[Question #2767] Follow up to 2731/2658

42 months ago
I apologize for returning to the forum, as well as for the lengthy post, but appreciate in advance any help and insight you can provide.  It has now been over 19 days since potential herpes exposure (brief kiss, briefly received unprotected oral sex).  Dermatologist confirmed 9 days ago that the lip dot, which has not changed in size/color, is a broken blood vessel, and nose bumps are benign angiofibroma.  Convinced neither is (or could become) a fever bister or cold sore.  To this point, no cold sores or fever blisters have developed, and IGM tested 8 days ago was negative (0.4), indicating no recent infection (still awaiting IGG).
Remaining symptoms include occasional tingling & burning of the lips.  This has been a recurring issue over a couple of weeks.  It is most prominent near the "burst blood vessel" on lower right lip, but at times involves the entire mouth.  Also occasional tingling/burning of right nostril.  (Recurring for over one week.). Finally (and most concerning) is an irritation around the right eye.  (Also approximately one week). The eyelid became itchy and appears somewhat swollen.  Also slight burning on forehead above eye socket.  Visited optomotetrist today who checked pressure and applied yellow dye.  Prescribed Flourmetholone drops, which I have now started.
Underlying all of this (as you already now) is an intense health anxiety over a 10-week period.  I know that HSV presents on one side of the face.  But usually any tingling is followed almost immediately with blisters/sores.
Can you help provide any guidance for me on this?  If you could please comment on my situation, your assessment of risks (oral/nasal/ocular), and potential course of action.  Thank you so much!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
You need to not do any more IgM testing - it is inaccurate and could give you a false positive so please avoid it.
It is excellent that the clinicians that you have seen so far are not considered about your symptoms being herpes.  There is just nothing better than an in-person visit to provide an accurate impression.
I honestly believe, at 19 days out, that you were not infected at this encounter with HSV 1 and that you do not have herpes symptoms.  Did you have a previous HSV 1 antibody test to know that you were not infected previously? 

Terri
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42 months ago
Thanks, Terri!  I just spoke with my Nurse Practicioner (who has seen my every week since this all began) and she concurs 100% that whatever symptoms I am experiencing now are unrelated to HSV.  She has never believed any of my "symptoms" were HSV, but ordered the lab work anyway to confirm and hopefully put an end to my health anxiety.  The lab was supposed to perform the IGM and IGG simultaneously, but for some reason there was a delay on the IGG.  So it will likely be another week before I have those results.  Prior to this ordeal, I had never tested for STIs.  From what I understand, most never test for HSV unless they are presenting symptoms (active lesions or cold sores).  If the IGG is positive, I'm guessing it would indicate that I have HSV (like most people) but am asymptomatic (like most people.)?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
It depends upon the level of the index value associated with a positive result whether we can believe that you have herpes or not.  Let me know the index value of your result, if positive, when you get the IgG please.

Terri
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42 months ago
Hi Terri.  The IGG came back positive with a ratio of 1:80.  (Reference <1:10).   So it appears I was exposed at some time in the past, and have built up antibodies.

 I am so scared, but I want to believe things are going to be OK.  I know you have mentioned many times that most people do have HSV.

It has now been 24 days since I briefly kissed & received the brief unprotected oral.  Since the acute (IGM) test came back negative, it would seem that I do not have anything going on right now.  I went to the dermatologist today, and she examined me for any signs of oral or genital herpes.  I thought I had spotted small dots on the penis shaft this morning, but she assured me they were 100% not herpetic..  She also did not find anything that would indicate oral herpes.  As detailed in my post 2658, previous exposure prior to most recent was approximately 11 weeks ago.

Can you offer any advice as to what I should do and/or expect at this point.  Since I do not have any lesions, and have never had a cold sore that I can recall, can I assume that at some point in my life I was infected, but was asymptomatic?   Would this likely mean that I will continue to be asymptomatic?  Please help Terri.  Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
So somehow, you had an titer test done which I have not seen done in about 15 years now!  What you need is a type specific IgG antibody test. This can be done either by Quest or Labcorp or any number of services online that use those two lab tests.  I don't have confidence in the titer test.  You may well be positive for either or both but it doesn't tell us what we need to know and I can't adequately advise you without that. 

Thanks

Terri
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42 months ago
Thanks, Terri.  I’m sorry I could not be more specific.  I asked them when they called me what type I tested positive for, and they said they couldn’t tell me.  I will try to find out.  I live in the Northeastern US.  Should I locate a Quest or Labcorp facility locally?  I’m sorry to ask more questions.  Just want to make sure I do everything I’m supposed to.  The IGM test was labeled HSV IGM I/II. The IGG test appears to be labeled 6 AB, IGG.  I’m not sure if this represents the titer test you refer to, or possibly the individual that called me didn’t know how to answer my question because she was unfamiliar with the testing.  She did say she would look into it.  (The NP that had been treating me and had ordered the test is off this week, so it was someone else from the office that notified me.). I will work to figure this out. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
42 months ago
Yes, that is the titer test and it is not type specific so you cannot know from this test if you have HSV 1 or HSV 2 or neither or both.  I think it would be easier to find testing online - like healthcheckusa.com for HSV 1 and 2.  If you have more questions, feel free to renew.

Terri
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