[Question #1934] Hsv1 on gums continued

45 months ago
I'm certain I have Ghsv1, cultured for both types came back + for 1 and - for type 2, my partner at the time has oral hsv1. Your answers to my scenarios helped that it wasn't me that transferred this. Background on my daughter... Monday evening she had a spot on her lip(no issues the previous night), it somewhat looked like a pimple and I figured it was bc she had caked on glitter chapstick, I assumed it was a clogged pore. I popped it with a needle that night and clear liquid came out so then I thought impetigo. It was very white in color like the center of a canker sore and seemed deep but was very painful for her. I kept wiping off (not letting it heal properly) the scab until Thursday morning as it wasn't getting better and I made an appt Friday with her dr. Other symptoms were sore throat and tummy hurt (Dr said she had drainage from a cold), she had spots along her gum line(also swollen) near her teeth that looked similar to the spot on her lip, chills off and on, and Saturday a fever of 103. The Dr only did a visual (acne cream was on it as I wasn't sure what it was) and he said it was a cold sore, I've put the knock off of Abreva on it and it has helped. He said we can culture if it comes back. I don't need the WB for myself, interested for my little but it sounds like it's hsv1 to me. Can you give me details on the WB like cost, when she should have it done, were to get it and % (accuracy)of testing for hsv1?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
Thank you so much for clarifying my questions. 
The antibody tests are not good for use with children.  With the IgG test, fully 50% of positives are false positives - I don't know how the western blot fairs with children but my suspicion is that it would be fine.  It is $206.85 and requires a blood draw and shipping to the University of Washington.  If this was my daughter I would probably wait and if it comes back, swab test it instead to avoid the blood draw and probably the swab test would be covered for her by insurance.  It does sound like first infection but so hard to know at this point.  Had she been exposed to someone with cold sores 2-10 days prior to her coming down with these symptoms? 

Terri
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45 months ago
No exposure 2 my knowledge. She is in Kdrgtn and attends before/after school care. She mentioned letting a girl use her chapstick, she said the girl didn't put it on her lips, stuck her finger in 1x. I don't recall when this happened (4 sure not the week b4, unsure about 2wk feels more like 3 @min.) Unsure it even happened that way as she is 5. 1 more scenario in regards to transfer-she cut her lip w/1 of my razors- I rarely shave above the knee, occasionally my thighs (don't believe I get sores there, not even with initial genital ob), and don't shave my private area bc I get razor burn- could it have been transferred that way and laid dormant (as I don't recall when that happened but know it wasn't in that 2-10 day time frame from her initial symptoms)? Still somewhat freaking out it was me- really that's the only scenario I have left I believe. Are you able to clarify why antibodies don't test well in kids for igg and wb?Looking forward to your thoughts on the razor situation and I believe I get one more post after this.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
45 months ago
No, it did not lie dormant and then infect her.  1) you didn't shave an area where virus would be shed 2) the virus would die on the razor very shortly if by any wild crazy chance there was virus on it.   3) the time frame wasn't right. 

The test isn't good in children as apparently children have some protein in their body that looks similar enough to one of the herpes proteins that it artificially trips the test as positive.  With adults, about 5-6% of people who test with IgG will have an index value (result) with a value between 1.1 an 3.5.  About half of those are false positives.  So that means there is probably a 3% false positive rate, at least for adults attending a sexual health clinic.  If you looked at seniors in high school where the prevalence is lower, there would be more false positive and even more with children - the test performs better if it is testing people at higher risk.  It is very poor for children because of so many false positives.


Terri
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