[Question #3566] Ghsv1 - looking for some clarity

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88 months ago

About 6.5 months ago I had a weekend encounter with an on again/off again partner. About 9 days after the weekend encounter I noticed what appeared to be an initial outbreak, which included a small cluster of blisters on the base of my shaft, swollen lymph nodes in my groin and some really sensitive skin/nervous system on the one side of my upper body; it almost hurt to touch (which to me was odd because the outbreak was below the waist). Nonetheless after a swab test I was told it was HSV1. My partner and I had used protection during intercourse and the outbreak happened where the protection may not have been. After digging into this further with her she told me she used to have cold sores as a kid but can’t remember having any since elementary school, so we aren’t certain if I contracted this from her orally or genitally (although through my reading it appears ghsv1 to ghsv1 is extraordinarily rare). As well, and just to note, I have never had HSV1 or 2 present in an IGG blood test, and I had been tested multiple times over a 10 year period. Upon receiving the results of her blood work, it appeared she was present for hsv1 (as we expected) and negative for 2. Now my one question stems from the contraction, she never gave me oral that weekend (and we hadn’t been together since 4 months prior) but twice she used some of her saliva ‘from mouth to hand to ‘me’ ‘(unprotected). Is there anyway for us to be absolutely certain that she gave it to me through the oral route or genital route without ‘to her knowledge’ her showing any physical symptoms whatsoever in either place in the past 10 years? If it is the former, I have to assume I was just ridiculously unlucky.


As well and to add another twist I just did IGG blood work (2 weeks ago) and I’m told that I’m negative for both 1 and 2. Should I presume I fall into the hsv1 false positive rate considering both the swab test and physical symptoms during the initial outbreak (I’ve had no outbreaks since the initial)?

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Terri Warren, RN, Nurse Practitioner
88 months ago
this is tricky because the HSV 1 IgG test misses 30% of HSV 1 infections.  So my thought is that the test is missing your infection and that you like contracted it a while ago when she gave you oral sex.  Or you could have acquired it from some previous partner who gave you oral sex and yes, it is true that this is mostly transmitted via someone giving you oral sex vs. intercourse.  I would accept that the swab test is correct - it's the blood test that is poor.

Terri
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87 months ago
Thanks for the feedback Terri. It’s crazy to think that 30% of the blood tests are missed. Will no antibodies show in those tests at all in those cases? I only ask as I spoke to my doctor recently, and  he told me it’s hard to believe I have it when no antibodies are showing up at all in my test, not even a marginal amount, and that there’s of course a chance the one swab could’ve been incorrect considering I haven’t shown anything since as well. He also told me I should probably just live my life as I would sexually at this point and go about like I don’t have it so I’m considering that as well. Could you shed any light on that?

Lastly, I guess the only other potential ‘symptom’ that I would’ve shown would’ve been the off/on again somewhat sore lymph nodes (groin) as mentioned. Is this a symptom that doesn’t get well documented, or something you don’t often see with others dealing with HSV? I ask considering I’m not ‘physically’ showing anything, and lets presume I do have it considering your original deduction, why would my lymph nodes stay sore for periods of time? I have no doubt that it’s more than just me being more ‘in tune’ with my body now. I also see others mention they’ve dealt with this symptom on varying message boards, and some quite severely for years, but it doesn’t seem to be that discussed at the higher level. Curious your thoughts on that as well. Thanks again for your continued help Terri. 
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Terri Warren, RN, Nurse Practitioner
87 months ago
Yes, no antibodies show up in the IgG test (but they do show up in the herpes western blot).  So the 30% missed is compared to the gold standard western blot.
So you could do as he suggests, for sure.  Or you could get the western blot but if the blot is positive for HSV 1 you won't know where the infection is - oral or genital.
Lymph nodes in the groin can be increased in size for any number of reasons of things going on in the lower part of your body - even an ingrown toenail.  They can also enlarge if you keep pushing on them repeatedly!  And for thin people the nodes are sometimes very easy to find and feel.

Terri
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87 months ago
Thanks Terri. It’s still hard for me to fathom that modern science (outside of the western blot you’ve mentioned which isn’t widely used it seems) can still incorrectly identify something so common 30% of the time. It’s not surprising the virus’s reach is immense. So when you say gold standard for the W.B. where would you rate it’s effectiveness? Curious if there’s been research done on what you ‘accept’ is missed with both 1 and 2 (if any) on that form of testing. Regardless, I would be happy to access a test that is vastly superior to the current one considering my unique circumstances. Unfortunately I’m located in Canada. Do you by chance know of a way I could get the western blot done here? If not, could I do it next time I’m in the US if I find a cooperative clinic and then get the results mailed to me or have you not heard of that happening?  Thanks again and have a great weekend!
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Terri Warren, RN, Nurse Practitioner
87 months ago
The western blot picks up about 99.9  of HSV 2 infection and slightly less of HSV 1.  I'm not sure what you mean by the question of "accepting".  We compared the results of hundreds of patients on their IgG vs. western blot results - western blot is far better, especially for HSV 1.
I have ordered blots for many people who live in Canada.  Many come to the states for the blood draw.  I can arrange all of that yes, at westoverheights.com

Terri
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