My HSV Status

[windowrain]

Hi Terri,
Prior to 2006, I was hsv free.
In 2006, I had a 2 minutes unprotected bj with a csw. No kiss.

36 hrs later, I felt what I can only describe as a pimple-like bump on my perineum close to my anus. I don’t recall it hurting or itching. 2 or 3 days later a Dr. visually diagnosed me with herpes and prescribed acyclovir for 3 days or so.

The only symptom I experienced was this single bump; no other blisters, swollen nodes or flu symptoms. I don’t remember how it resolved but if it did ulcerate, there was little to no pain or itch. Over the years I experienced a couple of symptoms that I assumed were outbreaks but they’ve been atypical at best; a single boil like lesion at the top border of my pubic region(once), and an occasional raw skin at the spot where I got the bump during my primary. This causes negligible discomfort and goes away in a couple of days. Wiping sometimes aggrevates it and it’s not out the realm of possibility that it causes it as well but I don’t know for sure. Happens more than once a year. I’ve always assumed this was my outbreak.

From 2006 up till 2012, I made out with 3 girls. No sex. In 2012, for the first time ever, I had a coldsore. This has since recurred about 4 times.

I recently had an hsv 2 scare which had me doing a lot of reading. I realised how atypical my hsv 1 primary was and how rare it is to have an hsv type in both places raising doubts in my mind about my ghsv status. My igg shows only hsv1 positive. My initial questions are;

1. I’ve read that initial outbreaks occur mainly at the site of virus entry. Does this have a scientific basis and have you seen cases like mine i.e my type of exposure and primary presentation.

2. Is it possible to have such a mild ghsv1 primary; just a single blister with no other symptoms?

3. What are your general thoughts on my status from my presented history

[Terri Warren]

1. I’ve read that initial outbreaks occur mainly at the site of virus entry. Does this have a scientific basis and have you seen cases like mine i.e my type of exposure and primary presentation.

That is correct. However, the perineum where it appears you had your first outbreak could be the location of a primary but it is more likely to be the shaft of the penis.

2. Is it possible to have such a mild ghsv1 primary; just a single blister with no other symptoms?

It is possible, but it seems less likely to me. And since you report no kissing with that person and have kissed other people and now have a cold sore, it seems more likely to me that you acquired the HSV 1 virus orally for the first time in 2012. It is, of course, also possible that you have had it for year and it is just now surfacing. Where is the cold sore?

3. What are your general thoughts on my status from my presented history

I think it is very possible that an error was made in diagnosing your bump as genital herpes. Since you continue to get symptoms now and then, I would strongly suggest that you obtain a swab test during the next one of these symptoms to see if any virus is present. Strange things can happen with herpes but sometimes a swab test is the only way to know for certain what is going on.

Terri

[windowrain]

Thanks Terri.

I’m confident that I didn’t have any hsv prior to 2006. I get classic outbreaks on my lower lips so there’s no question about that. I’ll try swabbing next time I get something suspicious. If I was actually diagnosed correctly in 2006, that means indeed I did acquired hsv 1 orally 4 or so years after acquiring a genital infection. That seldom happens right?

Now to my current situation. You responded to my post on askexpertsnow but I’ll recap below with updates;

Protected sex with a csw. Exposure to vaginal fluids via scrotum and anal rubbing with fluid covered hands.

Swollen armpit nodes + flu symptoms on day 3 days onwards.

A little sensitive skin area in pubics at day 8. Single pimple developed at said area on day 9 which was popped. Had yellowish not so watery pus followed by a little blood. Didn’t turn into a sore or ulcer. It more or less resolved after popping.

Scrotal rash with tiny white heads of sorts at day 11. Was just slightly itchy, no pain. Resolved completely within 5 days with fucidic cream.

Day 44: buzzing/crawling feeling on left cheek. Single bump developed and went away in 6 days without turning into a sore. Recurred 4 times in a space of a month and a half. Dermatologist thought it was a cyst or inflamed follicle.

Day 106: similar bump on right cheek after same buzzing/crawling sensation. Popped it after 5 days with a needle. It discharged thick creamy white pus and a little blood.

6 iggs taken. Hsv 2 Negative at 4, 8, 10, 12, 16 weeks.
These were at a lab with no index value reports.

Just received the results (5 months post exposure); hsv2 IGG: 0.8. Positive range is >0.9.

What should I make of this high negative? My CBCs have been off for the past few months with neutropenia happening a number of times. I’m concerned that I might be struggling to produce antibodies or something. I’m west African if it makes any difference.

Also took 1000mg acyclovir for 3 days at week 12 to ward off cold sore. Thoughts?

[Terri Warren]

A visual diagnosis is not always accurate so I would not count on it.

Your HSV index value is higher but it is still negative. Given that it is higher, if you were my in-person patient, I would recommend that you wait another month and retest with western blot. We know the IGG is not terribly reliable in the African population so that could be impacting this result. I don’t think the CBC has anything to do with this.

Terri

[windowrain]

Hi Terri,

If it wasn’t very clear my last test which was 0.8 was done 20 weeks post exposure. I took the 3 day dose of acyclovir at 12 weeks i.e 10 weeks ago.

1. Does your assessment still stand?

2. Is your recommendation to wait based on the fact that i may still be seroconverting at 5 months or is it because of the 3 day antivirals taken 10 weeks ago.

3. If the western blot is required, do I still need to wait an additional month which would make it 6 months?

My recurring visual symptoms have been a zit of sorts on my butt cheek which starts with a buzzing sensation. It’s always just one and doesn’t turn into a full open sore or ulcer. I popped the last one with a needle after day 5 when it looked filled up but still hadn’t opened. It showed thick creamy white pus with some blood.

3. Does that sound like an hsv lesion? Could a recurring herpes lesion be of this presentation?

Assuming that I just had Ohsv1 all along and though rare, I happened to catch hsv1 genitally with this sexual encounter.

4. Would my body react as if it were a new virus i.e still have flu like symptoms at the onset considering that I already have antibodies for hsv1.

I didn’t experience swollen nodes in my groin. I however had swollen nodes in my left armpit at day 3. I have since been having persistent discomfort in both armpits. Sometimes with a little swelling.

5. Are swollen groin nodes a fixture with first outbreaks when they do happen or that isn’t always the case? How common is it?

6. What do you make of my swollen armpit nodes?

7. Based on experience, would an outbreak react positively or negatively to fucidic topical cream or it’ll have no effect?

8. When you say the igg test is not very reliable with my demographic, based on your experience does the data have it leaning towards more false negatives or false positives? An explanation would be great. Your help is appreciated. Thanks.

[Terri Warren]

1. Does your assessment still stand?

yes. Three days of medication will not change a test result

2. Is your recommendation to wait based on the fact that i may still be seroconverting at 5 months or is it because of the 3 day antivirals taken 10 weeks ago.

it is based on the high negative.

3. If the western blot is required, do I still need to wait an additional month which would make it 6 months?

Given your high negative, yes, I would wait an additional month for the blot

My recurring visual symptoms have been a zit of sorts on my butt cheek which starts with a buzzing sensation. It’s always just one and doesn’t turn into a full open sore or ulcer. I popped the last one with a needle after day 5 when it looked filled up but still hadn’t opened. It showed thick creamy white pus with some blood.

I cannot say. You most assuredly should have this evaluated and swab tested by a clinician

3. Does that sound like an hsv lesion? Could a recurring herpes lesion be of this presentation?

It could

Assuming that I just had Ohsv1 all along and though rare, I happened to catch hsv1 genitally with this sexual encounter.

4. Would my body react as if it were a new virus i.e still have flu like symptoms at the onset considering that I already have antibodies for hsv1.

unlikely

I didn’t experience swollen nodes in my groin. I however had swollen nodes in my left armpit at day 3. I have since been having persistent discomfort in both armpits. Sometimes with a little swelling.

5. Are swollen groin nodes a fixture with first outbreaks when they do happen or that isn’t always the case? How common is it?

Not armpit nodes,no

6. What do you make of my swollen armpit nodes?

I have no idea, sorry

7. Based on experience, would an outbreak react positively or negatively to fucidic topical cream or it’ll have no effect?

I don’t know that either

8. When you say the igg test is not very reliable with my demographic, based on your experience does the data have it leaning towards more false negatives or false positives? An explanation would be great. Your help is appreciated. Thanks.

The IgG test misses 30% of HSV 1 and 8% of HSV 2. So false negative.

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

Terri

[windowrain]

Hi Terri,

Additional questions purchased. Considering my location (West Africa) and existing facilities, I’m facing difficulties in my getting the right logistical support for the western blot as you recommended.

I continue to look into this but in the heat of my frustrations, I took another igg test. To summarize, this was 2 and a half weeks after my 0.8 results and 22.5 weeks post exposure as detailed in my earlier messages.

So;

20 weeks: hsv 2 igg: 0.8
22.5 weeks: hsv 2 igg: 0.6

1.What are your thoughts on the test timeline and the slight decline?

Around week 13, I took 3 days of 1200mg acyclovir. This was from Saturday to Monday.

On Wednesday, while wiping after bowel movement I saw blood on the tissue. Looking at the area with a mirror, I saw a skin irritation right between the cheeks on my butt crack, about an inch from my anus as if I had wiped too hard. It looked like scraped skin with a row of 3 small red sores. It wasn’t raised and it only hurt in the shower when water hit it. No itch. Also, I didn’t notice any oozing and it faded back to normal skin 3 or 4 days after discovery without a noticeable scab. I got a PCR kit from the lab the day I noticed it and took a swab by rubbing the cotton bud hard on it. I didn’t wet the cotton bud before running the area. The PCR came back with no detection of hsv.

2. Does the above sound like an outbreak?

3. Did I use the PCR kit incorrectly?

4. As mentioned I took 1200mg of acyclovir daily for 3 days from Saturday through to Monday. I noticed the’irritation’ and took the swab on Wednesday. Could the such acyclovir intake within the timeline have affected the PCR results?

Thanks.

[Terri Warren]

I’m glad you were able to get a swab test that was PCR. It is important that this was negative. and you used it correctly, but I am concerned about the three sores and the timing of your dosing of acyclovir. It could have impacted the swab, yes

Terri

[windowrain]

Thanks Terri. You missed question 1 regarding my tests.

Also, I’ve noticed recently that my semen looks a bit odd. The colour had a light yellowish tinge to it. Hasn’t reverted back to normal since I noticed this ( about a month ago). Can herpes cause a change in semen colour and how does this happen? If yes, does this resolve on its own or only with antivirals.

[Terri Warren]

Herpes does not make semen look yellow.
I think the decline in the IgG is a good thing, a positive thing! And makes a western blot less necessary. Now well into the negative range.

Terri

[windowrain]

Hi Terri,

A lot has happened since the last time I posted.

– The butt crack ‘tears’ I mentioned in my last post happened again.I noticed their appearance after doing some leg stretches in the morning. Swabbed day 2. Results: negative.

– A cluster of semi hard swollen lumps appeared behind my right knee in the knee fold. They were present on a red base, red colored as well and itched slightly. I had a vague recollection of feeling a sting like an insect bite the previous night but I wasn’t sure. To me it initially looked like an OB considering how red the area was. It was circular, the size of a penny with the lumps in the center but it resolved quite fast for what it was. I applied some triple action Betamethasone cream and by the next morning the lumps had receded considerably leaving crumbled skin where there were and the red round base. There was no fluid, sore or break in the skin at all. I had the red skin swabbed around 60hrs. Negative. The area was back to normal colour by the end of day 3 with only little tiny dark scabs where the lumps were. Very tiny scabs.

– The perineum tear that I had always called my hsv1 outbreak happened again. I swabbed it and surprisingly came out negative.

– I had another hsv2 igg test. So my set of tests are;
– wk 20 = 0.8
– wk 22.5 = 0.6
– wk 27.5 = 0.5

Questions;

The knee lump got me worried, initially as a possible outbreak and later I entertained thoughts of erythema multiforme considering how circular the base was with the lumps in the middle. It resolved totally in 3 days with the help of a steroid cream.

1. Does this sound like a OB?

2. Is it possible for EM to be just a single lession and resolve fully in 3 days?

3. I PCR swabbed about 60hrs after appearance when there was nothing but normal looking red skin. Would it have picked up any present virus even if it was EM?

4. Thoughts on my tests? Worried why I’m not getting a ‘true’ negative e.g. around 0.2

5. Your general thoughts if I were your patient.

[Terri Warren]

1. Does this sound like a OB?

No, and steroid cream would make an outbreak worse, not better

2. Is it possible for EM to be just a single lession and resolve fully in 3 days?

Possible but not likely

3. I PCR swabbed about 60hrs after appearance when there was nothing but normal looking red skin. Would it have picked up any present virus even if it was EM?

Probably not

4. Thoughts on my tests? Worried why I’m not getting a ‘true’ negative e.g. around 0.2

I think you should trust your negative result for HSV 2 and move along. You can’t get the blot so you need to live with the next best thing plus you’ve not had anything that worries me since your swabs have been negative from areas that concern you.

5. Your general thoughts if I were your patient.

see above.

Terri

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