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Hi Terri, below is the timeline of my course. I had been having hetero penetrative sex with one man, unprotected. He denied STIs, however I am not convinced he did not lie.
22-24AUG2021: Vulvar pain, thought it was a tear from sex, did not visualize
25AUG2021: Visualized. Was a single, small, distinct blister-like wound. It was intact but lanced overnight
26AUG2021: Went to doctor, swab was taken directly from the small, now-lanced blister. MD thought she could POSSIBLY make out 1-2 other very tiny blisters, but it was all too small to tell. Swab was quite painful. Was put on a standard “first outbreak” course of Valtrex and have continued to take it every single day since then at a prophylactic dose
30AUG2021: Wound culture (DNA PCR QNT) resulted: POSITIVE for HSV2 / NEGATIVE for HSV1
01SEP2021: Serum sample taken for additional testing. Resulted: HSV 1/2 IGM = NEGATIVE <0.91 / HSV IGG1 = POSITIVE 10.60 / HSV IGG2 = NEGATIVE <0.91
18SEP2021: Repeat serum sample taken due to probable false results from 01SEP. Results nearly identical: HSV 1/2 IGM = NEGATIVE <0.91 / HSV IGG1 = POSITIVE 11.30 / HSV IGG2 = NEGATIVE <0.91
02FEB2022: Blood sample sent to UW for WESTERN BLOT. Resulted: HSV1 AB, W BLOT = POSITIVE / HSV2 AB, WBLOT = NEGATIVE / HSV WB INTERP: HSV-1 ONLY
The window of time between the initial blister that was cultured and the UW Western Blot is greater than 24 weeks. Nearly 6 months. I feel as though, SURELY, that is PLENTY of time for me to have seroconverted? I do not have any other chronic or autoimmune complexities. Can taking valtrex impact the validity of the western blot?
Ultimately I would LOVE to take the repeat negative blood/WB tests to mean I do not have HSV2, but I am having a very hard time accepting the idea that a DNA PCR wound culture could be wrong. Is there ANY WAY possible the initial DNA PCR was wrong, considering the repeat serum/western blot results?
I am desperate to learn what is happening. I appreciate your input, ty!
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One possibility is that the PCR could well be correct and the typing of the swab incorrect. It isn’t common but I have seen it happen. The other thing is that antiviral medicine has impacted the blot and stopped antibody development for HSV 2. If you were my patient, I would pull you off suppression completely and retest with the blot 3 months later
Terri
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1. If (or when) I have an outbreak in the next 3 months, I am assuming I should get back to the doctor ASAP to have that wound cultured, yes?
Absolutely, but not culture – PCR swab if at all possible2. If (or when) I have an outbreak in the next 3 months AND if it cultures positively, I probably would not need to bother with any more blood tests of any kind anymore.. or should I still?
If the swab test is positive AND typed (that is important) then I don’t see a need for future blood antibody testing, nho.3. Can you see any possible scenario in which I DO NOT HAVE genital herpes, regardless of type?
Oh yes. People often tell them that they have sores that don’t turn out to be herpes. There is hope.Terri
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OK, let me know the result
Terri
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I have had two patients who began taking antiviral medication daily during their first outbreak with HSV 2. One had not made antibody detectable by western blot 9 months later, a second had taken antiviral medicine daily since a new infection 2 years prior and her IgG was negative – she didn’t do a western blot but did come off antivirals and was positive a month later.
The University of Washington does warn that antivirals taken early and daily can impact the accuracy of the western blot. If the antiviral medicine is working well, the virus is not reproduced and therefore the immune system cannot see the virus and will not make an antibody response, even the western blot cannot detect.
I’m glad you were able to sort this out
Terri
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