[Question #2191] Continue question 2190

46 months ago
Terri- what is the possibility of skewing a later HSV2 IGG test by taking antivirals?  My inclination is to continue taking them, but I'd also like the quickest route to know for sure what's going on.  Also can you elaborate on the IGG level and correlation to when infection/exposure happened?  Is it not possible that an IGG level of 31 relates to a recent infection?  I've never had painful urination before, which made me assume this was an initial outbreak, but perhaps it isn't?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
The University of Washington now makes a note on the western blot results that antivirals can impact the testing.  So here's the deal - the job of antivirals is to  stop viral replication.  If it's working really well, there isn't enough virus present in a newly infected person for the immune system to see the virus so they can stay negative on the antibody test (making antibody is a function of the immune system) for a long period of time.  We had a clinic patient that got infected with HSV 2 and immediately went on antivirals - her case was clinically quite classic and painful and unpleasant  but she could not afford the PCR swab test and didn't have insurance but did have a negative HSV 2 antibody test at her first visit.  The physician who saw her initially agreed to keep her on antivirals for an extended period of time.  She decided to pursue legal action against that man who infected her (they had sex and he told her right afterwards that he had herpes - said he had used a condom but it turns out he hadn't).  By this time, it was 9 months out from the encounter, her only encounter.  In order to pursue legal action, she had to document that was indeed infected.  Her antibody test at that time was still negative and she had taken 9 months of antiviral therapy daily.  So she had to come off antivirals to seroconvert and prove her infection.  She seroconverted within 6 weeks while off meds.  So you can see that it can take a very long time to serconvert on the antibody test if on antivirals daily. 

The earliest I have seen seroconversion on an antibody test is 10 days, and the value was 1.2 10 days out.  It seems quite unlikely to me that you would reach 31 within three weeks was it?  I'm not saying it is impossible, but still somewhat unlikely, I think.  There is just no way to be absolutely certain but I think the 31 represents either an old genital HSV 1 infection or any old oral one without symptoms, but we just cannot be certain at this point.

Terri
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46 months ago
Thanks Terri- so, if I want to go back in 6 weeks for another HSV2 test, and ensure the antibodies have had time to develop, I need to quit taking anitvirals.  I've taken them for exactly 7 days, if I stop now, will that skew the test at 6 weeks?  I feel conflicted based on your previous response "I  wouldn't think you should assume it's herpes-  certainly other things can cause pain with urination but the sores do concern me."  Let's assume this is an old HSV1 infection, how common is it to have never recognized and outbreak until later?  Would that provide insight to the likelihood of future outbreaks?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Seven days of antiviral therapy is just fine. 
I think it is certainly possible that you were infected previously and didn't notice it - the other possibiities are that this isn't herpes at all, that you have old oral infection without symptoms that you recall, that you have new HSV 2 and have not yet serconverted - the possibilities are so numerous.  If you get another sore, please immediately have it swab tested.  People with genital HSV 1 recur on average about every other year.

Terri
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46 months ago
Thanks for all the insights/expertise. One thing I forgot to mention, on the day I did the STD blood tests (12 days ago today; 14 days after possible exposure), I also had a complete urine and blood work up done for my annual physical.  Would there be any details in those results (white blood cell count, infection in urine, etc) that would shed more light or provide more scientific clues on my situation?  I'm happy to pay for another session if I need to.  Thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
No, nothing in standard testing that would shed any further light on this situation unless they did gonorrhea and chlamydia testing from the urine.  Herpes testing would not have been done from urine.  Yes, you've used up your three questions for this subscription.

Terri
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