Unusual Symptoms and Seroconversion Questions

[floridaguy321]

Greetings, Nurse Warren,

First of all, I would like to thank you for taking the time to answer these questions. I greatly appreciate your advice and respect your knowledge on the subject matter. I was hoping you may be able to shed some light on a conundrum I am experiencing.

Back in September of 2014, I had a brief sexual encounter with a man of unknown sexual history, where we performed unprotected oral sex on each other only (there was no genital-to-genital contact). I was confident I was clean until a month later when a strange “sore” appeared just outside the corner of my mouth (not on the lips), which my doctor concluded was a cold sore by visual inspection. I was dubious as it didn’t follow the usual “symptoms”: it was only one small spot and not a cluster, never bled or wept pus/liquid, and crusted over almost immediately after forming, hurting less than a paper cut would. It lasted four days and disappeared. My doctor did a culture which came back negative (unsurprisingly, as it was crusted over) for HSV-1 and 2.

The day it vanished, I noticed an exceptionally large boil on my genitals (about the size of a small pencil eraser) which did not hurt at all, but burst and wept and bled dramatically. I immediately asked for a culture on it, which came back negative again for HSV-1 and 2. This boil healed over but remained as a bump where it continued to shrink down over the course of a month until it disappeared.

I have had no prior history of cold sores or herpes, or any venereal disease, and have been tested many times in the past, routinely, using IgG Elisa tests for herpes.

I have been tested at intervals, trying to determine what these all could have been. My results are as follows, all IgG Herpeselect Elisa:

April 2014 (5 months before suspected time of infection; baseline)
HSV-1: .09
HSV-2: .09

Suspected time of infection: September 2014

October 2014 (at time of initial “outbreak(s),” three weeks after suspected infection)
HSV-1: “Negative” (doctor phoned in)
HSV-2: “Negative” (doctor phoned in)

15 week test
HSV-1: .10
HSV-2: .09

18 week test
HSV-1: .12
HSV-2: .08

From what I understand, these values are very low and suggest I may not be infected with either HSV-1 or 2. I suspect I have not been infected from my initial contact (though I haven’t ruled it out), but I am still wondering if foul play is involved from some other pathogen. My doctor suggested that these were a series of mild Staph infections.

I have thoroughly read all of the material published by you and your clinic to understand how the two types of HSV are transmitted, symptoms, seroconversion rates by week, specificity and sensitivity of tests for both HSV by Elisa vs Western Blot, etc. I fully intend to order a Western Blot for confirmation.

My questions for you, if you please, are:
1) Is it possible to seroconvert further than 18 weeks, though unlikely?
2) Could these be something other than herpes, with these symptoms?
3) If I had kissed another person (romantically; “making-out”) about two months after my initial “outbreaks,” and my 15 week test and 18 week test were results considered to be at “7” weeks and “10” weeks respectively, can I expect a dramatic jump in numbers for seroconversion if I was infected with HSV-1 and I tested again at “16” weeks?

Sorry if that last one sounded complicated.

I have reason to suspect these may be bacterial in nature, as I had been taking antibiotics (ireggularly, stop-and-start, I must confess) for acne, and had been experimenting with Milk of Magnesia on my face to reduce facial grease (irresponsible, I understand, and quite strange). MOM is very basic and can affect the acid mantle of the skin, a risk I wasn’t aware of previously, but health gurus swear by it’s acne-killing potency.

In any case, I wanted your opinion on this very strange situation. Sorry for the length. I wanted to be thorough.

Thank you, and best wishes.

[Terri Warren]

I appreciate your thoroughness of explanation.

1) Is it possible to seroconvert further than 18 weeks, though unlikely?

Without taking any antiviral medicine, I have not seen anyone who is not positive at 16 weeks become positive at 18 weeks. Now given that the ELISA test misses 1-2 of 10 cases of HSV 1, this applies to western blot more than ELISA

2) Could these be something other than herpes, with these symptoms?
There is a condition called angular chelitis. Look it up. It is a type of fungal infection and it would not surprise me if after taking lots of antibiotics, you might see an overgrowth of fungal organisms. Just a possibility

3) If I had kissed another person (romantically; “making-out”) about two months after my initial “outbreaks,” and my 15 week test and 18 week test were results considered to be at “7” weeks and “10” weeks respectively, can I expect a dramatic jump in numbers for seroconversion if I was infected with HSV-1 and I tested again at “16” weeks?

You mean from the person with whom you were making out or from the original possible infection?

Terri

[floridaguy321]

Nurse Warren,

1) I intend to take the Western Blot soon just for confirmation, so thank you for that answer.

2) My doctor shook his head when I suggested angular chelitis, because the “sore” was circular and not linear, as most cases of chelitis are. And although it was in the general area of where chelitis takes hold, it was not exactly adjoined to the corner of my mouth. Still, I had had a bad case of chapped lips at the time, and in the months following the “sore” I did have on/off mild chapping and pain in the corner(s) of my mouth. Therefore, I wouldn’t rule out chelitis. Still, as I have read that chapped lips can cause a breakout of HSV-1, it really comes down to the monster of correlation vs causation, the chicken or the egg.

3)I meant to say the person with whom I was “making out.” Sorry for the verbose question.

I do have one other question in need of answering, if you please, and that would be: is the boil-like sore on my genitals a usual sign of an HSV infection, 1 or 2? Or would that likely be something else?

At this point I don’t feel panicked, and I’m just trying to play “Super-Sleuth” and figure out what this may have been. However, the internet is an awful place to do medical research, as I’m sure you’re aware.

Thank you again for the speedy reply.

[Terri Warren]

Obviously anytime someone describes a lesion in the genital area that makes me feel concerned. I’m not exactly sure what you mean by boil like sore. Could you describe the sore more thoroughly for me, for example what does that look like when it started, did it change over time, was it tender or nontender? Did anyone see the soar when it was present?

Terri

[floridaguy321]

By boil, I mean one large, round sore that had a very large, white head. I would say it was about half a centimeter or so wide. Almost like a gigantic pimple, but the discharge was runnier and the skin immediately surrounding the infection wasn’t swollen. A day or so after it formed, after it ruptured and all of the liquid was drained from it, the skin healed over and sealed off to be just a large red bump. It diminished in size very gradually over the course of a month. All this time, and even beforehand, the skin never tingled, burned, itched, hurt, or gave any indication that it was there. It was very unusual.

My PCP saw it and ran a culture on it (and I assure you he got enough of a sample), and two days later came back and told me it was negative for Herpes. “Hmm, should have checked for Staph,” was all he said as he scratched his head. We did test for every other kind of venereal disease possible, and all results came back negative (no Syphilis, Gonorrhea, etc.).

There is one thing though – About 4 months prior, I had had surgery in the area of where the boil had formed. I figured the site had healed thoroughly enough for sexual interaction, but it makes me wonder if it was a Staph infection. Still, I won’t rule out Herpes without evidence to the contrary.

Oh, and I wanted to mention also: during the course of this little brouhaha, I never experienced ANY flu-like symptoms (for either the “cold sore” near my mouth or the lesion on my genitals). No sore throat, no headache, no body aches, no fever, no swollen lymph nodes – nothing. And that, I should tell you, is very unusual for me. Every time I get the flu or the cold (or sometimes even a darned canker sore) I manage to get a sore throat or swollen lymph node(s).

Anyway, maybe you could make a better guess as to what the heck happened.

As Alice would say, “Curiouser and curiouser.” Thank you for your time.

[Terri Warren]

Hmmmm. Hard to know what to say about the boil. Yes I think the western blot is going to be very good idea. If you want to, let me know how that turns out.

Terri

[floridaguy321]

I’ll be certain to let you know how it turns out, thank you.

But, I was hoping to ask one last question, if you please. To answer my last question from my first entry, what is the usual way that a person seroconverts from showing negative results to positive results? If my results are…

Week 7 from possible exposure:
HSV-1: .10
HSV-2: .09

Week 10 from possible exposure:
HSV-1: .12
HSV-2: .08

…then would my numbers jump drastically between 10-16 weeks if I get tested at intervals, or would the numbers continue to slowly rise as the antibodies become detectable? What is the usual pattern with seroconversion? Should they have started to rise more by week 10?

(I understand that even numbers that “slowly rise,” but still fall short of .90 can be considered negative regardless, as there is no such thing as being “slightly” negative or “very negative”).

[Terri Warren]

The rise slowly.

We have now exceeded your subscription. If you have more questions, you can certainly renew.

Terri

[floridaguy321]

Nurse Warren,

I have renewed my subscription, and I have just one last concern. I have recently been tested again for HSV-1 and would like your opinion about this upward trend I am noticing. Here are my IgG values:

Week of suspected infection: .09
Week 7: .10
Week 10: .12
Week 13: .17

I fully intend to have a Western Blot done around week 16, as you suggested. I know you have stated before that the IgG Elisa isn’t necessarily accurate and misses 1-2 of the people tested for HSV-1, but if it DID manage to catch it and I am seroconverting, shouldn’t it be showing up faster than this? These numbers are still low negatives.

Also, how is the IgG test actually run? How do they get these values? Is there a sample that my samples are compared against?

Thank you again for all your help and your answers (and your patience).

(P.S., My values for HSV-2 were .09, .08, .05, .03, so I can at least rule out HSV-2)

[Terri Warren]

Yes, there are known positive and negative samples that your blood is run again.
You are consistently negative. The small variability between these tests scores is all normal. The test just isn’t great at picking up HSV 1 and I’m not sure why not because it is quite good with HSV 2.
Yes, I believe you can certainly rule out HSV 2.

Terri

[floridaguy321]

Nurse Warren,

Thank you so much for your information. I had been stressing out a lot about this for a long time, and I greatly appreciate all of your help and knowledge. I will be contacting your clinic soon to order a Western Blot just to make sure these results are correct.

Thanks again for everything, and have a wonderful Valentine’s.

[Terri Warren]

You are most welcome. The cost of the western blot and consultation to obtain it is $250 and the results take about two-three weeks to come back. When you make your appointment, please have your ELISA dates, last sexual contact, things like that for the clinician that talks with you.

Terri

[Author]

Posts