Negative Supplemental Test and Seroconversion Timeframes

[Lmc55]

Trying to help my son. Timeline and background:
20 year old male, only 2-3 sexual partners total prior to a one time encounter (9 months ago) with protected sex but condom came off at some point. A week or two later, had thinks he had a low-grade fever for one day but felt fine. Decided to get tested (STD Panel) at a random lab. All was negative but HSV2 index was 2.5. It was 2-3 weeks from the encounter and did not have an outbreak.
3 months after encounter got tested again (Quest). All negative but HSV2 still low positive, 2.4. Still asymptomatic but started observing things in genital area every so often – tingling, rash patches, small bumps, itchy, etc. Each time he feared the worst.
6 months after encounter finally went to family doctor who ran tests this time. I don’t recall the index but he said HSV2 was a low positive index and a negative supplemental. He remained asymptomatic and nothing presented since the encounter yet continued off and on to experience an occasional bump or rash, itchy, etc. Family doctor ruled these out as being HSV2 and gave him antibiotics to treat what could have been an infection of the urethra or prostate as another symptom my son experienced was dripping after urinating. Antibiotic seemed to help that issue. Went to a dermatologist about the other issues he was experiencing like the rash patches, itching, and bumps and was told it was most likely dermatitis, eczema, etc. At the time doctor didn’t see anything during the exam that was indicative of HSV2.
Family doctor’s clinical diagnosis was that he was negative based on low number of partners, low positive antibodies, negative supplemental, zero outbreak. Family doctor sent him to an infectious disease doctor who concurred that he was negative but added it could just be dormant and neither doctor would say they could 100% guarantee he was negative. Neither suggested the WB.
Son is not satisfied that that he’s negative based on all this and feels it’s just a matter

[Lmc55]

It looks like my initial post/questions didn’t completely appear even though I was under 500 characters so here are the questions:

1. You’ve advised there is good agreement between a negative supplemental and a negative WB. He isn’t convinced because of this statement, “Negative supplemental indicates not infected with genital herpes; or infected but not seroconverted (primary. Infection)”. He thinks he could still be infected and it just didn’t show up due to the timing or that he could have tested negative because “it” wasn’t “active” at the time he took the test. If the supplemental test was done approximately 6 months from encounter, would that have been enough time for seronversion to be done by then and his negative supplemental means he’s truly negative?
2. It’s almost 9 months since the encounter and he has never presented. Based on everything shared should he feel confident that he’s negative based on 3 low positives, a negative supplemental after 6 months and has not presented at this time?

[Terri Warren]

If the supplemental test was done 6 months after a sexual encounter and there haven’t been any sexual partners since then, that’s as good as it’s going to get. I personally have not seen someone with a negative supplemental test 6 months out be positive on the western blot. I feel strongly that he is negative. But if he can’t accept that and wants to do the blot, I can certainly work with him to get that done but so can any of the other providers that he has seen. Sometimes, peace of mind is better than any medicine.

Terri

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