[Question #4824] Possible Genital HSV1 ?

79 months ago

In 2008 I first tested positive for HSV2 thru IgG specific blood tests. Did not have any outbreaks or symptoms and subsequent tests in 2010,2012,2014 had same results - positive for HSV2, negative for HSV1, negative for everything else, no outbreaks / symptoms of HSV2.

Typical index numbers for HSV1 on tests - .35 or .46

Typical index numbers for HSV2 on tests - 8.79 or 7.28

In early Dec 2018, I had a cold + was run down and for the first time I saw what looked like 2 very small blisters on the shaft of my penis. There was some itching as well. I popped them, some clear fluid and a little blood came out. They did not hurt or ooze. There was a small hole from popping blister and in 3 days everything healed from a skin standpoint.

In late Dec 2018, I did another full panel STD test with these results -

Positive for HSV2 with index number 22.30

Positive for HSV1 with index number 54.30

Negative for everything else

My questions are

Q1 - Is there a chance the small blisters I got were HSV1 genital ? I realize that most likely they were HSV2 genital outbreaks if they were indeed outbreaks. But since HSV1 is new for me, HSV1 genital is possible? I have never had any outbreaks or issues in my mouth area. I realize the way to better confirm is get a swab/culture from an active outbreak.

Q2 – Is it possible to have HSV2 genital and HSV1 genital ? If yes, is it more likely to transmit asymptomatically to a female if she performs oral sex ?

Thank you!

Terri Warren, RN, Nurse Practitioner

79 months ago

You clearly had tests done that were different brands with different test ranges for results. The second brand may well have picked up an HSV 1 infection that the first test did not. The IgG tests in general misses 30% of HSV 1 infections and I'm quite sure this is the case with you. Acquiring HSV 1 after having HSV 2 happens something like one in 55,000 cases. So i don't think that's what happened here. have you ever in your life had a cold sore on your lip or in your nose? If yes, then that's the location of your HSV 1 infection.

Please let me know what other questions you might have

Terri

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79 months ago

Hello Terri

Thank you for your reply. To answer your question, I have never had an outbreak in the mouth or nose area even to this day.

I have 2 followup questions if I may -

Q1 - Do you think the small blisters I described in my original message were my first hsv2 outbreaks or is it just something else ? Having been positive for over 10 years and never seeing an outbreak previously I just do not know if a possible first outbreak after so long could be that small or (for lack of a better word) that benign. ?

With respect to the tests, they were done either a doctor's office who told me he used Focus Diagnostics HerpeSelect or directly at a Quest Diagnostics lab using an on-line service. I actually called Quest regarding the last set of numbers and they did give me a direct number for Focus and Focus said they still supply the test kits to Quest Diagnostic labs. Quest did purchase Focus Diagnostics years ago so Focus is now part of Quest but the people at the main Quest number knew what I was asking and gave me a number and when I called Focus they did confirm they are part of Quest and that I was talking to the right people with respect to test kits.

As far as the ranges, on my last results printout it had the standard ones I have always seen <0.90 Negative 0.90 to 1.09 Equivocal > 1.09 Positive

But I agree with you, my last set of numbers are very odd with respect to the size of the numbers

One thing I forget to mention - after each number there was an H so HSV1 54.30 H and HSV2 22.30 H

It is my understanding that if a person had HSV2 it was harder to get HSV1 afterwards. I do understand that. That is why in all those prior years I was always confident I would see the same results because I would go to a Quest lab using what I understood to be the Focus test kit. What I did not know was the 30% miss rate for IgG for HSV1. That is very surprising.

Q2 - I guess it may be worth it to do a test using LabCorp since they use a different test kit and I can see what their numbers are ? I know most people are surprised when I ask about test kits but I read a very good article on Serological testing from Dr. Anna Wald (University of Washington ) who I am guessing you may know and she had a chart in the article on various companies and their Sensitivity % and Specificity %, so I know it varies.

Terri Warren, RN, Nurse Practitioner

79 months ago

Something is up in regards to the testing, I'm not sure what but something is different.

Remember that the statistics quoted in the lab packets for these tests are based on comparing those positive on the serology test and those positive on a swab test already. The numbers that I quote are based on a study Anna and I did on a screening population, not people confirmed by swab test to have herpes - two very different populations. And yes, Anna and I know each other very well indeed.

terri

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79 months ago

Hi Terri

I understand all you have written with respect to the tests, I appreciate the info.

With respect to the outbreaks I described, have you ever seen or heard of mild herpes outbreaks for a man after 10 years of being outbreak free ? Is it possible for outbreaks to start that much later ?

I have read that the first outbreaks for a person are usually within the first year and they are usually more than a pin sized blister. Of course anything is possible, I am just asking based on your experience with respect to outbreaks.

Terri Warren, RN, Nurse Practitioner

79 months ago

I would say that I have not seen what you describe as herpes, no.

If a person is newly infected, the symptoms show up within 2-10 days and acquiring HSV 1 after having HSV 2 is virtually unheard of.

Terri

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