Questions regarding acquiring virus

[lookingforexplanation]

I’m so grateful to have this as a service. I’m a 40 year old physician who recently tested positive for HSV IgG (index of ~6.7). About two weeks ago I noticed 4 papules on my left buttock. There was also about 1 cm erythematous streak with what appeared to be vesicle at its superior aspect. This linear lesion was in my buttock crease – about 1 cm lateral to anus. It was itchy and a little uncomfortable when walking for few days. I freaked out and made an appt with Ob-Gyn about 36 hours later. My Ob-Gyn stated that the 4 grouped lesions looked like an area of folliculitis (more pustular). He said that the linear lesion and ? vesicle didn’t look like Herpes and didn’t think PCR swab would show anything. However, I was still worried that this may be recurrent HSV 2 episode so he ordered HSV IgG to put my mind at ease. I have an 8 month old son. During pregnancy with him I had another episode of a group of itchy erythematous lesions on buttocks. There were also 2-4 episodes of what felt like fissures or shallow linear ulcers about 1 cm lateral to anus. I had hemorroids and vulvar varicose veins so there were lots of episodes of itching and discomfort. I am waiting for results of HerpeSelect IgG with reflex to suppression test. Question 1) What is the chance that my positive test result is correct? Question #2 What is the most likely way I contracted it? I have had two partners – only one by choice. I was raped as an eight year old girl by 14 year old neighbor. Definite vaginal-penile penetration. Don’t recall any oral sex or anal intercourse but I disassociated. My husband and I have been married for 7 years – regular unprotected vaginal intercourse and oral sex. Neither of us get cold sores. We do get occasional apthous ulcers (inside mouth). Both of us dated one other person prior to marriage. Each of us “French kissed” and “made out” with our previous significant others. But fully clothed. No hand-genital, oral-genital, or genital-genital contact. My rapist, my husband, and I are all Caucasions. Question #3 How often is HSV 2 oral? Can it ever be transmitted in health care setting? ie swabbing throats, placing NG tubes, etc. Thanks so much!

[Terri Warren]

I would say there is an excellent chance that your IgG test is positive if that is what was done with the index value of 6.7. I’m a little confused though – you are waiting for another IgG? And suppression test? Do you mean confirmation test perhaps? I don’t recommend any confirmatory test at this point besides the herpes western blot.

The rape that occurred when you were 8 is just tragic, I am so very very sorry. It does seem unlikely that a 14 year old boy would have HSV 2, however. Has your husband been tested for HSV 2 through an IgG test?

So if what I am reading is correct, aside from the rapist, neither of you had intercourse with anyone else prior to your marriage?

Then the 6.7 doesn’t make any sense to me. But then I am confused about the IgG test – whether it has been done or not or where that value came from. HSV 1 is rarely JUST oral – likely more than 95% is genital. It is not transmitted in health care settings through the means that you describe at all.

Can you help me understand the issue of the index value better, please?

Terri

[lookingforexplanation]

Thank you for your kind response. My sexual assault was horrific. But the amazing thing is how much healing and redemption I’ve experienced in our marriage. Which is why I couldn’t bear the fear and shame resurfacing – especially if lab test was wrong.
One question regarding your response, did you mean HSV 2 is very rarely only oral? My 1st lab test was HSV Type 2 IgG performed by PAML lab out of Spokane Washington. The index was 6.77. My doctor didn’t order the HSV Type 1 IgG because he felt it was less likely to cause recurrent genital symptoms. I convinced him to order a confirmation test because the likelihood seemed so low given my rapist’s age and given lack of other partners. Sorry for confusion – I meant to type HSV 2 inhibition test through Quest labs. I couldn’t figure out how to obtain Western Blot (now I know). Anyway Quest does Herpeselect 1 and 2 IgG first and only do HSV2 inhibition test if HsV2 index is over 1.1. Now I’m really confused. Both my HSV 1 and 2 IgG tests are negative – indexes are less than 0.90. I’m very happy. But should I trust this result? What can cause that type of false positive? My husband was supposed to be tested in few weeks. Can I cancel that? I have no reason to doubt him. I’m a little curious about his HSV 1 status. I’m not sure how risky oral sex would be if he’s positive but a symptomatic. Then I wonder if I’m just paranoid now. Thanks again…

[Terri Warren]

This is a bit of a mess. There is a huge difference between these two values. I would definitely advise a western blot. Something is really wrong here somewhere. The western blot can clear this situation up, I believe. And it wouldn’t hurt for him to be tested – wouldn’t it be a surprise for him to be positive for HSV 2 and you not?

I am presuming that they couldn’t do the inhibition assay because you were negative for HSV 2 correct?

Terri

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