I would disagree with whomever you spoke with at UW. A lab supervisor? Do you recall who is was? I’ve had two patients who have taken valtrex since a brand new infection who did not seroconvert by the blot until after the stopped suppression – one did this for 9 months and another for two years.
You could certainly have anal herpes, from your description, and possible HSV 1, yes.
1) repeat the HSV2 test I listed above in mid to late November
I think you could do a normal IgG for HSV 1 and 2 in NOvember.
2) I’m so scared to go off these antivirals, especially given the reduction in transmission rates in discordant partners. How deeply could they affect results?
So are you saying that you have a partner that is negative for HSV 1 and 2? And the sexual contact that you had was with someone different? I’m a bit confused about this part. Could you clarify? If you do go off daily antivirals, the risk of infecting someone who is not already infected does go up, correct. You’ll need to weigh that risk against getting an accurate diagnosis. If you do go off antivirals, yes, any symptoms should be promptly swab tested using PCR or NAAT testing.
3) if the test is negative proceed with the Western Blot, as HSV1 remains part of the differential diagnosis.
4) obviously if I have a fresh crop of lesions I’ll swab promptly.