Second Opinion

[GAN2112]

Terri,

I’ll start with a brief history of events followed by my question:

• First noticeable outbreak 10 days after last possible exposure (unprotected sex- oral & genital). Clinic visually diagnosed as HSV, drew blood and prescribed Acyclovir 800mg, 5 x day, for 7 days
QD Herpselect Blood test result:
IGG HSV1 – 1.76
IGG HSV2 – 0.32

• Second outbreak (mild) 4 weeks after last possible exposure. Swab test was performed; prescribed Acyclovir 800mg, 5 x day, for 7 days
Swab test result: Herpes Simplex Virus Isolated (type not specified)

• 21 weeks after last possible exposure, second blood test prescribed by my GP. No outbreaks for 17 weeks; no antiviral medication for 16 weeks.
2nd QD Herpselect Blood Test Result after 21 weeks (5 months):
IGG HSV1 – 1.36
IGG HSV2 – 0.36

Based on these results, my GP’s diagnosis was Genital HSV1. My last sexual partner did have recurrent cold sores and I don’t recall ever having a cold sore in my life, so that seems to be a plausible explanation.

My questions:

1. Do you agree with his diagnosis?
2. Can the Acyclovir medication affect seroconversion 16 weeks after I stopped taking it?
3. Do you recommend any further testing?

[Terri Warren]

Hmmmm. Interesting. And all of these questions and $20 could have been saved, just by asking for typing at the time of the culture as the CDC recommends!
I suspect that your doctor is correct but your HSV 2 level is a little higher than we sometimes see and your HSV 1 is in the low positive range and would normally need confirmation if that was our only piece of evidence. However ,with the positive swab test, I think it is likely that you have genital HSV 1. However, if you were my patient, I would probably run a western blot just to be sure with the antiviral therapy in for a couple of weeks.

I would guess that with 90% certainty, you have genital HSV 1. There are just a couple little things in here that make me very slightly less certain.

Terri

[GAN2112]

Terri,

Thank you for your response.

It was my fault to assume that clinic would order a type specific culture test after having ordered a type specific blood test…lesson learned.

Three more questions:

1. So is an IGG HSV2 value of 0.36 after 21 weeks considered a “high” negative?
2. How common is it for antiviral therapy to suppress seroconversion?
3. How do I go about ordering the WB test though your clinic?

[Terri Warren]

1. Not really high, no. But not really low either. Not really worrisome, but a little higher than the usual. Many things can cause that, including proteins that are just part of you!

2. Antiviral therapy can suppress seroconversion, but you only had two weeks of it and then 16 weeks without so it shouldn’t be an issue really.

3. We can order it for you at a Quest lab near where you are. It’s probably really HSV 1, maybe I should have said 95%. There’s just something about it that makes me a tiny tad uneasy and I’m not sure why. You’ll probably be fine without doing the confirmatory test.

You are not the one that should have known to ordering typing with the culture.

[GAN2112]

Thank you for clarifying. I would say in the absence of a confirmatory culture or WB, 95% is as good as it gets. My GP would probably agree with you. I’ll give it some thought, but given the differences between type 1 and 2 on the genitals, I don’t see the harm in doing a confirmatory WB.

Speaking of that…after reading your handbook, it is my understanding that genital HSV- type 1 and 2, generally operate in the same manner during the first year of infection. However, after the first year, type 1 is a associated with fewer recurrences and fewer episodes of asymptomatic shedding. Is that correct?

I’ll thank you in advance for your response.

[Terri Warren]

Oh, I would say even in the first year they are different for most people. HSV 1 recurs less, sheds less and is less infectious to others, given the high prevalence of HSV 1 in the US population. If you have to get herpes, it is the better one to have, I guess. If you don’t have a recurrence in the first year, there is an 88% chance you won’t have another. So part of this is wait and see.

We would be happy to help you arrange a western blot if you would like to do that. We can set up a blood draw near where you live and the lab will send it to UW. Let us know if we can help.

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

Terri

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