[Question #3312] Brief Follow Up

36 months ago
Hi,

See previous inquiry but relates to a non-penetrative lap dance where the woman had panties on (thong, so low coverage) and the majoriy of my penis was exposed pinned above my pant line. She grinded in reverse on it for several minutes. This was 8.5 months ago now. 

Follow up is on HSV-2. I had no initial breakout and no symptoms. I got tested at about 13 weeks (0.96 equivocal) and 15 weeks (0.97 equivocal). I put it out of mind but got a bump on shaft near the base recently and went to doctor. It started out looking like a small pimple (was post shave) but got inflamed to a bump, almost like cystic acne but was not painful to the touch. Doc seemd to think likely folliculitis but wasn’t sure. I got another HSV-2 IGG. This time 1.7, so low positive. This has been the only ‘symptom’ for the 8.5 months. 

Questions
- How volatile are IGG hsv-2 results?
Ie is the ‘trend’ of the three results notable?
- Does it impact results that i have hsv-1 and have had shingles?
- How often do initial breakouts occur with contraction?
- I’ve read on this forum and your others that in your entire careers you haven’t seen a credible case of contraction without penetration (ie. rubbing) let alone when one of the person’s genitals are partially covered, is this true? Would i literally be the first?
- How do I get my doctor to send in for the western blot?
- Wouldn’t I have been positive with a considerably higher score at 15 weeks? Gets back to volatility of results questions I guess. 
- Anything else you can point to (research or data points or anecdotes) to alleviate my panic and fear?

Thanks again for the time
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
36 months ago
Hmmm.  Bummer that things changed a bit here with your test over time.
There is actually very little change between the first and second IgG index values, even though technically it went from negative to positive.  If you really had herpes, I would expect your index value on the second test to be considerably higher though every now and then someone just has a low index value and they are truly positive. 
About 80% of those infected with HSV 2 don't recognize having had an outbreak
I think contraction of HSV 2 without penetration is incredibly rare - I don't know that I can say it never happens.  The partial clothing cover is very helpful, yes.
Technically, you need a herpes western blot, yes.  The CDC says that everyone with an index value of 1.1 to 3.5 needs the blot.  You can print out this guidance from the CDC for your doctor to see and also print out information from UW about how to get the blot.  If your doc can't work with you on this, I can help you get the blot at my website, westoverheights.com.  If a person's index value is 1.1 to 1.5, there is an 85% chance it is a false positive - you are very close to that number so you can get an idea about how unlikely this is to confirm.  But I do believe you should get the blot nonetheless.
Terri
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36 months ago
Thanks Terri. I’ll pursue the blot. Two last questions then I’ll post my results when I finally get them. 

What studies or data are you referencing on the false positive rates? I’ve seen some things online but curious if there is a more medically aclaimed research study on the topic. 

On the IgG test, what is ‘normal’ variability in your experience and how long does that take to happen. Ie: If I retest in X amount of time, it is sufficient enough to get a different score, which can vary by Y. When you say the difference of 0.97 to 1.7 is small in the 3-4 month interim, it sounded big to me but I have no context. 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
36 months ago
If you go to PubMed and put in Warren T herpes you will find the article I think - it was published this past year and is about comparing the results between herpes western blot and IgG testing for herpes.

It is very small - a big one would be if you changed from 0.97 to 22.  That would likely represent a true seroconversion - going from negative to very positive.

Terri
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35 months ago
Hi Terri,

So I asked 3 different doctors to help get the Western Blot and none will do it. 

So I got the IgG again and was 1.78. This means my post exposure history testing is 13 week test was 0.96....15 week test was 0.97, 37 week test was 1.70, and now 42 week test to 1.78. 

Does the fact that it has continued to climb, albeit slowly, mean I most likely have it? I would have expected more variability up and down. Over these last 42 weeks I cannot recall (and have closely examined) a true blister like break out (especially in the initial few weeks). I had one non-painful bump near the base of the penis week 35 that two separate doctors believed to be foliculitis. 

I’m coming to terms with the fact I likely have it based on these numbers, but given exposure type risk, asymptomatic length of time, and low absolute values here I’m still just confused I guess. 

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
No, it does not mean you likely have it.  I can help you get the blot if you like and at this point, you should get it, per the CDC.  Go to westoverheights.com and on the home page, there is a link to video conferencing - make an appointment on the evisit.  You are still a low positive for sure.  Please do not assume that you are infected at this point.

Terri
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