[Question #2] Ex girlfriend with STDs and Dr. Handsfields video

53 months ago

Hello Doctors this forum is a godsend,


I left a relationship last year with a girlfriend who had hsv2 genital and had a LEEP procedure for HPV (she was first infected with both herpes and hpv probably a little less than two years before we dated).   I have had type 1 orally likely since childhood.  I waited over six months after we split and got tested both by herpeselect and western blot.  both were negative for hsv 2, and of course my hsv 1 was positive.

My concern is, from what I have read, that my testing has a decent chance of being a false negative, because people with hsv1 do not show seroconversion as often...  estimates range from 5-25% from what I have read... It just isnt reliable like it is for people who test with primary hsv 2.  To top it off, My sample required 'absorbtion' from UW, which I realize can be worrisome...


My question is, what is your understanding of the sensitivity of the test in my situation... how often do false negative nonprimary hsv2 results show up?  Off handedly, Dr. Handsfield mentioned that the blood tests arent perfect, I had hoped he could expound on what he meant by that if he happens to be the one who answers...  This uncertainty rattles me so much, I have considered trying to contact Dr. Morrow if possible, as she is the one that developed the test?


Additionally, I can only assume I would have been infected with High Risk HPV during our relationship.  How does this change my disclosure for future relationships?  I assume HR HPV is significantly less common than normal wide spread HPV, so perhaps I have new responsibilities now?



I hope you can help, Doctor... you have my infinite thanks for all the grand work you do!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
Dr Handsfield referred this question to me as my specialty is herpes infections.  If you still want to talk with Dr. Handsfield after I answer your question, you certainly can.
People with HSV 1 serconvert more slowly, true, but it has not been my experience that people with HSV 1 really don't seroconvert to HSV 2 ever.  The fact that your specimen had to be adsorbed is not a troubling situation.  They wanted to be certain that they took out all the HSV 1 so that could be certain there was no HSV 2 to identify.  Because HSV western blot is considered the gold standard of herpes antibody testing, it is not possible to know for certain how much HSV 2 is missed by the western blot.  In 33 years of practice specializing in herpes, I have seen it miss culture/PCR positive patients 9 times.  We send about 15 western blots a month from our own clinic and probably 30 a month from people who are distance patients (they don't live in Portland but we order western blots for them through our clinic system after they become our patients by phone and email).   I have not had a false negative western blot in probably 3 years so it doesn't happen often.  But again, since it is the gold standard, we can only report out the patients we have that swab test positive and test western blot negative.  Clearly, antiviral therapy influences seroconversion profoundly so if you've taken any of that, you could be a candidate for a false negative.

Since there is no way to routinely test males for HR HPV, it is difficult to know if you have contracted this or not.  We just don't have great data about the question that you ask.  I don't personally think it is necessary to disclose this to all future partners.  If sex partners are getting routine pap smears and HPV testing as appropriate (everyone over 30 and select cases under 30 and over 21), this should be picked up.  HPV, even HR HPV, is so common.  Most HPV clears but the HR HPV is certainly more concerning.

Again, if you would like Dr. Handsfield's input as well as mine, feel free to ask for that.

Terri Warren
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Thanks for the thanks. I thought I would add a comment to let you know I agree with Terri. Also, I disagree with your premise. Prior HSV1 is not known to prevent or delay seroconversion to HSV2. Either you found inaccurate sources, or you misunderstood. With no symptoms plus negative testing at 6 months, you can be confident you didn't catch HSV2.

Past contact with someone else with HR HPV doesn't mean you should inform future partners. Nobody ever should inform partners of STD risk if they themselves were not known to be infected. (The same applies to HSV2. Since you don't have it, you need not discuss your past partner's infection with future partners.) Your future partners are just as likely to have HR HPV someday whether or not you had such contact. And again your premise is wrong: HR types of HPV are among the most common types. Probably 60-80% of all humans have a HR HPV infection somewhere along the line. Informing potential partners has potential for unnecessary alarm with no health benefit for them. In other words, there is only a downside with no upside. Don't do it.
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53 months ago

Thank You Nurse Warren and Dr. Handsfield for both taking the time to answer my questions.  It is just hard to accept any kind of doubt when you are dealing with something so emotionally impactful.  I am sure I am not alone.  Your old medhelp site had folks in the community forum site just like me, I think.


I ran into these couple of entries from that site dealing with the same issues with Dr. Hook:

www.medhelp.org/posts/STDs/HERPES-2/show/463636

www.medhelp.org/posts/STDs/Question-about-Seroconversion/show/447341


Ever since my exposure, everything seems to be herpes.  I got a blister on my arm, or pimple in my groin, or a canker sore in my mouth...  When does a person know they can stop thinking about it, or should they get everything swabbed that is remotely questionable?


I have never had an overt, crop of vesicles appear on my genitals or my mouth, but those little things above add up with worry over time, and herpes seems to be so mysterious in its presentation.


There are certain risk factors that may have made me more susceptible too... including my ex still having a relatively new infection (>2years), I occasionally trimmed/shaved my groin during our relationship, and she was not on therapy.


Also, for a short time I used anabolic steroids when I was younger.  I do not know if they would have impacted my testing, or antibody production?
53 months ago
One more I forgot to link...  I hope you dont find these links combative in any way...  I am just showing how a concerned person can be full of questions after reading all of these opinions from super intelligent and knowledgeable professionals like yourselves... 

 www.medhelp.org/posts/STDs/HSV-2-test-decisive/show/1263922
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
53 months ago
Hi Mark,
I don't perceive your links or questions as combative in the least!   You ask a questions that many people ask - when have I waited long enough to be sure about my test results and how sure can I be?  You could certainly use some PCR swabs to swab test areas that you think might be herpes.  You could have those swabs at home so that they would be at the ready should something pop up that you are concerned about.  The PCR swabs are very sensitive and stable over time with shipping, temps, etc.  You can talk to your health care provider about that option as it might serve to reassure you.   However, in the long run, the western blot is the gold standard and you've done that and it was negative.  You can't do more than your best.  You've certainly gone the extra mile here, more than most people do.  At some point, you are going to have to tell yourself that you have done all you can, that life is short, that everything we do must involve even a tiny risk and that if you want richness for yourself or those around you, you will need to accept this negative and move on.  I know it's not easy for you but other than doing some PCR swabs, there is really nothing else you can reasonably do here. 

By the way, I don't think the anabolic steroids are impacting your testing in any way.

This was your third post and the program ends things after the third post.  If you have more questions, you can certainly purchase more questions/posts. 

Best, Terri
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