[Question #4912] HSV - 2 Antibody Development

27 months ago
Hello - I was exposed to an HSV2 infected individual via protected sex four years ago.  5 days after exposure I developed a cluster of blisters in the lower abdomen area, accompanied by flu symptoms and nerve pain.  My doctor took a swab of the area and put my on 10-day valacyclovir.  The swab came back negative, but it wasn’t a timely swab.  The blisters went away after 3 weeks,  but the nerve pain remained.  I was then perscribed long term valacyovir (6 months), along with gabapentin.  Over the next 6 months no significant sores appeared, however the nerve pain grew much worse.  After 6 months I was tested via IGG and came back negative for both hsv 1/2.  I stopped taking all medications afterwards and the nerve pain grew worse, and many very small blisters appeared intermittently, but none for long enough to get swabbed.  I continue to have neuropathy from this incident, but test negative for HSV antibodies.  I had the western blot done 2 years after exposure, it was negative.  My question is can the long term valacyclovir affect the development of hsv antibodies?  I continue to have nerve pain and rashes in the genital and thigh areas, but test negative for hsv antibodies.  I’m going to my doctor next week, any advice on other things to ask about?  Thank you.  
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
27 months ago
Valacyclovir can impact antibody testing. However, that impact is temporary. When patients have been on daily antiviral therapy, I ask them to go off of therapy for three months and retest for greatest accuracy. It sounds to me like you were off of medicine for perhaps 18 months before you had the Western blot, is that correct? If that is correct, the use of antiviral medicine would not have impacted your Western blot. So for example, I had a woman who presented with classic herpes lesions after an encounter with someone who told her after intercourse that he had HSV-2 but she could not afford the cost of the swab test so she was diagnosed visually only. One are the physicians in my office prescribed daily antiviral therapy for her and she took it for nine months every day.  At that point, she decided to pursue legal action against the person who infected her and needed to prove that she was antibody positive. When we drew her blood, she was antibody negative.  I instructed her to stop antiviral medicine and return to me in three months and have her blood drawn again. At that point, she was antibody positive. That is just one example of how antiviral medicine can impact testing for herpes. I do not think you are infected with HSV-2

Terri
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27 months ago
Thank you Terri, this is very helpful information.  I had the western blot at least 12 months after stopping Anti-virals and standard blood test more recently, all negative. One more question, are there any rare or unusual diseases that can cause recurrent blisters and nerve pain in the genital area?  I continue to have sharp shooting nerve pain and blisters that are common in hsv primary infections. 

My doctors have tested me for all of the standard diseases and my results have been clear.  Any thoughts or advice that I could discuss with my doctor would be very helpful. Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
27 months ago
There are some other infections or conditions that an cause blisters in the genital area - Shogren's disease is one, bacterial infections are another.  You could have bacterial cultures done of the blisters.  So are they blisters or are they more pimple like?  Blisters contain clear fluid, pimples contain pus.  I'm sorry you are having all these troubles.

terri

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