[Question #2041] Testing window for escort exposure

47 months ago
More then 14 weeks ago I had protected intorcourse with and escort.  There was also unprotected cuntilligus performed.  Afterwards I felt horrible about myself as I'm married and love my wife.  7 days post event I had some burning on the tip of my penis that I had been checking for days and later I had some pimples on my legs.  I assume the pimples where from change in the weather and running as I've noticed this several times in the past.  As for my penis I put some baby cream on it and it went away over night.  I was nervous enough by this pain that I went and had a panel at 4 weeks hiv, hep a,b,c, Ngu, etc...all came back clean.  Still being nervous at 7 weeks I tested again.  All was negative but positive for igm hsv, negative igg 1&2.  All this has had me overwhelmed but with travel for work I could not get back again but I did have chance to take another hsv igg 1&2 at 10 weeks and I was in the area a few weeks back so I had a WB done at 12 weeks and when I returned home I took another full panel statist including the  hsv igg 1&2 from labcorp.  All of my test for everything has come back negative.  Do I need further testing for std's and what is my hsv status having had a positive igm at 7 weeks with negative tests inclusive of the Western Blot at 12 weeks.  A member of the UofW virology team said that negative igg results with negative Western Blot testing is conclusive.  Still shaken-up with everything but I need to know if I'm clean and able to sleep with my wife again as it has been over 14 weeks since we were together last?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
I believe that the negative western blot at 12 weeks, given the kind of contact that you had, should suffice for accuracy.  usually we like 16 weeks, but the most recent blot that I got back says 12 weeks is mostly adequate on the report, so I think you're good.  If you had had unprotected intercourse with an escort, I would ask you to wait the 16 weeks previously suggested but because of your condom use (good job, BTW), I think you can feel quite secure with the 12 weeks result.

Terri
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47 months ago
Terri,  

Thank you for the response, I have a few follow up questions.  
First things first, I wanted to get insight relative to the other testing.  Just wondering are my tests for other std's conclusive at 12 weeks?
You mentioned being accurate at 12 weeks for the hsv testing but you also say that sometimes go out to 16 weeks, just wondering about the differential...is the igg/WB test accurate at 12 weeks if so what would be the percentage of accuracy?
I worked from home and had a chance to reflect on my life and this experience and it really upset me.  To actually realize what I might loose if positive, and how I couldn't live if I infected my wife thus the need for accuracy.  That said I literally cried most of that day and the next day and then the next day I noticed some burning from the penis and the meatus seems a bit swollen.  It went away in a day  after I put cream on the tip, but now I feel like I'm getting the same pain every 5 to 7 days...is this an internal outbreak it feels like every time I start to get nervous I get urethra pain?
I know you said 12 weeks but could I be infected and the tests missed it?
What about the positive IGM at 7 weeks could this be a delayed seuroconversion?
I've had itching throughout this process but it was after I shaved my genital area and it lasted for several weeks on and off but I just assumed it was from the hairs growing back, could this have been the initial outbreak?
I'm just nervous thinking through this and am afraid that I missed something.  Do all outbreaks have blisters or could they manifest internally?
Do you have referrals for hsv experts in the Chicago area?
Thank you for your time and for what you do.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
Good morning John,
The IgG is about as good as it is going to get at 12 weeks and apparently UW now has changed their guidance from 16 weeks to 12 weeks, as you report fromyour conversation with them.  The IgG relies upon detecting a single protein of the HSV 1 and HSV 2 antibody (separate ones) while the western blot looks at ALL the proteins associated with these two viruses.  Their report says he western blot picks up about 99% of infections and results says <1% of infections could take longer than one year to show up.  I think this is directly influenced (and they do too) by the use of antiviral therapy 
That's the best we can offer I'm afraid in the way of statistics about the test.
Your other tests are fine at 12 weeks, yup
I don't think you need to be concerned about the swelling at the tip of the penis as you used a condom to cover that area. 
I know the consequences of a missed infection are huge in your life but I honestly think you are just fine in terms of herpes infection. I'm so pleased that you did the western blot as an additional confirmation of the IgG result - thanks goodness we have something better to use as a confirmatory test! I don't think the IgM is about late seroconversion, no.
The itching is certainly more likely due to shaving and hair growing back.
The opinions of UW and mine are that HSV is extremely unlikely in your situation.  I think you want absolute certainty, but this is as certain as it is going to get and that's pretty damn certain. 
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47 months ago
Terri, 

Thanks for getting back to me and I appreciate the response and while your professional opinion does help give closer I'm still reluctant to accept these results as there are so many mixed responses.  The virology department response after following up was that 12 month testing is the only conclusive timeline.  They also mentioned that at 12 weeks w/out symptoms a negative IGG and WB would be conclusive.  However I've had symptoms, while they were not blisters they were pimples and there was itching.  I also saw a lecture that Dr. Hansfield, Dr. Peter Leone, and moderator Michelle Manzo gave back in 2007 where they show a graph that portrays the herpes select having 50% testing positive in 3 weeks and flatlining at 90 days and along side that line graph the WB showed 50% testing positive at 100 days and flatlined after 19 weeks.  With all of this information, some of it contradicting one another it's hard to get comfortable with a 12 week result.  Is 16 weeks your professional  opinion on the WB window as the UofW has not echoed that information for being 99.9% conclusive?  I need to appreciate your expertise in this area as I have none it's just very unsettling with all of the inconsistency.  I understand from other posts that you are not here to convince only to offer direction from your 33 years of experience.  I just would really like to know what is conclusive respectfully to the WB?  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
I wish that I had better evidence for you, more consistent research so you would have a much more certain response to your testing.  The truth is that herpes testing just isn't perfect.  The western blot is the best we have. I have had 9 patients in 33 years who were swab test positive and western blot negative - they were repeatedly positive by swab test and remained negative over time - I cannot tell you how long exactly but some well over  year.  I don't believe this is your picture - you've not had any swab tests that are positive.  So many people have itching for a variety of causes - that by itself cannot be interpreted as herpetic.  And I dare say everyone gets pimples on their body.  So that isn't definitive either.

So you can wait a year for certainty, you can also get any suspect symptoms (itching and pimples) swab tested each time they show up.  If you have several negative swab tests and continue to stay negative, I hope this will allow you to embrace your negative status. 

Terri
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