Low Positive HSV-2 – Very Worried

[holdingouthope]

Hello Terri,

First off, thanks so much for having this forum. I appreciate your efforts.

I am a 30 year old single male. Last Wednesday, 3/25/2015, I had an STD test. Everything came back fine except for my HSV-1 and HSV-2 results. Here are the results going back to 2013 (for a frame of reference):

10/16/2013:
HSV 1-2 IGG HERPESELECT AB
HSV1: 3.05 (out of range)
HSV2: 0.53 (In range)

10/10/2014:
HSV1: not done
HERPES SIMPLEX VIRUS TYPE 2 AB,IGG (PT;SER;QN): 0.58

3/25/2015:
HERPES SIMPLEX 1/2 IgG (Both) Seperate
HSV1: 1.76 (positive)
HSV2: 3.08 (positive)

The latest test the doctor believes was HERPESELECT. As you can see from above, this was my first positive HSV2 test, although it is a low positive (below 3.5) as I have been reading about online/on this site. I have known about my HSV1 since the first test above, but I have never gotten any cold sores in or around my mouth (at least those I noticed).

In terms of symptoms, I don’t think I have had any. I have attached a photo of the head of my penis this morning. I have gotten this redness before. I am uncircumcised and there are times when, if I don’t clean it properly, I get inflammation. I noticed the redness on Sunday morning after I fell asleep on my couch with my clothes on (didn’t get to wash it before bed). Usually the inflammation goes away with regular washing. The skin above the redness feels smooth. Regardless, I went back to the doctor today and got a culture done on it, as well as another blood test.

My sexual history recently has not been good. I have been engaging in high-risk behavior (no prostitutes/workers) but many one night stands, many times unprotected. From October 2014 to the weekend before my last test, I have had 12 female sexual partners, only 6 of which I used a condom with (so stupid, I know). Only 2-3 have been repeat partners. I mention the one night stands because I am hoping that the statistic that I have seen you throw out there of a 4% rate of female-to-male transmission (out of 100 times during the year, but when both partners know about HSV-2, etc.) helps me.

I have several questions I hope you can answer:

1) Does the attached picture look like a herpes outbreak?

2) Is there any hope that I do not have HSV-2? When I get my blood test back next week, I assume that if the HSV2 value goes up, I am not in good shape. But if it goes down, what does that mean? I realize that a negative culture result may not mean much because the doctor has to catch a potential herpes lesion at the right time.

3) The doctor kept insisting that the positive HSV-2 signified that I have been exposed to the virus, and that my body has developed antibodies to fight it. Is there any hope that it has fought off the virus? (Probably a dumb question)

3) Can I transmit HSV-2 orally?

4) Could my HSV-1 have triggered an HSV-2 false positive?

Thanks in advance for your answers. I know I am grasping at straws here.

[Terri Warren]

1. The picture looks more like candida balanitis to me.

2. If your index value goes way up, then that is not good news. If it stays about the same, I would suggest a western blot. However, for you to get the most accurate answer on that test, you need to wait 16 weeks from your last sexual contact. You could do one now and get another when 16 weeks have passed if this one is negative. If it is positive, then there is no need to retest.

3. Yes, if it is truly positive you have been exposed to the virus and it infected you and you can infect others, unfortunately. There is no such thing as an antibody test being positive and you just being exposed but not infected.

you would only transmit HSV 2 orally if you are infected orally and we know that at least 95% of people who are HSV 2 positive have it at least genitally (some have it orally as well).

4) Your HSV 1 could be triggering a false positive HSV 2, yes. You are under 3.5 and that is the cutoff for most false positives, although I have seen some higher lately which is disconcerting.

Terri

[holdingouthope]

Thanks for the response, Terri. For #3, I meant can I give someone HSV-2 if they have unprotected oral sex with me?

In terms of the western blot, do you recommend that I wait until today’s blood/culture test results come back next week? And by “if it’s positive there’s no need to retest” do you mean higher than 3.5 or higher than the upper equivocal number? Also, if the number does go down substantially, is that just variation or more indication of a possible false positive?

Finally, is it possible that my HSV-1 tests, since both also below 3.5, could have been false positives? And would a western blot clear that up?

I have a Quest Diagnostics lab near me (in DC) and would be interested in a western blot regardless.

Sorry for all the questions. Thanks again so much for your help.

[Terri Warren]

Are you asking if someone gives you oral sex (your penis, their mouth) and you have HSV 2, can they get HSV 2 in their mouth? Yes, they could

Wait until you get your culture results back to get the western blot ordered. If the culture is positive, you don’t need a western blot. If you do have a positive culture be certain it gets typed.

If the first western blot is positive, you don’t need to repeat at 16 weeks.

Any index value that is below 3.5 and has not been discovered by a swab test should be confirmed by a western blot. If you want to order a western blot, we can arrange that for you through the clinic. We can set you up with an appointment on Tuesday of next week.

Terri

[holdingouthope]

Hello Terri, and thank you again for your help. I believe this is the last follow up of my subscription.

Yes, I have been obsessively reading forums and articles and research in the last 2 days and it looks like there is indeed a chance, albeit very low (1-2%), that I can give someone HSV-2 in that manner.

If my HSV-2 IGG test result comes back lower than the 3.08 from last week, does this mean anything other than simple variation? Or does it mean there’s a higher chance of a false positive?

I am obviously very stressed about this situation. In the last 2 days I have felt an itchy sensation on the inside of my penis, although there are no lesions on the outside. Is that a symptom of HSV-2? Or is it simply anxiety?

I believe I should be able to get my results back Tuesday morning. What is the lag time in setting up a Western Blot appointment? Meaning, can I call your office on Tuesday after I get my results and (if necessary) set up an appointment for that afternoon or the next day? Can you also tell me the cost and/or if Aetna Open Access covers it?

Thanks again.

[Terri Warren]

I would actually disagree that there is a 1 to 2% chance of someone acquiring HSV-2 orally. I’m not sure what the one to 2% chance is is that at a single encounter? Is that over a period of the year? I have not seen that statistic nor do I believe it. If your HSV-2 test results come back lower this time it is likely just a variation in the testing Control that is run at the same time your sample is run. The itching inside your penis mayor or may not have anything to do with herpes, It is impossible to tell. However I can tell you that when people find out if they are positive for HSV-2, Or in your case, maybe positive for HSV-2, They become hyperaware of any symptoms in the genital area. So it could be anxiety or many other things. In terms of setting up an appointment for a Western blot, we can usually do that with a day or two notice. For example if you wanted to order a Western blot if you called on Tuesday, we could have the appointment to set that up on the following Thursday. Or if you got the results in the morning on Tuesday it might be possible to have a brief conversation that afternoon if there are still appointments available. If you test you are a clinic the cost for the consultation and Western blot is $250. Quest will not bill the insurance of our patients for this service. If you want to use your insurance to pay for this, it may be preferable for you to set this up through the University of Washington directly as they may be able to bill your insurance. I’m not sure about that.

This is the final post on the subscription but if you have other questions Lee’s feel free to renew your subscription.

Terri

[holdingouthope]

Hello Terri, I just renewed.

I just got my results back from last week. My culture came back negative. The new index values for HSV-1 and HSV-2 are 1.79 and 3.46, both higher than last time.

This is obviously not good news. The increase in the HSV-2 index value is indicative of a true positive, correct? Does the fact that both tests were under 3.5 still mean there is a chance for a false positive? Or, does the consistently high IGG level (relative to the 3.5 borderline) mean that I have little hope? Could it really be possible that my HSV-1 is consistently triggering a false positive this much? I tend to think not because this wasn’t a problem in past tests where I had a positive HSV-1 value.

In terms of a western blot, my last sexual contact was 2.5 weeks ago. Do you recommend I wait until the 16 week mark to order one? If I do one now, the best case scenario would be that it tells me that I was HSV-2 negative as of 16 weeks ago, correct?

I have done so much reading and research regarding this in the last week, almost every night. I guess it is my way of coping. I have no one to blame by myself for my irresponsible behavior. I know that I can live with this disease, but I’m worried about being asymptomatic. In many ways, having symptoms, albeit uncomfortable, serves to protect partners better since one can simply not engage in sexual activities during breakouts.

Thanks again for all you do.

[Terri Warren]

Yes, you are still in the low positive range. My suggestion would be to redo the ELISA test once more when 16 weeks have passed. If it is still low positive, let’s get a western blot. If it is over 3.5, then I don’t think you need to do one. If you get a lesion in the meanwhile, be certain to get it swab tested using PCR as soon as it appears, please. And try to stop reading on the internet!

Terri

[holdingouthope]

Well, unfortunately, reading the internet is my way of coping! I’m trying to gather as much information about HSV-2 from informed people, such as yourself 🙂

Some follow up questions:

1) Do you recommend not going on any anti-virals until I can get my ELISA/WB (if nec.) done at the 16-week mark?

2) If I do not have any lesions now or in the near future, what other symptoms are there to look out for?

3) It looks like I am an HSV-1 asymptomatic. Have there been any studies on the prevalence of HSV-1 asymptomaticy translating to HSV-2 asymptomaticy? (don’t think that’s a real word, but you know what I mean)

4) For people who are HSV-2 asymptomatic, is there a difference in risk of transmission to a partner? I am wondering about the best way to reduce the risk of transmission, which may be difficult for someone who is asymptomatic since they do not know when/where the virus is shedding.

Thanks.

[Terri Warren]

1. Yes that is my recommendation for sure
2. That really is the symptom to look for – any break in skin or lesions between waist and knee that is new for you.
3. The person who has HSV 1 is far less likely to recognize or have recognizable genital lesions when they acquire HSV 2.
4. if you are infected, taking antiviral therapy and using condoms will help to reduce the risk of transmission even if you are asymptomatic.

Terri

[holdingouthope]

Hello again Terri,

I believe I have one more follow up to go. I recently got tested again and here are the results (along with my prior results for reference):

3/25/2015: [3 weeks since sexual contact]
HSV1: 1.76
HSV2: 3.08

4/1/2015: [4 weeks]
HSV1: 1.79
HSV2: 3.46

5/27/15: [12 weeks]
HSV1: 1.86
HSV2: 3.62

As you can see the levels are relatively similar, except my most recent one is over the dreaded 3.5 mark. In terms of symptoms, I do not believe I have gotten any HSV lesions (although sometimes I guess it is difficult to tell given candida balanitis, but those go away quickly). I have had a tingly feeling fairly often, but I think that is my anxiety over everything.

What do you recommend I do at this point? I was under the impression that if I waited long enough after sexual contact, if I truly had HSV-2, the levels would be much much higher than they are now? Is there still a chance of a false positive, or does the >3.5 level negate that possibility? Perhaps my HSV1 keeps triggering a higher HSV2 result? And finally, is there anything else that can be wrong with my body that can trigger these results?

Thanks again so much for your help.

[Terri Warren]

There is still a chance of a false positive, yes, though it is not likely. I had a woman with a 3.44 this week NOT confirm with western blot. I would recommend that you obtain a western blot to be certain. This is for a lifetime – the diagnosis should be clear. Our clinic can help you obtain this test if you want to do it.

Terri

[holdingouthope]

I live in NYC and have read that it is an extreme hassle to try and get the WB delivered here, then tested in Jersey, then having a doctor sign off on the test, etc etc. I guess I wish my tests were more conclusive and not hovering around the 3.5 mark. I figured 12 weeks out they would be a lot higher if I in fact did have HSV-2…

[Terri Warren]

Our office can definitely get you a western blot in the state of New York. We are doing a research study on the rate of false positives in the five states that do not allow western blots to be shipped out of state and research is different than normal treatment and evaluation. If you are interested in doing this, please contact Rene in our research department at the clinic.

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

Terri

• This reply was modified 7 years, 8 months ago by Terri Warren.

[holdingouthope]

Thanks, Terri. I will reach out to Rene in a couple of more weeks as I get close to the 16 week mark post contact.

[Terri Warren]

OK

Terri

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