[Question #49] Diagnose based on symptons or lab results

40 months ago
Sorry to trouble you today but I just had a question for you as I am clueless. So last year I had unprotected sex with a woman and shortly after went to my PCP and he ran an STD panel that ruled out common STIs' (syphilis,HIV, chlamydia, etc.) About two months later after the encounter, I noticed a lesion on my penis and again went to my PCP. He thought it might be herpes so he ran a HSV 1 IGM Screen, HSV 2 IGM screen, and HSV 2 IGG, HERPESSELECT$Type Specific AB. They all resulted negative. My PCP then referred me to a dermatologist, who biopsied it and found it to be lichen planus. Six months later, I had another outbreak and the clinical symptoms seem to resemble Herpes lesions i.e. there were red bumps on a red base that scabbed over and went away after like 2 weeks. So with negative laboratory results but what appears to be clinical symptoms of Herpes, do I have the disease? I will be getting second titers drawn to ensure the accuracy of the last results and have taken the necessary precautions as if I've had it. Thank you very much for assistance!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
Probably good that you are having the IgG drawn again.  The IgM test is useless and has many false positives - please avoid having that one done again.  So to be clear - you had a type specific antibody test done 2 months after your encounter and it was negative.  We do like 16 weeks to pass before relying on the antibody test, so it could be that testing was done too soon.  Another possibility is that you have HSV 1 and the antibody test missed the HSV 1 infection.  Did you receive oral sex unprotected at this encounter as well?  The herpes western blot is more sensitive than the screening test for HSV 1 infection - the screening test misses 25% of HSV 1 infections.  Another possibility of course is that you don't have herpes at all, but I am concerned about the recurrent nature of these lesions.  If you were our patient, we would send you home with a PCR swab kit.  You could then swab any lesions that appeared, right away, and return the vial to us to send to the lab if it happens again.  Please feel free to let me know the results of your most recent testing, OK?

Terri
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40 months ago
Thank you for your response Mrs.Warren. No, I did not receive oral sex during the encounter and the lesions I encountered did not fit the description of HSV1 (blisters) so I do not suspect it is the culprit. So just to be sure- in the event that a repeat HSV1&2 IgG is negative, then I should assume that I do not have herpes? Also, if this turns out to be true, I cannot find any explanation for the lesions that looked just like HSV2 lesions. Honestly, I just feel like I've been living in limbo whether I have it or not and I just wanted to get some closure on this issue once and for all! I'd like to either tell my future partner either yes I do have it or no I do not, if that makes sense. So again, thank you very much for your help!!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
40 months ago
If we aren't worried about HSV 1, then the antibody test for HSV 2 screening is quite good - probably 97% accurate.  By the way, HSV 1 and HSV 2 lesions look identical - there is not way to know by looking which type of virus you are seeing.  If you have questions once your test results come back, please let me know, OK?

Terri
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