[Question #304] herpes type 1 with negative IgG for HSV1 and 2

35 months ago
Six months ago my BF got a single ulcer non-painful on the head of his penis. No blisters or vesicles first. He went to ER and they took a scraping and did a "smear".  They said it was HSV1. I also got some vulval ulcers and a severe urinary tract infection that responded to azithromycin. We assumed it was all HSV1 related-- neither of us has ever had cold sores though-- but my BF has tested negative twice (3 and 6 months after this) for HSVI and HSV2 IgG antibodies. I was just tested (at 6 months--we both went at the same time for 6-month testing) and I am HSV1 IgG antibody "high" positive. We both have normal immune systems and the immunoglobulin G "QN" was normal for both of us. My question-- Do I have an HSV1 STD? I was not with any other sexual partners. If my BF did not give it to me how could  I get it? And If my vulvar ulcers and UTI were not herpes-related, what else could it have been? This is just very confusing and the main thing I want to know i:s do I have a herpes STD? Thank you.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
So we know your BF has HSV 1 genital infection.  And we know you have HSV 1 somewhere because you have a positive HSV 1 antibody test.  What we don't know is if you had HSV 1 prior to him having this ulcer on his penis.  If you didn't then the vulvar ulcers and UTI symptoms could certainly have been a new HSV 1 genital infection - the symptoms fit pretty well with that.  If that is the case, then the UTI symptoms (which could have been herpes) may have just resolved on their own vs. responding to azithro.  And a rather interesting choice for UTI treatment, I will say.  Your boyfriend likely tested negative on the HSV 1 antibody test (in spite of being swab test positive for HSV 1 from a genital lesion) because the screening test for HSV 1 misses 1 out of every 4 infections - not a great test at all, when negative.  We cannot know anything about where your HSV 1 infection is since you were diagnosed only with an antibody test.  I'm wondering - did you get the ulcers evaluated when you had them?  You likely saw a clinician since you got a prescription for antibiotics.  What did they think?  The only way to know if you have HSV 1 genitally if you were NOT swab tested from the ulcers is if you get another ulcer to have it swab tested. 

Terri
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35 months ago
My doctor didn't think it was herpes-- that was the thing-- It was a painful, raging infection, and I had to get on a plane the next day, so there wasn't time to wait for a culture, it could be gonorrhea, etc.  It did get much better quickly with the z pac. 
 As far as the test-- it wasn't a screening test so if you thought that I'm sorry. It was the "type-specific serology" -- I just looked up the test from the lab that did it to check and it says:  
"These assays are highly sensitive (91%–100%) and specific (93%–100%) for HSV-1 and HSV-2 infection, even in the absence of symptoms. Thus, a negative result suggests absence of infection. Because antibodies may take several weeks to reach detectable levels after primary infection, negative results should be confirmed by repeat testing 4 to 6 weeks later in cases of suspected early infection."
http://www.questdiagnostics.com/testcenter/testguide.action?dc=TH_HerpeSelect


Could the  "DFA" ulcer test (it wasn't a culture) have been interpreted wrong? My doc says-- maybe, " it's a subjective test, the tech has to be well trained to interpret the slides and not be lazy."   
 I know it's impossible to give an exact answer.  Everything I read says HSV1 is so common and usually acquired from childhood. But then, it seems to be showing up more as an STD, too.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Actually, you did have what I am referring to as the screening test (type specific IgG).    We presented a paper at the international STD meeting comparing type specific HSV 1 results with western blot results for HSV 1 and found, that when used for screening, the TSST missed one out of every four infections with HSV 1.  The herpes western blot is a far superior test for HSV 1 than TSST. 
Also, DFA as a swab test is not as sensitive or specific as the newer PCR test which is a gene amplification test, looks for the genetic material of herpes. 
This is all just to say that at this point, it is very difficult to know if you have HSV 1 or not, based on your testing.
When you say it painful and raging, can you elaborate a bit on that?  What did it look like more specifically?

Terri
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35 months ago
It was very red, no raised bumps, didn't itch or tingle.  Urination was really painful, urine was bloody until 24 hours after I started the z pac. The discharge was grayish-yellowish discharge, it came out in my urine,  and I had some blisters just inside the lips with grayish stuff.
  I actually took a picture-- but I had cornstarch on to soothe the pain, so I'm not sure how much you can tell. Everything was red. the discharge is visible in the pic.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Actually, we don't do pictures here.  The blisters are very concerning for herpes - were they like water blisters?  I'm concerned that the discharge may have been the result of herpes on your cervix.  But then again, I'm a little confused because you say there were blisters but no bumps?  We probably aren't going to be able to resolve this right now on this board.  I think you will need more antibody testing in the future and/or swabbing of any lesions that show up.  But I must tell you that this does sound a lot like herpes to me maybe also a UTI.  Hard to say after the fact. 

Terri
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