So confused!

[SarahM85]

I am a 29 y/o female always monogamous/long term- the most recent has been about 14 months. I have also always been very mindful of sexual health – I’ve had three negative HSV tests in the last 6 years two of which have been during my current relationship, but recently I had a positive IgM and culture. Here is a timeline of events of the situation:

7/21 – Had my annual visit and a full STI screening including HSV IgG

7/23 – Had yeast like discharge, but had a lot of sex the day before so I figured it was cervical.

7/26 – 8/1 Had fever, chills, etc and noticed swollen lymph nodes in groin. Noticed bumps and irritation but I had shaved several days in a row. Could not get a hold of my OBGYN for results. Started to notice lesions, went to Urgent Care and told I had BV, razor irritation and contact dermatitis. Went to second UC when pain was bad for relief, told my skin looked like a bacterial infection and not herpes.

8/3- OBGYN APN called that 7/21 tests were negative, including my HSV 1/2. I told her my current symptoms and what was going on and she told me to come in. She said I had a serious yeast infection and put me on a two week diflucan treatment. She did a PCR culture as well as an IgM. She said there was a 60 percent chance it was herpes. I was a mess and my boyfriend was shaken up- we both confirmed that neither of us had cheated, and I honestly believe him and I know I have been faithful.

8/9 – I got the news that the PCR came back positive for HSV 1 and the IgM was positive for HSV 1 index 4.5 and weakly detected HSV 2 (she told me to disregard that).

8/13 – My partner had his labs drawn (nearly 3 weeks after my initial fever).

8/26 – His results were negative for HSV 1/2 IgG and IgM.

I was sure that he was going to be positive for HSV 1, given that so many people have those antibodies, and that I contracted it through oral sex. I did sip out of a few peoples drinks at a party on July 18, and a few puffs of a cigar. I shared a fork with a friend and sipped a friend’s cocktail. Those are the only things in the last two months I can remember..

My first question is: Is it possible that my partner’s IgM’s were undetectable due to the exposure not being recent enough but his IgG’s not developed? The urologist he consulted said it’s impossible, he would have had one or the other.

[Terri Warren]

So we know you have genital HSV 1 infection. That is confirmed by the PCR and so glad the ANP did the PCR – all of those previous clinicians totally missed it?
In terms of your partner – the screening HSV 1 test misses 25 out of 100 infection, when comparing the gold standard western blot to the ELISA screening test that you had done. So it is certainly possible that your partner does have HSV 1 and the test missed it. Was an IgG test also done on 8/9? You mention an IgM but not IgG. Odd that she would do an IgG for HSV 2 but none for HSV 1. How high was your HSV 2 IgG?

Terri

[SarahM85]

Hi Terri,

Thank you for a quick response. I actually had my testing done 8/3 and received the results 8/9 and I only had a PCR and IgM HSV 1/2…. I did not have an IgG because I had just had my blood drawn on 7/21 during my annual and had negative IgG results for HSV 1/2, so she said the infection must be very new. I had no index for an IgM for HSV 2.

My partner had HSV 1/2 IgG and IgM done. He is going back in 6 months to be re-tested. Thank you for providing that statistic. How long do IgM antibodies last before declining/becoming undetectable?

Another main question(s) I wanted to ask is regarding autoinoculation. I know it will make me crazy trying to pin point transmission, but I am afraid I could have contracted it orally through sharing drinks/utensils then given it to myself through oral sex with him followed by vaginal?

And yes, both those other clinicians missed it!! I practically begged the one to test me and she said there was no point, it was an infection. Honestly this is the most stressful thing I’ve ever had, and my partner looks at me like I cheated and it’s killing me.

[Terri Warren]

The IgM test is poor, lots of false positives, IgM antibody can come up early in infection, it is often present with recurrences, it is just too much of a wild card to depend upon in any way.
Again, the IgG test could have missed your old HSV 1 infection, it could have missed his old HSV 1 infection, it is so hard to know here. However, if, down the road, you test positive for HSV 1 IgG then you will know that it likely IS new infection, that you do make IgG detectable by the screening test. does that makes sense to you?
Usually, if the screening test misses it once, it will miss it every time.
First, people don’t get genital herpes by sharing utensils and then transmitting it to the genital area. That’s not how this goes.
Your partner get could a herpes western blot test now to try to pick up his HSV 1 infection. But at a minimum, tell him the screening test misses one of out four HSV 1 infections. Was your boyfriend the giver of oral sex to you?

Terri

[SarahM85]

Terri,

I guess I was under the impression that it was next to impossible to have three false negative IgGs, as was the case with myself. So what your saying is if he has had an old HSV 1 nfection and tested false negative, he will continually test negative? Is it possible that a great immune system can cause false negatives, because until recently I have been a model of great health and he is the healthiest person I know… Also, how quickly do IgM antibodies decline/become undetectable?

Thank you for the information on the autoinoculation – I read that it was possible but it sounded rare. I though that the primary way to contract HSV 1 was through sharing, so the idea didn’t sound too far fetched. To clarify, we both gave oral sex frequently, and in the above question my concern was my mouth/saliva on his penis followed by vaginal sex…I was half blaming myself because I really was afraid I could have done it to myself because we had oral and vaginal sex just 4 days after me sharing drinks and such with people!

I realize that I used my follow up question above, but I have more so I am going to post this, then purchase more questions. I know it is a lot but I have been researching (probably too much – but trying to stick to professional journals), plus I work in healthcare so I understand the complexity of these issues, but I still like to investigate and gather information.

[SarahM85]

Ok…I really don’t mean to bombard you, but here is another question I’m really curious to ask:

I have read that the PCR is extremely accurate, do you have any statistics regarding its false positive/negatives.

What is the likeliness of the PCR cross referencing with another virus like CMV or Herpes Zoster? I know I am fishing here, but is there any possibility it could have been vaginal shingles or psoriasis or the yeast infection I also had at the time or anything else?

[Terri Warren]

A great immune system would not mean a false negative, no, it has to do with the test, not the person. If a person tests negative falsely, then they continue to do that, in my experience. IgM antibodies come and go and are often present with recurrences as well.

The PCR would not cross react with other viruses, no, it is specifc for HSV 1 or HSV 2.

Terri

[SarahM85]

Terri,

Thank you again for your answers and clarity.

Are you able to provide information regarding false positive or false negative PCRs?

I did have what I thought was an infected nail/cuticle cut shortly after I clipped them around the same time as all this.. I work in healthcare, what are the chances of herpes whitlow and transferring it to my genitals?

I would also like to thank you for being so understanding that I am asking these far out questions, I have been unable to relax. I am just truly struggling with the idea that this could have originated from me because of the repeated negatives and because I have only even kissed two men in over 6 years. My previous partner had a full blood test in our last year of dating because of non-sexual related medical concerns, I contacted him and he told me it included HSV 1/2 and he even offered to get a second for both our peace of mind.

[Terri Warren]

False positive PCRs are very rare and we have no way to know how frequently false negatives happen because there is no test more sensitive with which to make the comparison. I would believe a positive PCR.
I have no way to know if the thing on your finger is whitlow but if that is a concern, I would recommend that you have it looked at. In my experience, whitlow is pretty remarkable and often really miserable.

The false positive thing about IgG applies to you, to your most recent partner and your older partner.
Only time may be able to tell if this is new or old infection. If you go on to have a positive IgG for HSV 1, you will know that this is new and that you ARE making antibody that is being detected by the screening test. You could certainly test sooner than 12 weeks out and if it is positive you will have your answer.

Terri

[SarahM85]

Terri,

All my outlandish questions are done, at least for now.
My finger healed very quickly with extra good hygiene, Neosporin and peroxide, so I highly doubt whitlow…

To recap our discussion and questions/answers:
1) In no way did I autoinoculate myself – Even if I had HSV 1 exposure was recent due to sharing drinks.
2) The herpes whitlow idea is a major stretch (I don’t have contact except for the occasional hand shake)
2) PCR’s do not cross reference with other viruses and are extremely accurate
3) I could have had repeated false negative for all these years
4) My recent partner’s tests could have been negative due to not having antibodies established yet because the infection was too new and IgM’s are unreliable and unstable, or he could have had an old infection and test false negative.

I am getting an IgG next month, and another a few months later. Based on the above, if I test negative and my most recent partner tests negative I am going to let it rest. If I test positive and he tests negative, then I am going to ask him to get a western blot because I really can’t think of another feasible explanation if the above conclusions are true. If we are both positive, than I am going to assume that he recently contracted it, as there would be no other explanation. Do you agree with this assumption?

If the Western Blot is based on IgG’s, will it be negative for that individual who may be repeatedly testing false negative on the ELISA? He has not told me what types of test he had, but I looked up the testing at LabCorp where he said he went, and they have a CLIA and IFA…what is the difference between them and ELISA?

I hate to assume cheating or lies, as I always believe people are honest and good, but he has cut communication, ignored my request to discuss it and has not shown me his results although I shared mine – so who knows, he might be positive and hiding it?

[Terri Warren]

1) In no way did I autoinoculate myself – Even if I had HSV 1 exposure was recent due to sharing drinks.
correct
2) The herpes whitlow idea is a major stretch (I don’t have contact except for the occasional hand shake)
correct
2) PCR’s do not cross reference with other viruses and are extremely accurate
correct
3) I could have had repeated false negative for all these years
correct
4) My recent partner’s tests could have been negative due to not having antibodies established yet because the infection was too new and IgM’s are unreliable and unstable, or he could have had an old infection and test false negative.
correct

I am getting an IgG next month, and another a few months later. Based on the above, if I test negative and my most recent partner tests negative I am going to let it rest. If I test positive and he tests negative, then I am going to ask him to get a western blot because I really can’t think of another feasible explanation if the above conclusions are true. If we are both positive, than I am going to assume that he recently contracted it, as there would be no other explanation. Do you agree with this assumption?
Yes, I tend to agree with those assumptions. If he tests positive and you test negative, then the antibody test is missing yours and he could have gotten this from you or from someone else close to when he had contact with you.

If the Western Blot is based on IgG’s, will it be negative for that individual who may be repeatedly testing false negative on the ELISA? He has not told me what types of test he had, but I looked up the testing at LabCorp where he said he went, and they have a CLIA and IFA…what is the difference between them and ELISA?

western blot is NOT based on IgG as the ELISA is. IFA is a swab test – I’m not familiar with CLIA in the way you are referencing it here.

I hate to assume cheating or lies, as I always believe people are honest and good, but he has cut communication, ignored my request to discuss it and has not shown me his results although I shared mine – so who knows, he might be positive and hiding it?

You were in a 14 month relationship and all of a sudden he cuts communication with you? Why?

Terri

[SarahM85]

I don’t know why he did but I think that’s what is making me the most stressed over this whole situation…

I am racking my brain about autoinoculation and just can’t let the idea go, I suppose because I keep regretting sharing those things. I think I might remember my tounge having a few spots on it, would autoinoculation be possible via oral/vaginal sex if those were sores from a primary outbreak?

[SarahM85]

It was more like a blotch or two on my tounge, no pain when eating or drinking. No bumps, puss or ulcerations, at the time I thought it might just be heat or dehydration or something. Ahh this is scary!

[Terri Warren]

Sorry, you have no more questions available on your subscription Sarah

Terri

• This reply was modified 8 years ago by Terri Warren.

[SarahM85]

Terri,

You wrote me the following which was unable to be posted/followed up upon until I updated my subscription:
Herpes normally does not present on the tongue when it is acquired orally. It might have been
something called geographic tongue. Google it and see if it looks familiar. It is not caused by herpes.
I wish you would believe me that herpes is not transmitted via sharing drinks.

Thank you for clarifying about my tongue, thinking back I believe my dentist commented on it at one point. I do believe you about my genital HSV not being transmitted via sharing drinks. I know I should absolutely stop reading posts online and disregard answers/explanations that come from anyone except a sexual health medical professional. That being said, I have read about autoinoculation being possible during the initial/primary infection and still have a small concern. My understanding is that the most probable circumstance would be if a person had a blister or lesion, but what about if a person did not? I did not have any cold sores or symptoms around my mouth, but is it possible that I could have acquired the infection orally, then touched my mouth and then my own genitals and autoinoculated myself that way because it was during the primary infection/incubation period? Who knows how often I do that in my own home when using the bathroom, dressing, etc?

I was doing much better, but then got a call from my best friend – who is the only person I’ve told- that she had symptoms and went to Planned Parenthood, who told her it was likely HSV. Of course I instantly became paranoid because we spend a lot of time at each other’s homes and we share a lot of items.

Thanks again.

[Terri Warren]

I do not believe that you autoincolulated yourself, no! I think you are way overestimating how contagious herpes is. And I’m a little lost about why this matter so much to you. You have genital HSV 1 infection. YOu either have had it for a long time and the antibody test missed it in your or it missed it in your partner.

Unless you are having sex with your best friend, her herpes has nothing to do with you.

Terri

[SarahM85]

It matters so much to me because I feel this looks very bad on my behalf to my (ex)partner. If I was with someone who repeatedly tested negative then randomly had a genital OB and when I was tested I was negative, I would be extremely suspicious. I think if I had not gotten tested prior (which I only did after he unknowingly gave me chlamydia shortly after we were together and my gyn screened me for all STI’s and the whole experience freaked me out and prompted me to get screened at this years annual gyn visit too just to be on the safe side) my possibly having it for years would be a much easier concept to accept. It is also a big deal to me because I suppose I am in denial that he may have been with someone else.

Yes I am overestimating how contagious it is- children get it from innocent kisses from family members, so what would stop me from contracting in orally from kisses on the cheek from friends? My family is enormous and we kiss each other hello and goodbye all the time – cheek and lips – so it’s very likely I could have contracted it orally through them?

He is a big kisser too, I’ve seen him give female friends/family little pecks on the lips. I guess am trying to find answers for the various senarios that may occur in 6 months.

[Terri Warren]

OK I get now why it matters so much except that I thought you had broken up and he had stopped communicating with you.

Children get herpes on their mouths by adults with cold sores kissing them on the mouth. A kiss on the cheek does not result in a herpes infection because the cheek is thick skin unlike the lips. And a kiss while asymptomatic but infected would be very unlikely to result in infection because the volume of virus, if present would be much lower.

I can’t help you with your question because I”m not clear – are we assuming you have it orally also? If yes, then if you have a cold sore you should not kiss other people on the lip and maybe they won’t want you to kiss them on their face or cheek. But I am not concerned if you have no sore to kiss someone with a peck on the lips.

Terri

[SarahM85]

Honestly, I’m not sure why I even asked that question because if autoinoculation is so unlikely, I am going to assume I could not have gotten orally from family or friends – and that the only way I could have both oral and genital HSV 1 would be if my recent or a previous partner gave it to me through kissing during or close to the same sexual encounter where I contracted it genitally. And no, I did not have a cold sore or any oral symptoms, but I will move forward assuming I have it orally too because obviously kissing occurs during sex.

My next question: Are you able to provide any information regarding seroconversion. For example, how frequently do IgG antibodies appear after exposure and could one individual be exposed and a carrier but never seroconvert?

[Terri Warren]

I’m not sure you should assume that you have it orally just because you were kissing but I guess you can if you want to to be extra cautious.

Seroconversion can happen as early as 10 days (in my experience) from a contact (not from date of symptoms). An individual could be a carrier and not serconvert, yes, particularly for HSV 1 as the test isn’t great at picking it up. Is that what you are asking?

Terri

[SarahM85]

Terri,

Hope you had a nice holiday weekend. Thank you for your response.

I suppose that was what I was asking because I had been read that IgGs can take up to 12 weeks to develop. I was tested again last week and received my results yesterday – I was positive for HSV 1 IgG index 1.76 – I am wondering if I could have been a carrier all these years and the high stress I was under (had an adverse reaction to birth control and a major family issue) caused me to have an OB and seroconvert?

Thank you again.

[Terri Warren]

I think it is far less likely that you would test negative all this time and then all of a sudden start testing positive for HSV 1. a more likely explanation is that you recently acquired HSV 1 and you have now seroconverted.

terri

[SarahM85]

My family physician who ordered the recent IgG said it was possible to have had the virus on my fingertips or to have autoinoculatrd myself, although very uncommon. I assume that providers are obligated to say something is possible even if it is very very rare?

At this point I still haven’t seen my partner’s results. I’ve come to the understanding that my genital HSV1 is no mote risky to an uninfected man than if I had oral HSV1. Never have I seen anyone be romantically rejected because they get the occasional cold sore, as there is little stigma with that opposed to the unfortunate location of mine. I have also read that genital HSV 1 sheds far less than oral and genital to genital infection is rare, is this true?

Thank you again for your help.

[Terri Warren]

I do not agree that you autoinoculated yourself.
Your genital HSV 1 is quite a bit less infectious than oral HSV 1, yes! HSV 1 oral infection sheds from the boy 9-18% of days while genital HSV 1 might shed on 5% of days. And remember that if you have sex with someone who gets cold sores, it is extremely unlikely that they will acquire your genital infection.

terri

[Author]

Posts