% and transmission by about 50%. If they are not stopping outbreaks, I would 1) have the outbreak swabbed to be sure that’s what it is and 2) considering giving Famvir a try instead – 250 mg twice a day. A few people do better on Famvir but not commonly – many people do worse.

Terri

[655321]

Thanks Terri—so just to confirm your answer above—-even if antivirals are not making my outbreaks less frequent can I still assume they are reducing shedding and will help with protecting others from transmission? Or because they don’t seem to be helping me am I to assume they are also not helping protect others and prevent shedding? If I owe you more $ please let me know. Thank you-

[Terri Warren]

I don’t know the answer to your question, for certain, but yes, I would assume that they are reducing viral shedding at least somewhat.
What was your index value on your IgG test?

Terri

[655321]

Thanks—unfortunately, Kaiser does not give index values. Despite my plan to start daily suppression as I stated above (500mg 2x/day) I decided not to do that just yet. I’m single and would like to try to get to the bottom of this. I only took one 500mg dose before deciding to go back to only using it episodically. I would like to see if the every other month thing continues.

Quite honestly I am certain my outbreaks are herpes. They are always in the exact same place. Twice they have had a positive HSV-2 PCR and they always look the same, itch the same and cause swelling the same way. It’s just funny that they heal so fast (always less than a week).

I can always get another IgG via Quest or Lab Corps to see what my index value is. Which lab do you prefer? I paid for another round because I have lost track and I’m sure I’ll have more questions after getting another IgG.
Thank you again-

[Terri Warren]

I don’t think you need another IgG test since you have had two positive PCR tests. It is not unusual for herpes lesions that are recurrences to heal within a week.
it’s fine not to take daily therapy unless 1) you want to reduce the frequency of recurrences or 2) you want to reduce the risk of transmission to a partner

Terri

[655321]

Got it—I had mentioned getting another IgG since you asked about my index value. You piqued my curiosity—can you tell me where you were headed with the question about my index value?

Additionally, I meant to ask about the location of my outbreaks. They are always in the same spot. On the inside my labia majora right at the top near the clitoris. Given that, I am curious if that makes someone more likely to contract this virus from me given that a lot of friction occurs in this area during sexual activity and it is not necessarily an area that a condom would cover. I could see this area touching the base of a partner’s genitalia right where the condom ends and so I’m a bit worried that the whole thing about condoms drastically reducing transmission may not apply to me. If I ever manage to find a partner I’d like to know that what I’m telling them about protection is accurate. So far I don’t feel super convinced by the stats.

Thank you again for your time. It’s never ending on this site—amazing that you keep up with all of it!

[Terri Warren]

The main site of outbreaks in females is the labia majora so you are in the same boat as anyone interims of transmission likelihood. Hopefully, the combination of antiviral medicine and condoms Will go a long way to preventing transmission.

I was only asking about the index value to see if it was low or high, just a matter of curiosity

Terri

[655321]

Hi Terri,

I’m following up on my old posts so you have my background. I was your 10th person in 30yrs who was positive for HSV2 but had a neg WB.

My question is around my recurrent outbreaks. I get one every month or so without fail despite being pos. for over 2 years. To be clear, I am 100% certain this is HSV2 and I always get an outbreak in the EXACT same place as my initial outbreak. It itches to high heaven for days regardless of how much Valtrex I take.

I take Valtrex episodically. What I am wondering is if I am not treating the outbreaks long enough and then it seems like “another” outbreak might be the previous one not having been healed fully.

1. What is your episodic dosing recommendation of 500mg Valtrex to ensure an outbreak is fully eradicated? I typically overdo it and take 1000mg 3 times a day (yes, 3000mg total per day) until the outbreak seems to be completely gone. Then without fail it returns within a few days or a couple of weeks.

2. If I were to move to taking Valtrex as suppressive therapy do you still believe 500mg two times a day is the best dosing schedule? If so, how far apart should the pills be taken? 12 hours?

3. I seem to have very odd prodrome symptoms before every outbreak. I experience what can only be described as a deep “ache” in my groin on whatever
side the outbreak is on (usually always the same side and place). It’s a deep ache in my lower pubic bone right above my labia majora and it is uncomfortable. Sometimes it radiates to my hip and down between my legs but always on the side of my outbreak. I NEVER had anything like this until I was infected. It almost feels bruised. At times the ache radiates up toward my upper pelvic area and toward my hip. Is this a common experience? Anything I can do to make it stop other than just take more pills. It feels like all I do is take pills now…

Thanks for your help as always!

[Terri Warren]

1. What is your episodic dosing recommendation of 500mg Valtrex to ensure an outbreak is fully eradicated? I typically overdo it and take 1000mg 3 times a day (yes, 3000mg total per day) until the outbreak seems to be completely gone. Then without fail it returns within a few days or a couple of weeks.

The typical dosing is 500 mg twice a day for three days. Studies have not shown a benefit for taking the medication longer.

2. If I were to move to taking Valtrex as suppressive therapy do you still believe 500mg two times a day is the best dosing schedule? If so, how far apart should the pills be taken? 12 hours?
I think that schedule would be best, correct.

3. I seem to have very odd prodrome symptoms before every outbreak. I experience what can only be described as a deep “ache” in my groin on whatever
side the outbreak is on (usually always the same side and place). It’s a deep ache in my lower pubic bone right above my labia majora and it is uncomfortable. Sometimes it radiates to my hip and down between my legs but always on the side of my outbreak. I NEVER had anything like this until I was infected. It almost feels bruised. At times the ache radiates up toward my upper pelvic area and toward my hip. Is this a common experience? Anything I can do to make it stop other than just take more pills. It feels like all I do is take pills now…

I think going on suppression is the best move right now. This is an odd prodrome but not completely unheard of. I’ll be interested to know how that’s going for you when you take it.

Terri

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