Test Interpretation

[Generic123]

Hi Terri,

About 4 months ago I had protected sex with a new partner, who informed me she was clean (not sure if truly ever tested for HSV though, but no clinical signs). A month later (3 months ago) we had unprotected sex. About 2 weeks later I decided to get tested for everything (previously always negative, but don’t think ever tested for HSV). I had no typical clinical signs of HSV2, however I did notice an ~0.5mm superficial scab (I think a scab) just below the head of my penis (there was no prior sore, pain, etc). The doctor said it did not look like herpes. It also appeared shortly after some jock itch after golfing on a really hot day. My LabCorp IgG came back as 1.35 for HSV1 and 1.68 for HSV2. After doing massive research online, I asked for a Western Blot in hopes of this being a false positive (no previous cold sores either). One week later I got tested (Dr. thought he could get Western Blot, but ended up doing IgG again). This time results were HSV1 1.68, HSV2 2.47. I was then informed that he couldn’t order Western Blot. He told me not to worry about it as unlikely to be true. I still have no clinical signs, aside from aforementioned scab which is still there (3 months later). To be honest, however, I have become obsessed with checking myself multiple times/day. I have never seen a lesion, never had pain, but am constantly imagining that I do. I even feel that sometimes I check myself so much that I am causing irritation. My questions for you are: 1) How likely do you think that this could be a false positive, especially with HSV1 being positive? 2) What are your thoughts on significance of increasing titers after 1 week? 3) Should I think less likely false positive considering this elusive “scab” that has been there unchanged for 3 months, although from my research this doesn’t sound typical for clinical signs to last this long. I know I need a Western Blot and I intend on getting one, but while I’m working on arranging that I could really use your advice to calm my mind as I can’t really concentrate on anything right now and feel I have become obsessive on the topic. Thank you in advance.

[Terri Warren]

The change in you index value is, by itself, not definitive. However, now your chances, at this index value of having a true positive, are 50-50. So there is also a 50% chance that this is negative. You are correct you need a western blot but another way to sort this out would be to ask your partner to be tested. If she is negative, then there is less worry about this. I doubt that this is a true scab if it has lasted three months – it must be something else other than a scab or it would have fallen off by now, i think.

If you want help with the western blot, our clinic can order one at a Quest lab near you.

Terri

[Generic123]

Thank you Terry, that is very helpful. I talked with the parter to see if she had been tested for HSV and she reported that she had been and was negative. She also reports no clinical signs ever. In light of this, how do you think I should proceed? On a side note, since you moderately put my mind at ease with your comments, I have not been checking myself as often and have not had any issues. However, yesterday afternoon I decided to check around and noticed two small sores on the shaft of my penis near the head. They were not painful at all (even when manipulating them with a cotton tip applicator), wouldn’t have even known they were there if I didn’t look, and there was no prior lesions (ulcer, papule, bump, cyst, etc.) there in the days before for sure. Did not have any prodrome symptoms either. The only thing that changed is that I masturbated that morning, so maybe trauma? After a moderate freak out, I decided to give it time to see what happened overnight. This morning they are scabbed over. They look nothing like the previous chronic “scab” that I mentioned (which resolved after I applied anti-fungal topical therapy btw). I wanted to get your opinion on this and potential differentials. I am certainly concerned that maybe it could be herpes, but the lesions were not painful, and scabbed up extremely fast I feel for typical herpes lesion. Am I incorrect in this thought? Is there anything else this could be? I tested previously for syphilis and was negative, but looking back, I didn’t see chlamydia on the test order. Maybe something non-infectious? And in light of this, with a previous low positive HSV2, do you think it is pointless to get a western blot. Any help would be appreciated. Thank you.

[Terri Warren]

Did you have anyone swab these sores? Any time someone tells me they have sores in the genital area, I do worry about herpes of course and with a low positive, the concern increases. I would very strongly encourage you to get the western blot to clear this up once and for all. And if you get another sore, for heaven’s sake, try to find someone who does PCR testing and get it swab tested immediately.

Terri

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