Testing

[overit]

Thank you Terri, for your invaluable service. As a quick recap, I have had HSV2 genitally for 25 years. I am 45 years old and in a monogamous relationship (for 23 years) and to date, my husband has shown no signs. I have been on suppressive therapy (500mg daily Valtrex) on and off for many years, but most recently for the last 5 years. I have a 6 year old son, who I am most concerned about with regards to transmission. I only became concerned with transmission in the last year as I’ve had symptoms of hsv on my face which I have not been able to confirm. The symptoms present as tingle and itching. For at least a year the itching symptoms have been frequency (monthly) in the same exact spot each time, one on my top lip and one of the bottom. there have been no blisters or outbreaks on my lips, though the one spot on the top lip does sometimes present as a small fissure. These have been swabbed (pcr) multiple times and all come back negative for hsv. However, I’ve just learned that this may be invalid as I’ am on suppressive therapy and that could alter the test result. This is most frustrating to me !! I have had one recent blood test come back positive for HSV2 (expected) and negative for HSV1. I understand that the blood test is less sensitive for HSV1 and could be an error. here are my questions:

1. Does the suppressive therapy affect the blood test ? Can I stay on the suppressive therapy and get an accurate blood test. I am thinking I would get two more tests to see if there is consistency with the HSV1 negative result. I am interested in a true diagnosis of HSV1 where the facial herpes is concerned.

2. If I need to get the facial areas swabbed again, how long would I need to be off of suppressive therapy to get an accurate swab test result ?

3. If my facial symptoms are aborted outbreaks (because of the suppressive therapy), can I trust they are minimally contagious if they are HSV1 – how about if they are HSV2 ?

4. Most recently, I had an odd presentation of sores on my nostril which went away very quickly. Then in the last two days I’ve had some tingling on my upper lip in an entirely new spot. Is it possible that after all of these years, I am seeing a new ocurrence of hsv which has never been in these spots before ? Again, I’ve never had signs of facial herpes at all before what I have described above.

5. My dermatologist believes I have an allergy which is why my lips itch – and that is possible of course, but the most recent presentation feels like a tingle, not an itch in a new spot on my lip. I have refrained from getting allergy testing done because I want to exhaust the possibility of hsv. How best can I accomplish this ?

Thank you !

[Terri Warren]

If you had HSV 2 first you would not subsequently acquire HSV 1. So the suppressive therapy would not impact the blood test for HSV 1 if you are thinking that is a new acquisition. If it is an old acquistion it would not affect it either because you would already have antibody. So I don’t think the suppression is an issue, for the above reasons.

The main problem here is that the HSV 1 antibody test misses about 25% of infections. A western blot would clarify this for you, I believe.

Sores in your nose could certainly be herpes. Did you have them swabbed?

I think the western blot is the best option for you now.

Terri

[overit]

Terri – thank you for the prompt response. I am going to pursue WB to ease my mind. I believe a local Quest lab will do that for me, but if not, I will contact your office for assistance with the test.

I did NOT have the nose sores swabbed because they came and went so quickly – also, I was under the impression that I may not get an accurate result since I am on suppressive therapy. Do you agree ?

I believe the nose sores could have been impetigo from nose hair trimming. when you have herpes, you think everything is herpes. The itching and tingles on my lips never produce anything, but I still worry they are herpes aborted outbreaks and that I could be contagious – hence the need for WB to confirm HSV1 or not. I can’t imagine these itch incidences are HSV2 facial.

Appreciate your final thoughts on this.

[Terri Warren]

The local Quest lab will not be able to arrange that for you, but we can arrange for Quest to draw your blood at a place near you if you want the western blot.

It is less likely to get an accurate swab on suppression, that is correct, but if something is swabbed right at the beginning of an outbreak, sometimes you can get a positive swab from a lesion.

No, I don’t think the facial sensations are HSV 2 either

Terri

[overit]

Thank you Terri. I would like to proceed with the SB through your clinic. Do I need to call your office to start the process? Final question – if I were to go off of suppression in order to get an accurate swab from the recurring area of tingling (facial/lips) how long would I need to be off of suppression to get an accurate result ?

[Terri Warren]

You would need to be off suppression for five days to get an accurate swab test.
Yes, if you want us to help you with the western blot, you would just all and set up an appointment with me

Terri

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