Recently Diagnosed

[upsetaboutherpes]

Hi Terri,

I experienced a severe genital outbreak in December 2017, 9 days after an encounter that involved oral and vaginal sex. At the time, the gynecologist visually diagnosed me with herpes and prescribed valacyclovir. 20 days post-outbreak (Jan 2018) I had blood work done to confirm this diagnosis. The results came back as follows:

HSV-1 (IGG), TYPE-SPEC AB 30.20 H
HSV-2 (IGG), TYPE-SPEC AB < 0.90

Given the timeline described above, the gynecologist seems to think that this is a recent infection. However, I’ve read that a high index number could also mean that the infection has been present for a while and a positive result is not common for recent infections since it takes your body some time to build antibodies.

Can you please clarify what the index numbers mean and how or if there is a connection between this number and the amount of time one has been infected? Do you think I’ve been infected for a while or is this new?

[upsetaboutherpes]

Since the December outbreak, I have experience six more genital outbreaks. Half of these outbreaks were brought on as a result of sexual intercourse and ulcers appeared on my perineum and on the skin of the vaginal entrance every time. The other three outbreaks occurred on the labia and around the anus. Considering that HSV-1 in the genital area recurs less often:

1. Is it normal to have had 6 outbreaks in a matter of three months? Since the initial outbreak I have been taking 500 mg of valacyclovir everyday (twice a day when having an outbreak). Recently the gynecologist switched me to 500 mg of famcyclovir daily to see if there are improvements.

2. Sex no matter how gentle seems to be a trigger so I have completely refrained. How likely is it that this will continue to be a trigger for me?

3. I know HSV-1 is the same virus that causes cold sores but I’ve never experienced an outbreak in or around my mouth. Could I now carry the virus in or around my mouth too?

[Terri Warren]

Did your doctor do a swab test of the lesions to determine if the infection was HSV 1 or HSV 2?
HSV 1 is unlikely as you have a high index value for HSV 1 and with new infection, it would not likely be this high right away.
If you have been on antiviral medicine since the start of this, you could have HSV 2 and the medicine is keeping you from making antibody. It doesn’t really matter except that a correct typing and diagnosis cannot be made if someone is taking suppression right after a first outbreak if no swab testing of lesions was done (which it should have been).
At this point, HSV 2 seems a more likely diagnosis given the frequency of outbreaks and your high index value when first diagnosed.

Terri

[upsetaboutherpes]

I had several lesions the day I was visually diagnosed but no swab was taken at that time. I returned to the doctor 4 days later because I was also diagnosed with bacterial vaginosis and the doctor wanted to check the ulcers to see if they were getting infected. At this time a swab was done but it ended up coming back negative for hsv. She explained that this was due to taking the swab too late and there not being enough virus to detect.

Based on the information you provided I plan to have another blood test done. How long should I be off the antiviral in order to get a more accurate result?

Or given the frequency of the outbreaks should I just wait to have one and get that swabbed for a more accurate and definitive answer?

[Terri Warren]

One strategy that might work is to come off the medicine and wait for the next outbreak. When it comes IMMEDIATELY get it swab tested.
Your situation is somewhat unusual in that a person with HSV 1 usually has a mild first outbreak when they acquire HSV 2. We know this isn’t your first outbreak with HSV 1 due to the high antibody levels when you were first symptomatic. The other possibility is that this isn’t herpes. The swab test is absolutely essential to know what is going on here.
You should be off medication for at least 6 weeks before testing again and if negative for HSV 2 at that time repeat when off 12 weeks.
BTW, herpes lesions almost never get superinfected.

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

Terri

• This reply was modified 5 years, 6 months ago by Terri Warren.

[upsetaboutherpes]

Hi Terri,

I am following up regarding your advice on my last post. I have been off the antiviral medication for exactly 40 days and since then I have not had an outbreak.

On April 2nd, I had a doctor’s appointment for something unrelated to this situation though I mentioned my case to the doctor. She offered STD testing (herpes was included in this panel). At this point I had only been off the antiviral for 5 days and the results came back as follows:

HSV 1 IgG, AB HERPESELECT POSITIVE
HSV 2 IgG, AB HERPESELECT NEGATIVE

Since mid-April I’ve been dealing with a yeast infection (confirmed via culture) with symptoms that have failed to completely go away. Due to persistent symptoms this past weekend (May 5th, 38 days without antiviral medication) I went to urgent care and they ran a new STD panel that included testing for HSV-2 only. The urgent care facility utilized Bio Reference Laboratories and results can back as follows:

Herpes II Ab .(IgG) 0.14 ai <0.90 ai Final

You had recommended to get tested at 6 weeks after being off medication (this last test puts me at just 4 days shy of 6 weeks) and then again at 12 weeks after being off of medication:

1. Given the two negative HSV-2 results by 6 weeks, do you still recommend I get another test at the 12-week mark? What are the chances that in the next 6 weeks my HSV-2 results will become positive?
2. I’ve seen my regular doctor, an infectious disease specialist and a dermatologist. All three individuals seem stumped by my situation and the timeline of how things happened. The ID specialist is skeptical this might not be herpes related but didn’t want to get my hopes up without something to culture. You too had mentioned that perhaps what I experienced could not be herpes related. Just so I am informed, what other non-STD conditions can cause a combination of painful blisters and cuts in the genital area?

[Terri Warren]

1. Given the two negative HSV-2 results by 6 weeks, do you still recommend I get another test at the 12-week mark? What are the chances that in the next 6 weeks my HSV-2 results will become positive?

I think the chances are low but I believe that you need to do it anyway to be more certain.

2. I’ve seen my regular doctor, an infectious disease specialist and a dermatologist. All three individuals seem stumped by my situation and the timeline of how things happened. The ID specialist is skeptical this might not be herpes related but didn’t want to get my hopes up without something to culture. You too had mentioned that perhaps what I experienced could not be herpes related. Just so I am informed, what other non-STD conditions can cause a combination of painful blisters and cuts in the genital area?

You are HSV 1 positive – do you have a history of cold sores? This could be HSV 1 genital infection? I would recommend that you consider staying off your medicine until 12 weeks and even then, until you have another outbreak and when you do, if you do, get in immediately and get a swab test and try to be sure it is PCR, not culture. PCR is swab test in this case, never a blood test, OK?

You have two more posts to do.

Terri

• This reply was modified 5 years, 4 months ago by Terri Warren.

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