[Question #10362] HSV testing periods

23 months ago

Hello - thank you all for providing a great, no-frills service. It’s really too bad seeing people stuck on the internet and Reddit and not having billboards direct them here!

I had what’d I’d call a low-risk STI exposure at a strip club in Mexico about 23 weeks ago. Male, had sex and oral, both protected. Only thing unprotected would be kissing the sex worker after insertive protected vaginal sex and her mouth subsequently on my genitals, then some making out.

For HSV testing, I had an ELISA igG finger prick test at 7 weeks and then a type-specific igG blood test at 19 weeks, both negative. Same with HIV on timing and tests - wish I would have seen earlier that I’m well past the conclusive window on HIV!

I’d say I’ve had some symptoms that are inconsistent with the hallmark herpes symptoms (i.e. no blisters, clusters, oozing, rash, anything painful), but believe new ones are there since this encounter - general pubic itching and on penis where circumcision scar is. Some anal itching after bowel movements. I’m not opposed to any thinking that those symptoms are somatic, maybe with the exception of the anal itching.

I’ve read several answers on the forum around the conclusiveness of HSV testing, likely due to older answers and changing guidance, but wanted to be clear on two things:

1.) I think I’m seeing that Terri usually calls HSV tests conclusive after 16 weeks (no antivirals or further possible exposures). Is that right?

2.) I don’t think I’m clear on how the conclusiveness of HSV tests can equate with the possibility that the herpes virus (and related symptoms) can lay dormant for months or years after infection. Would the ELISA test and/or type-specific HSV 1/2 tests still pick up antibodies in these delayed dormancy scenarios?

Thank you.

Terri Warren, RN, Nurse Practitioner

23 months ago

Thanks so much for your post.

1.) I think I’m seeing that Terri usually calls HSV tests conclusive after 16 weeks (no antivirals or further possible exposures). Is that right?

well, now we recommend that people NOT do HSV IgG tests due to the high rate of false positives results, requiring confirmation then with an expensive western blot test.

If someone is truly infected with HSV, the virus is still active in the body, even if it isn't producing symptoms so the antibody test will still be positive, even if someone is asymptomatic.

Does that help?

BTW, the western blot now only requires 12 weeks of waiting after a concerning encounter, not 16

Terri

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23 months ago

Thanks Terri. Would you agree with my assessment that the encounter was low-risk across the board? If I were your patient, would you even recommend any further testing?

Just in case I want to leave the option of WB open for absolute peace of mind - if you can remind me how to work through you to request one, I’d appreciate it. How long is turnaround time on those once blood is shipped off?

23 months ago

And I’ll leave my last question at this: Is your concern around igG testing false positives only? Or is it the overall reliability of the tests (which I suppose means both false positives AND negatives)?

Or maybe asked another way - what stock should I put into my HSV testing thus far?

Terri Warren, RN, Nurse Practitioner

23 months ago

I think your risk is more likely HSV 1 from receiving unprotected oral sex. I don't big risk with the other activities the condoms reduce transmission of herpes from women to men by 65%. Yes, my only concern about IgG testing is the false positives and it misses 30% of HSV one infections. If you want to do the Western blot. You can make an appointment on my website at westoverheights.com. I figured that your test is negative so far but I don't know that it's definitive.

Terri

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23 months ago

Thanks Terri. I’ll clarify that the oral wasn’t unprotected, rather that it just happened in a sequence (vaginal protected insertion, protected oral, then kissing) to where I suppose it COULD be considered unprotected, and perhaps that’s what you’re saying.

Let’s (finally) close thread on this - would you (and Drs. HHH and Hook) would say that assuming a negative HSV WB, plus my other 19-week negative tests for all others (HIV, syphilis, Hep, gon, trich) would be conclusive across the board?

Many thanks one last time for your time and responses.

Terri Warren, RN, Nurse Practitioner

23 months ago

oh yes, upon rereading I see that the oral was protected as well - sorry, my error.

Yes, the blot would be conclusive for sure, at 12 weeks out from the encounter.

If you want to do the blot, go to westoverheights.com and you can make an appointment by following the links available.

But I do think the risk here is just very low indeed.

Terri

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