January 10, 2020 at 7:13 am #68709
Thanks for the valuable resource here! I have a question for you regarding some bad anxiety I’ve been having about if I should or shouldn’t retest.
Here’s some background:
I was diagnosed with Genital HSV1 after a swab and igg blood test confirmed hsv1. My lesions were very active, and it was a culture swab. My blood test results were 36 which I know realize is very high and leads me to believe that this was NOT the primary outbreak or at least it wasn’t a recent infection.
The location of my hsv1 was in and around my anus. I had only had Receptive anal sex once at the point of my out break.
I had been experiencing severe anal pain on and off over the course of a few months (at least 4 months was when it first began) this would be around December 2018 when my first symptoms that I can remember appeared, which was a painful anal rash that would spot blood when I would wipe. I did not assume this was herpes at the time. Then in February of 2019 my symptoms turned too severe rectal pain, and mucus/blood discharge. I did not have lesions at this time but I went and got tested for an sti panel and then did swab the area which came back with no results. I’m assuming I did not get an hsv test.
This pain went on for about 1 month until I saw a proctologist who recommended a colonoscopy. After the colonoscopy I had a severe outbreak, which led to the swab and blood results showing high Hsv1 and culture typing it hsv1
My question is, should I be concerned that my culture was typed wrong? I know that hsv1 rarely outbreaks genitally, it’s usually the first one that is severe, and I am just now realizing my igg levels were too high for it to be a recent infection (but maybe it was still the primary?) my blood test also came a week after my swab test so at least 3 weeks since severe symptoms.
There was also a bacterial infection of anal Streptococcus in the swab results, could this have led to a nasty secondary outbreak of hsv1 I experienced?
January 10, 2020 at 10:41 am #68712
I would also like to add that although I had only had receptive anal sex once at that point, I had received analingus (anal rimming) many times over the course of the previous 4 years from many partners (10+). I know infections typically are at the point of infection so wanted to clear up there is a chance it is the HSV1 as diagnosed. I also had this severe out break at a time that I can honestly say was the highest amount of stress I’ve ever had in my life and During a period where my immune system was completely wrecked, also I’m thinking it’s possible the colonoscopy was a trauma that triggered a severe outbreak. As I write this all I’m thinking I really do sound like I’m searching for something that isn’t there (a possible hsv1 misdiagnosis instead of hsv2) but I’d really appreciate the advice of an expert. Also if it helps, my results were done through Quest. Thank you!!
January 20, 2020 at 9:00 am #68809Terri WarrenKeymaster
A few things could be going on here. But my best guess is that you are correct, the HSV 1 anal infection was long standing and not new. Not with that high an index value. One thing that might be going on here is that the pick up of the HSV 1 on the swab test was incidental – that is, the severe symptoms were not necessarily due exclusively to the HSV 1 but rather perhaps due to the bacterial infection you mention. Mis-typing of the virus has happened but is rare and given your sexual practice of receiving rimming at the anus with multiple partners, HSV 1 seems far more likely here. You could do an Igg test to confirm that you don’t have HSV 2 if this remains a concern for you. If you continue to have more outbreaks than are optimal, you could ask your clinician for suppressive therapy, even though that is less usual for genital HSV 1.
February 26, 2020 at 1:23 pm #69403
Thanks for your response. That explanation is interesting but makes a lot of sense to me.
I have another question for you, it’s somewhat of a hypothetical. Would it be possible that my hsv1 positive culture was inaccurate, and was actually an overgrowth of streptococcus all together?
My symptoms were excruciating, large swollen skin lesions that bled a lot and burned. Much more on par with what I’ve seen of anal strep than with herpes. I had tested negative for all other STIs on a standard panel and even got swabbed there two weeks prior and again one month after. It doesn’t make sense to me that my hsv1 antibody index was so high, meaning it wasn’t recent, and yet my outbreak was soooo severe given that it was hsv1. Would it be worth investigating with Quest Labs if Streptococcus is/was the dish next too hsv1?
I know this must sound ridiculous, and I myself acknowledge it’s a stretch. But I have this gut feeling that something isn’t adding up quite right here, especially since I haven’t experienced any symptoms again since that outbreak, and given that it wasn’t a new infection since the igg levels were so high, that would be indicative of being more likely to have another outbreak in comparison to someone who only had their primary around the time of infection (although I know ghsv1 in general doesn’t recur often at all).
I’ve completely come to terms with my hsv status, and have no issue on disclosing it, but it would make my life a little bit easier if this were the case and I was just like all the other 70% of people who have hsv1 and are asymptomatic and didn’t have to feel an obligation to disclose the location of my hsv1.
March 1, 2020 at 7:25 am #69435Terri WarrenKeymaster
The other possibility here is that you have anal HSV 1 BUT what was going on right then was not HSV 1 but your HSV infection was shedding at the time. The testing for the two types of organisms would have been completely different so bacterial samples would not be grown where HSV PCR is being done. It’s not like that. At this point, there is simply no way to know for sure. But I would say that it would be unlikely for strep to resolve on its own with no antibiotics.
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