[Question #3654] Questions about HSV1 Titers and New vs Old Infection

33 months ago
weeks ago, I posted a question that was answered by Dr. Hook - I was concerned that I recently caught HSV1 from receiving oral sex (I am a male) from a CSW. Based on my symptoms, my lack of a 'primary' outbreak, the length of my symptoms, and evaluations from Drs, Dr. Hook seemed confident that I don't have new herpes from this. Since it was oral sex only, I'm not worried about HSV2, but I AM positive for HSV1 and am hoping I can just get clarity on what my tests suggest in relation to my symptoms and if they are related. 
So, as a short background: 5&4 years ago & 6 months ago, I tested negative for HSV1/HSV2 IgG. I received unprotected oral from a CSW on 2/24/28. ~1.5 weeks later, constant burning discomfort in my urethra. no severe pain during urination, no visible sores.  I got a 10-panel STD test at exactly 2-weeks after the encounter (3/10/18). Went to urgent care, got antibiotics for chlamydia/gonorrhea while awaiting results. Urine test showed no WBC or UTI, urine slightly cloudy + trace blood. Results came back on 3/13, negative for everything other than HSV1 which was 3.67. dr prescribed acyclovir and doxy. Took both for about 7 days until Urologist told me that I don't have Genital Herpes and acyclovir isn't necessary. Stopped acyclovir that same day, about 12 hours later I got radiating, throbbing back pain that kept me up, twitching in my leg, and itching/tingling on my thighs. No rash, applied lotramin, helped with the itch. Another HSV test at 4.5 weeks, HSV1+ at 3.70. Another test at 8 weeks, HSV1+ at 3.56.

  1. How likely is it to convert in only 2 weeks with a high value of 3.67?
  2. Does the fact that my titers are unchanged in 3 tests spanning 8 weeks suggest older infection?
  3. Does my lack of obvious primary GHSV1 outbreak suggest its unlikely HSV?
  4. It's been 9 weeks of low back pain, pinching feelings in my thighs, and urethral discomfort, still no obvious herpes sores/outbreak. Could this be something else? HPV?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
How likely is it to convert in only 2 weeks with a high value of 3.67?

I would say that is extremely unlikely.  In my practice, the earliest I have seen serconversion is 10 days, and the index value was 1.12. 


Does the fact that my titers are unchanged in 3 tests spanning 8 weeks suggest older infection

Older infection

Does my lack of obvious primary GHSV1 outbreak suggest its unlikely HSV?

Yes, it does suggest this.  If I had to guess, I think you might have an older oral infection without symptoms - I take it you have never had a cold sore on your lip or inside your nose?

It's been 9 weeks of low back pain, pinching feelings in my thighs, and urethral discomfort, still no obvious herpes sores/outbreak. Could this be something else? HPV?

No, not HPV, and BTW, herpes symptoms would not continue for this long.  I would suggest that you speak with your primary care provider about your current symptoms - they sound neurologic to me, something you should be evaluated for.


Terri

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33 months ago
Hi Terri,

Thanks for your reply. To answer your question, no I have never had a visible outbreak on my lip or nose, not at least one that I can recall. I also know for sure (or at least with 99% confidence) that I did not have this earlier in life based on numerous (probably 6) negative tests over a span of 7 years across multiple labs.

You mention that it sounds like my symptoms are neurological... that is kind of what concerned me into thinking this could be HSV, as I know there are some mixed reports on whether or not HSV causes post-herpetic neuralgia, and all of my symptoms seem to be isolated to nerves in the sacral ganglia area which is where genital herpes likes to make camp.

Also, the fact that my symptoms seemed to get worse after I stopped taking Acyclovir concerned me further.

A few more questions if you would be so kind...

1. If a person were cross-infected (i.e., I was infected orally and genitally at the same time in the same exposure), could my titers rise more rapidly? Or would this not have any impact on how quickly my body makes antibodies? In your opinion could this in any way explain a possibility of a 3.6+ after only 14 days?
2. Even though I am not that concerned about the possibility of HSV2, I am still going to get another blood draw today at a lab which has in the past been known to provide actual titer numbers rather than ranges. If my HSV2 titer is still <0.20 after 9 weeks, should I consider that a pretty confident sign that HSV2 is not a concern here?
3. Is it always the case that new infection titers would show a change over a period of weeks? You say in your last reply that my repeated, unchanged titers are suggestive of an old infection. Does that mean that new infections always start lower (in the low 1's), and then a visible rise can be seen over a period of say 4, 6, 8, 12 weeks? I'm just trying to feel confident that this is (almost definitely) a pre-existing oral infection rather than a new genital infection.

Just trying to get back to normalcy... very concerned about being intimate with my partner without knowing if I have some sort of infection or virus that I could pass to her. Seems all too coincidental that it all happened after a one-time, 15 minute mistake, but no doctors can find anything wrong with me, and the only discovery I have made is HSV1.
33 months ago
Oh I wanted to add: I did have one, very, very small tiny white blister of some sort show up on my upper pelvis. Not really anywhere near my penis. It had a red base and a white head. No doctors would swab it because they insisted over and over that it was an infected hair follicle and nothing more, so unfortunately by the time I got it swabbed by someone it had already mostly gone away. However, it never ruptured, oozed, it shrunk on its own and never scabbed. I've also not had any pain during urination, nothing to the level that would suggest a primary Herpetic Urethritis outbreak, and have had nothing on my penis or testicles other than a few small forcyde spots which I've always had in my life.

How often would you expect a primary Genital HSV1 infection to only present as a single blister on the pelvis without any other blisters or any outbreak on the penis itself? Would 7 days of acyclovir have completely stopped a primary infection from presenting? Should I try taking acyclovir again to see if it makes any change to my symptoms?

Thank you in advance for addressing my new questions in my last post and this one.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
1. If a person were cross-infected (i.e., I was infected orally and genitally at the same time in the same exposure), could my titers rise more rapidly? Or would this not have any impact on how quickly my body makes antibodies? In your opinion could this in any way explain a possibility of a 3.6+ after only 14 days?

I don't think the location of an infection or locations would increase the index value of the test,no.

2. Even though I am not that concerned about the possibility of HSV2, I am still going to get another blood draw today at a lab which has in the past been known to provide actual titer numbers rather than ranges. If my HSV2 titer is still <0.20 after 9 weeks, should I consider that a pretty confident sign that HSV2 is not a concern here?

What you are looking at are not titers but rather index values.  If your index value is <.91, for most tests, at 9 weeks,there is an excellent chance it will stay that way

3. Is it always the case that new infection titers would show a change over a period of weeks? You say in your last reply that my repeated, unchanged titers are suggestive of an old infection. Does that mean that new infections always start lower (in the low 1's), and then a visible rise can be seen over a period of say 4, 6, 8, 12 weeks? I'm just trying to feel confident that this is (almost definitely) a pre-existing oral infection rather than a new genital infection.

Normally, with new infection, yes, index values rise.  That isn't true every single time but most often, it is true. 

The thing about a  blister in the pubic area and not on the penis is that most often, brand new infections appear in the location that was exposed - in your case, the penis, not in the pubic area.

Terri
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