Likelihood w isolated protected encounters, and timing of confirmatory WB

[bloom]

Hi Terri,
25 F. I recently got a HSV2+ IgG that has given me pause, because all potential sources were isolated sexual encounters protected w/ condoms, with males who were not having symptoms at the time and have never previously had an outbreak to their knowledge.

My last fully neg HSV1/2 was in Aug 2013.
From Aug 2013 – Sep 2014, I had only condom-protected sex with 5 men, one consistent from November 2013 (my “main”/primary partner, “A”) and the others in isolated encounters (Oct 13, Feb, Apr, and Jun 14).
I had a HSV1-, HSV2+, probably HerpeSelect ELISA, in early Sep 14. The gyno called me to tell me this result and mentioned “your titer was really low” but she didn’t give me the actual index value, and I haven’t called back to get that value because she was so flippant and dismissive.
I was really upset and went to my PCP’s office to get more tests, late Sep 2014. I got the IgM and 1/2 IgG testing, and was NEGATIVE on all–something like a <0.40 on the IgM, and there were no index values on the HSV1/2 IgG, so I think it was the HerpeSelect Immunoblot. I considered this to be the more-reliable result and continued in that vein, going barrier-free with A, who was HSV1+ and had known he was for many years, but had never had a known outbreak. I felt kissing and rec oral sex from him to be within an acceptable risk level.

A and I broke up in early Apr ’15, after about 6 months of consistent unprotected sex. He tested later on in Apr ’15 and was, as predicted, HSV1+ but HSV2-. After the breakup I’ve had two instances of protected sex with a less-primary partner (call this one “B”), who as of Jun 12 ’15 was HSV1+ but HSV2-, and a single incident of unprotected oral but condom-penetration with a new man (call this one “C”), on May 2 ’15. On May 13 ’15, C had a blood draw for testing, and told me May 18 he’d tested HSV2+, but didn’t provide the type of test. His strong implication was that I’d transmitted it to him on May 2, but I doubt that, even if I’d had it, it would show up in an IgG test less than two weeks after our solitary encounter, right?

Jun 8 ’15 (37 days after encounter), I go to a new gyno to get an IUD and get my STD test, and come back HSV1-, HSV2+ with (assuming) HerpeSelect Immunoblot–new gyno said no index values.
-I’d had itching and fluid-filled abscesses (they burst when squeezed) in late Jun 2014, which I suspected was a few bad ingrown hairs or staph after a waxing aesthetician dug in deeply with tweezers. In Oct and Nov 14, I had no lesions but bad vaginal itching with thick white discharge which seemed to respond to antifungals, but maybe I was interpreting outbreaks as ingrowns or yeast infections??
-What’s the likelihood of having gotten it from a single (or two) sexual encounter(s) protected by male condom with a man w/ no lesions?
-I’m now 49 days from the single protected encounter on May 2. Would a Western Blot help now or should I wait even longer for clarity? I’d like to know sooner rather than later, though!

[Terri Warren]

A western blot will definitely help ut you need to wait until 16 weeks have passed for greatest clarity. The Immunoblot is so hard to read, I hate it. You could get a copy of your first test result – you are entitled to that and let me know the index value.

I think it is a very low risk to have protected sex with someone twice even if they are HSV 2 positive, though I can’t say for certain you aren’t infected, of course.
The rest of your symptoms are pretty general – I think you are going to have to rely on antibody tests to know what’s going on here unless you get an obvious lesions which of course should be swab tested.

Terri

[bloom]

I guess my thought is that a WB could be useful even sooner if I was in fact infected prior to that Sep 2014 positive result–I had one protected encounter with one man in early Oct 2013, and two protected encounters with a different man, one in late Oct 2013 and another in early June 2014.
Q: So if that initial Sep 2014 positive result was real, the HSV2-negative Immunoblot result from three weeks later was a false negative–how likely is that?? And if so, I’d definitely test positive on a WB done this summer, right?

I’ve spoken with both of them after this recent (Jun 8 ’15) positive test; the latter got his blood drawn on Jun 12 but has no results yet and the former was traveling when I spoke with him but should be getting tested soon.
Q: Do you think I should wait until they both have their results back before getting my WB done? That could really help me figure out whether or not I was exposed earlier than May of this year, right? All my other exposures are known–two negative (the consistent partner and the sporadic one), and the one HSV2+ from the single protected encounter on May 2 ’15. And they’d probably have IgG results back before the 16-week window from May 2 has passed…

I’ll call for my index value from my previous gynecologist on Monday, since it seems that might be useful. (I live on the East Coast; I appreciate you answering so quickly!!)

Last question: I’ve also received oral-sex-only from three women and two men during the timeline I’ve described here. My sincere instinct is that I should get the gold-standard test before notifying them of this current result, based on the very low statistical likelihood of having transmitted potentially-genital HSV2 to them orally. Does that seem sensible and ethical, or is it more appropriate to notify and then clarify once the confirmatory result has been received?

[Terri Warren]

You could do the western blot now and if it is positive, well, then it is. If it is is negative, I think you would need to repeat. And I would certainly wouldn’t tell anyone anything at this point. I think it is more likely that if you were infected your values would go up not down.

Terri

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