[Question #3738] Hsv1

33 months ago
I was diagnosed with HSV-1 via a PCR swab about 6 days after having oral sex with a partner with no visible cold sores. I had burning itching and itching symptoms. My doctor put me on 1 gram of Valtrex twice a day for 5 days and then suppressive therapy of 500 mg once a day. I stayed on the Valtrex for 5 months and I since came off and have been off for 3 months and have yet to have another outbreak. I had an HSV IGG test 15 days after having oral sex with the partner and my result was 21.7 positive HSV-1.
My question is the fact that my HSV 1 IGG level was high after only 15 days at an index of 21.7,I does  this indicate it was a primary outbreak? I never had a cold sore or outbreak prior to this.
 About a month ago I had an irritation on my perineum after wearing a thong and also a slight irritation on the hood of my clitoris after masturbating. The irritation on my perineum became like a sore within four days I went to my doctor who wasn't available another doctor looks it it and Visually diagnosed as a classic HSV-1 vesicle after me telling him I was positive for HSV-1 I asked him to culture it to swab it and he was not happy that I just wouldn't take his word for it anyway he cultured both the irritation on the hood of my clitoris and the one on my perineum two different swabs but  put them in the same container and they went to the lab like that they came back negative but with having them both in the same container mess up the results? I went back 3 days later when my doctor was in and she swabbed  the  sore on my perineum again alqnd it was negative so is it safe to say that was not a recurrent outbreak?
How well does Valtrex work at preventing  HSV-1 genital to genital transmission and how many days should one be on Valtrex for it to be effective in reducing transmission?


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
I suspect this was NOT a new infection with an index value that high after 15 days and I suspect you were also taking antivirals during that time?
These lesions could have been herpes but the antiviral medicine would have made a false negative on the swab test more likely.  Also, if they did a culture vs. a PCR it is more likely to be a false negative.  Putting them in the same vial wouldn't screw it up but if positive, you could not have known which site was positive or if they both were but with a negative, it doesn't matter at all.  HSV 1 genitally is rarely transmitted through intercourse but using antiviral therapy daily will reduce that frequency to an even lower number.  If you are having sex with someone who has a history of cold sores, it is highly unlikely that transmission would occur with this person.

Terri

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33 months ago
Not sure if I was on the anti virals at time of blood test .  Would that affect the results?   Also  I had flu like symptoms... Lower back pain burning sensation in my feet.  I am 49 years old and was married for 16 years and my husband did get coldsores..but I never had an out break..so confusing because I thought it was definitely an initial infection.  
As far as the recent sore in the perenium after wearing thong I was NOT on antivirals  and it was a PCR swab that came back negative 4 days after the irritation started.  So is safe to say the negative result  was accurate.?  Thank you for your responses.
33 months ago
Thank you Terri for your response.  My 2 follow up questions:

1.  I was not on Valtrex with the recent irritation and had PCR swab done 4 days after the irritation.. It was open and raw and came back negative.  Is it safe to assume the PCR was accurate ?

2.  With respect to IGG level being so high when I had blood test. I had all the symptoms of a primary outbreak swollen lymph nodes flu like symptoms, lower back pain.. and just had oral sex performed on me 6 days before.  Yet you said you suspect that it was NOT a primary infection.  Is it possible that I just was one of those people that developed antibodies more quickly?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
Hmmmm, very difficult to say about that one.  In someone with a well established infection, the body's immune response can clear virus from a lesion pretty quickly.  And honestly, not too many things cause open and raw sores in the genital area.
I stand by my 'opinion' that this was not a first infection with an index value that high.  My earliest documented seroconversion was 10 days and the index value was 1.1 ( that is, the person had a negative antibody test with initial presentation of a swab test positive HSV 2 lesion, then we drew her 10 days later and she was at 1.1.  About 50% of people who are going to serconvert with new infection do so by 21 days out, the rest of the people take longer.  It could be that you were infected years ago and are just having your first recognized outbreak .  HSV 1 recurs infrequently as you probably already know.  You are never going to be able to nail down exactly when you got this. 

Terri
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