[Question #3026] Seroconversion Question

93 months ago

Hello,

I was hoping to continue a question with Dr. Handsfield, however I am happy to speak with anyone who can be of assistance.

As I’ve previosly mentioned, I had a white, painful only when touched, bump in my clitoral hood over 2 years ago; there were no other issues like stinging, burning, or flue like symptoms. I did have leg aches for a week but that could have been from dance (ballet).

I have not had any other similar lesions since that time, over 2 and a half years ago and no swab was done.

The last time I was tested I received a 0.8 neg for type 1 & <.2 for type 2. This would not worry me however the negative did rise from <.2 to 0.8 just at 12.5 weeks.

I have recently decided to get tested once more to confirm and had to questions while I wait for my results.

1. Is 12 weeks enough time to seroconvert from a primary OB? Would results change between 12 & 16 weeks?

2. What is the likelihood of a 0.8 moving into the negative past 12 weeks.

3. Do the negative numbers matter?

Thanks for your time, hope to speak with someone soon!

93 months ago

Anyone...?

Terri Warren, RN, Nurse Practitioner

93 months ago

My concern here is your rather high negative for HSV 1. The IgG test for HSV 1 misses 30% of HSV 1 infections, compared to the gold standard western blot. Your high negative index value may represent nothing at all, but it may also represent a missed HSV 1 infection. On the other hand, the HSV 2 IgG test misses only about 8% of infections, so I have far fewer concerns about that.

HSV 1 genital infection doesn't recur often, if at all, in most people so that could be consistent with no other symptoms other than those that you had 2 years ago. Have you been the receiver of oral sex - some one's mouth on your genitals? That's how most HSV 1 genital transmission occurs, rather than through intercourse. So if you've not received oral sex, that lowers the risk of the bump being HSV 1 in my mind.

Anyone can obtain the herpes western blot through the University of Washington with the help of a clinician to order the test. This would give you clarity about the HSV 1 test. However, if positive by western blot, it wouldn't mean that this bump was HSV 1 - only that you have it somewhere on your body. If positive, the only way to know if this is oral or genital infection would be to have a swab test done of an oral or genital lesion.

Please let me know what other questions you may have.

Terri
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93 months ago

Hi Terri,

1. I did receive oral a few days prior to the bump. Again, there were no additional symptoms.

2. Thank you for clarifying. I get that the high negative is probably a bit disturbing so I’m just wondering what exactly the likelihood of it returning a positive on this new IGG two years later are.

3. Is there a huge difference between being tested at 12 rather than 16 weeks?

Thanks

Terri Warren, RN, Nurse Practitioner

93 months ago

In my experience, when the IgG test misses an HSV 1 infection, it misses it repeatedly so comparing results two year apart is probably not helpful, if you are trying to eliminate a false negative.
There is not a huge difference at all between 12 and 16 weeks unless you have been taking daily antiviral therapy.

Terri
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93 months ago

So (please correct me if I’m wrong) the IGG taken two years later is likely to be negative again (due to the missed infection issues) ?

Do you know how likely returning a positive after a negative (or high negative) at 12 Weeks is?

Thanks again.

Terri Warren, RN, Nurse Practitioner

93 months ago

IF you have HSV 1 and the IgG test missed it the first time it could well miss it a second time, correct.
If you waited to test 12 weeks after a concerning encounter to be tested, the HSV 1 IgG would pick up 70% of infections and the HSV 2, 92% of infections.

Terri
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