[Question #2844] primary infection?

40 months ago
im 33. I have been with my current partner sexually for 5 months before my first painful outbreak. We have had unprotected sex before several times. I started having nerve pain behind my knee and had extreme chills and slight fever 99.3 (high for me). I went to urgent care and I tested positive for group b strep and BV and ureaplasma.  4 or 5 days after encounter I had a severe herpes outbreak and ulcer was whitish fluid (flat-flesh like) but also had like 10 or 15 raised red grouped bumps bilaterally. It burned when I urinated and I had swollen inguinal glands for like 3 weeks. Two weeks later after outbreak I had a blood test. IFA w/ reflex  IGM HSV1 >=1:320 pos ,  IGM HSV2 >=1:320 pos, IGG- HSV1  <.90 neg, IGG HSV2 5.05H pos.  I understand that IGG can turn positive after 2 weeks of initial exposure. Are these symptoms classic for primary infection? My test were always neg. Last test 11/15 and I have had 2 other partners. 8/16 unprotected and 12/16 protected. History: I have had false positive RPR test when tested with FTA-ABS 9/14 , 2/15, and 11/15 but my test I did in Sept 2017 was neg right away (I dont understand that, never diagnosed or treated).  I also had positive EBV like 5 years ago. I have history of chronic hives and angiodema  since I was a little girl so I figured my body would react severely a while ago if I did get herpes years ago. No history of HSV1. Had weird rash near armpit 3 yrs ago they said was shingles but I think it was an irritation from my bra. Came back only one more time there like a year later and never appeared again.  No weird bumps in vaginal area. Had two irregular pap smears in 2015 and 16 but my last two pap smears were normal... Dr. said that tends to be normal in young women. Three of my doctors agree that this was my primary infection but I was to double check with an expert. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
I'm not sure where you read that you can have a index value of 5.05 at 2 weeks post infection.  I personally have not seen a value any where near that level at 2 weeks post infection.  However, your symptoms do sound like a primary outbreak so I don't little confused about that. Has your partner been tested to determine that they are or are not positive for HSV-2? I'm wondering if it's possible that you were infected quit a while before you actually had a classic outbreak presentation? How long exactly before the antibody test did you go there's a care clinic with a slight fever and chills and nerve pain?

Terri
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40 months ago
I am not sure if he was tested for herpes. I am nervous to confront him about the issue because I am scared to lose him. July 28th I had nerve pain down my left leg but specifically behind my knee. It was a varicose vein that was bothering me, took a Norco and it went away. I walk alot at work and I was wearing hard sandals that day. The vein was pretty blue, not too dark but prominent in color. I have arthritis in my lower back from a car accident. I would upload the picture if I could. I then had the pain come back Aug 7th for a few days. Vaginal pain/nausea on Aug 10th and 11th. Aug 11th I went to the office with back/leg pain and starting getting extreme chills in the office. My slight fever was some time during that week, I believe the 14th. My temp was ranging between 98.8 and 99.3 since Aug 11th.  Aug 14th was when my primary outbreak occured. Aug 15 the gyno did PCR swab and it came back positive for HSV2. I cant guarantee that I am the only one he was sleeping with. He was very promiscuous before I met him. My immunologists says that I have an overreactive immune system (hence my hives)so she assumes that my immune system would react immediately to the herpes outbreak. I wish there was a way to privately message you so I can explain the rest. Don't want anyone to recognize the situation. I just read during seroconversion that IGG will start peaking quickly ex:NCBI website. My dr said she never saw anyone with igm present in recurrent herpes. i also read that recurrent herpes is way less severe and usually occurs unilateral. 
40 months ago
It was the 14th I had 99.3  day of primary outbreak that took two weeks to crust over 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
IgM is present very often with recurrent disease and it has tons of false positives.  And I wonder if your doctor really is using IgM testing with recurrent herpes to even know that.  The CDC says IgM should never be used to try to diagnose herpes in the adult - it should not have been drawn in the first place in your situaiton.  The earliest that I have seen seroconversion is10 days in and that was a 1.15.  It is true that recurrent disease is often less severe correct but not with every one. 

You and I can have a private conversation via video conference and talk more about testing at my website, westoverheights.com if you want to do that. 

Terri
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40 months ago
Oh no! The only time for video chat is 10/24 =(  Going to die of anxiety til then. I scheduled the appointment.  I have been with him sexually for 5 months so I guess my 5.05 igg could be from that.  I've never had experienced anything like this in my life. I break out easily in hives when I touch anything I am possibly allergic to. I just don't understand. I did not take any acyclovir until 2 weeks after, the day before my blood test. It was so bad that I had to use acyclovir cream to help with the excruciating burning feeling. Do you think if he takes a blood test, he will most likely be positive? I just want to crawl in a hole and die before confronting him. I have not had any sexual contact with him since my diagnosis to be safe. I just don't see how that rash under my armpit could've been hsv2, it was a little blistery. That was 3 years ago. My last test in 11/15, which I realize was a while ago, my igg was 0.09 barely anything. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
I'm going to open up some earlier times - didn't realize that this coming Tuesday was full.  I find it hard to believe that the rash under your arm was herpes, really.  And I'm not sure that talking to me sooner is going to be of too much help really.  So you are avoiding sex with him now but what are you going to do long term?  Are you thinking that if he is negative (meaning you had this previously) that he will break up with you?  I mean if he is positive, there is a good chance you acquired this from him and he would be silly to break up with you if he has this.  And if he is negative, you will know you didn't get this from him and he might but you've been together 5 months and if he didn't get infected already, he is less likely to get infected in the future, by a bit. 

I'll open up more time Tuesday

Terri
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