[Question #3603] Hsv2 infection and seroconversion timelines

35 months ago
Good day Dr's new to the forum and hope you can clear up my confusion and provide clarity.
Background: Early Oct 2017 was last possible exposure and took a course of pep due to the exposure which in hindsight was an overreaction. Tested 3 months out for the standard std panel (hiv, hepA/b, syphilis, chlamydia, gonorrhea) all negative & immune to hep b. End of Jan had a vasectomy and early march had vesicular rash and multiple red raised bumps on right side of pubic area. Saw 3 different dr's and a infectious disease specialist. Yes am a hyper-contreact.. all drs concurred it was shingles do to recent surgical drama to area and stress I was under and visual inspection of lesions. Specialist says hsv2. I had 4 swabs done for hsv and hzv zoster. All swabs came back no virus isolated.  Specialist also did igg blood test. Test came back hsv1 reactive which is no surprise since i have had cold sores since childhood. Hsv2 result said non reactive, report didnt show the numeric levels (lifelabs). Specialist says takes time for seroconversion and to restest in 3 months (june'18) which would be 3 months post outbreak. My family Dr. says not needed because my last posdible exposure to herpes was oct'17 (5 months ago) and if I was infected, antibodies would have developed by now and show up in the igg test. 
Question: based on last possible  exposure of early oct 17 & negative non reactive results for hsv2 igg march 2018 should I retest based on outbreak in march?  Do antibodies develop after outbreak or after infection? Is it possible to get infected and not develop antibodies until after an outbreak? Can a month of pep delay hsv2 seroconversion hence why outbreak 5 months later and still no presence of hsv2 antibodies? Am confused and not sure what next steps should be... 



Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Interesting case.  Have you taken any herpes antiviral medicine?  Vesicular lesions worry me in the genital area.  But it is good news that the swabs were negative as well as the IgG test.  Did you have sex with anyone between October and March?

Terri
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35 months ago
Hi Terri thank you for the reply. I forgot to mention that i was put a 7 day course of valacyovir which dr told would treat either virus hsv or hzv and everything healed and cleared well. For sex between oct to mar just with my significant other who  has had no other partners but me. So i know my last possible exposure was oct. So thats why am confused on diagnosis and further testing. mostly what i read online is you should wait up 12-16 weeks from date of exposure for igg test, the test i had was igg immunoblot not sure if this considered a western blot. But in my case the specialist is going off from the date of outbreak so am confused what timeline i should follow based on my possible exposure and history. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Immunoblot is definitely not a western blot - far inferior to the western blot.  If your last possible exposure other than your virginal partner was October, then that's where the timing starts, not the start of a lesion.  With 92% accuracy (compared to the gold standard western blot) you don't have HSV 2.

Terri
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35 months ago
Thanks Terri for confirming. Am in Canada and not sure if western blot testing is available here.  I did the test through lifelabs out in victoria BC the report did say "new testing method for hsv1/2 igg where the immunoassay has similar sensitivity and specificity as the previous immunoblot assay, though the immunoassay will produce considerably fewer equivocal results"  

Could it be a case of hsv1 genitals? Is that possible knowing i have had cold sores since a child? Also is there need for further igg testing or can i accept the results as negative and put this behind me. Thanks again 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
It would be highly unlikely for you to acquire HSV 1 genitally after having it for years orally.
Western blots can be done for people who live in Canada - I've done it several times.  You would have to find someone who would draw and spin your blood.  You could ship the sample yourself. 
Remember that there is about an 8% chance that the test missed a possible HSV 2 infection.  This has to be your call, how much certainty you want and I know it's difficult for you to know what to do either.  If I were you, I would try hard to get the blot, given the symptoms that you experienced and the opinion of the specialist.

Terri
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