[Question #1116] Test Windows

48 months ago
What is the window period for Hep B? i.e. when is a test conclusive post-exposure?

What is the window period for herpes? One week after unprotected intercourse, I broke out in lesions on my buttocks. The lesions were round, crusted over, painful and itchy. They were singular and spread in two straight rows of three lesions across my right cheek, and disappeared after a week or so. My GP examined them and concluded it looked like herpes, but did a blood test not a swab test. Blood test was negative at 1 week. I took another test at 16 weeks post and it also came back negative. Is this conclusive? I was tested for both HSV1 and HSV2. I'm confused because I did have weird lesions and most literature says lesions appear one week after infection, which fits my timeline. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
Welcome back -- but sorry to see you have additional STD concerns.

Hepatitis B:  At age 27 (as I recall from your previous thread), are you sure you weren't vaccinated in childhood against hepatitis B virus? HBV immunization wasn't as automatic in children 15-20 years ago as it is today, but many kids were vaccinated in the 1980s-90s. If so, you have lifelong immunity and HBV testing isn't an issue. Even if not vaccinated, HBV is less frequently sexually acquired than you might think from many health resources. Although usually an STD in gay/bi men, it is quite uncommon as an STD in heterosexuals, and we don't test for it in my STD clinic after any single exposure unless particularly high risk, such as a known infected partner. But if you plan to seek testing after a particular exposure, 6 weeks would be conclusive.

Herpes:  Almost certainly you didn't have a new HSV infection from a recent exposure. Recurrent herpes outbreaks can involve the buttocks, but initial infection usually occurs where the virus enters the body, i.e. areas of prominent friction during sex:  in women, the vaginal opening, labia minor, etc. Further, your negative HSV1 and 2 blood test at 16 weeks shows it almost certainly wasn't HSV. It might have been herpes zoster (shingles), which is a localized recurrence of chickenpox, can look just like HSV, and often occurs in a linear pattern. Your doctor's impression that it looked like herpes fits with either HSV or shingles, but even the best herpes experts often both under- and over-diagnose herpes type outbreaks by examination. That's one reason lab testing is important:  a test of the lesions for HSV and varicella zoster (the chickenpox/shingles virus) might have given a clear answer. However, as for HBV, at your age it is possible you were vaccinated against chickenpox as a child. If so, almost certainly the recent rash wasn't shingles.

My guess is you'll never know what the rash was, unless it recurs, in which case you should be reexamined ASAP. Whatever it was, you can be confident you don't have genital herpes.

Regards--   HHH, MD

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48 months ago
Hi Dr H

I was vaccinated as a teenager, but my doctor must have given us a dose that expired because all my siblings and I took tests recently and found we did not have antibodies  from vaccination. My ex is from the DR and he is unsure of his vaccination status, but refuses to get checked. My latest hep b test came back negative according to my GP and I have not been sexually active in the last 3 months, can I be safe to presume I'm definitely hep b free? Want to be sure as I plan to get the vaccine done properly this time.

About herpes, I wasn't vaccinated against chicken pox as a kid as I was infected with it when I was 6. I've never had a rash that looks like this till the unprotected encounter, which freaked me out. My rash was in two neat lines, and doesn't look like the random scattering of herpes rash I've seen in pictures online. Does this sort of linear neat pattern happen in herpes though? I did not have anal intercourse and the rash was closer to my thigh than the anal cavity. My GP mentioned that the tests are only 96% accurate, which worries me. I'm upset he did not do a swab test. Should I do another hsv blood test? 

Thanks Dr H. I'm new to STDs and my previous diagnosis has got me on hyper vigilant mode as I did not see it coming. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
A recent research study (only published a month ago) shows that protection against HBV continues for at least 20-30 years and probably for life, even if a blood test shows no apparent vaccine response. This assumes that you received all three recommended doses of the vaccine. That said, it's strange that you and your siblings all remained negative. Vaccine expiration dates are pretty much meaningless; I doubt that explains anything. In any case, you probably are not susceptible to HBV, and your negative test is still solid evidence you weren't infected. The main point of all this is that you probably need not be vaccinated again. It wouldn't do any harm, but your risk of sexually acquired HBV probably is very low. Anyway, I wouldn't recommend it, but it's up to you.

If you had chickenpox, you could have a future recurrence in the forum of shingles. I agree that the strict linear pattern you describe doesn't sound like either herpes or shingles for your recent rash. I don't understand what your doctor meant about 96% reliability of testing. A positive result for either HSV or VZV would have been 100% reliable. But a negative result probably is a lot less than 96% certain. But for the other reasons we have discussed, almost certainly it wasn't either one, so no big deal at this point. As I said above, see a doctor for exam and testing ASAP if a similar rash occurs again.

I think you're overreacting to your HPV diagnosis. HPV is just as common in the general population as it is in persons at high risk for STDs. In other words, your abnomral pap and HPV result do not mark you in some way as at special risk -- not in the slightest. If you have a reasonably average sexual lifestyle -- i.e. until and unless you enter a long term, mutually committed relationship -- I would recommend yearly testing for gonorrhea, chlamydia, HIV, and syphilis. But no testing after any particular new sexual exposure unless you come to learn your partner has an active infection. Plus follow your doctor's advice about follow-up paps and/or HPV testing because of your recent abnormal pap. That's all -- no other testing for HPV at non-cervical sites, and no blood tests for any other infections unless you have symptoms that suggest a new infection. (Putting it in personal terms, this is exactly how I have advised my own daughters and what I will say to their kids in the not too distant future.)

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48 months ago
Many thanks for the detailed reply Dr H! I've checked with my parents, and we did complete all three doses of the HBV vaccine. We joke among ourselves that the doctor injected us with saline water. I've decided to go ahead and get the vaccine, since it's heavily subsidized in my country and I have nothing to lose. 

I plan to not think about herpes or testing unless another outbreak of rash happens, and I'll follow up with a doctor as recommended if that happens. 

I have one last question, and I apologize as it refers to my previous thread on HPV and is one last niggling fear I have. I've read your replies on this forum regarding HPV related oral cancer, and you mentioned that most if not all HPV related oral cancers are confined to the pharyngeal and caused by HPV-16. What is the research on HPV related cancer of the tongue? I'm asking because for the past few months, I've noticed a steady white discoloration of my tongue papillae. I brushed it off as thrush, and since I didn't have any oral gonorrhea or chlamydia, I wasn't worried. I had a yeast infection and my doctor said the medication should clear up both. But the white discoloration continued and appears to be getting worse. My gynae examined me at my request, and concluded that it wasn't thrush but inflamed papillae. He did not mention anything else. I'm unsure if I should get an oral cancer screening. As previously mentioned, my throat HPV swab was negative, but I'm not entirely sure about the reliability of oral hpv tests. 

Thank you in advance for your patience and detailed replies. Glad to be able to get reassurance and answers here. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
48 months ago
I'm not an expert on all oral cancers. Pharyngeal cancers are the only oral or head/neck cancers caused almost excluxively by HPV (HPV 16 in particular). I don't know specifically about tongue cancer, but I believe it is not associated with HPV, at least not most of the time. In any case, anything you can brush of your tongue clearly is not cancer or a pre-cancerous lesion. I am unaware of any legitimate, routinely recommended "oral cancer screening" tests or examinations; and in any case, don't see any reason for you to have anything like this. Your risk of HPV related pharyngeal or oral cancer is no higher than that of any average person -- and all these are rare cancers, even in people with oral HPV or who regularly perform oral sex.

Thanks for the thanks about our services. That completes this thread. 
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