[Question #5030] HSV 1 & 2 IgG Tyoe Spec blood test vs viral culture testing

26 months ago
On Monday, Feb 18 2019 I saw an unusual sore place on my penis which I had never experienced before.  I had spent the weekend dragging brush at my farm and thought that maybe it was a reaction from poison ivy, a bug bite or something similar.

I had a STD panel before getting involved with my new girlfriend, back in August 2018 and nothing showed up however they did not test for HSV 1.

On Tuesday, Feb 19, 2019 I went to Lab Corp and had a full STD panel including blood testing for HSV 1 & 2 IgG Type Spec.  The results came in on Thursday and HSV 1 was 52.60 - HIGH.  HSV 2 was <0.91 - Normal.

On Wednesday, Feb 20, 2019 I went to my primary care office and saw one of the Nurse Practitioners.  So at about 60 hours after I noticed this sore place on my penis, she swabbed the area and ordered a viral culture.  I received the results today and and is says "Herpes Simplex Virus Type II Isolated.

What does this all mean? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
26 months ago
Interesting.  has your current partner been tested for HSV 2?  If not, it would be wise for her to do so.  Though the HSV 2 IgG test is not perfect (it misses 8% of HSV 2 infections  compared to the Gold standard herpes Western blot) it is also possible that your current partner is infected and is unaware that they are infected. You mentioned that you had an STD panel done in August 2018 but I'm wondering if she did also?
The fact that the HSV 2 igG was negative at your most recent draw suggest that you may have new infection now. You also have a well-established type one infection and people who have that, sometimes have a very mild new type II first outbreak. The fact that you had a positive culture five days into the appearance of this lesion suggests that it might be new as well.  People with recurrent disease Will normally clear the virus pretty quickly from lesions though this is not definitive in terms of sorting out if this is new or old infection.

So in terms of what to do next, I would suggest that your partner get an HSV2 IgG test now.  If she is positive, that strongly suggest that this is no infection for you. If she is negative, that's suggests That either your IgG test missed your infection or her IgG test Mr. infection or she has had another partner where you have had another partner. I'm just throwing out the possibilities. I am definitely not accusing anybody of anything.

Please let me know what other questions you may have.

Terri
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26 months ago
Not sure what your statement "current partner isn't affected and is unaware that they are infected."  

My current partner was tested in 2015 when she left her husband and all was good.  She says that she has not have sex since.  

In your second paragraph, it sounds like you are suggesting that a well established HSV 1 can cause a new HSV 2?  FYI - It's been over a year since I recall ever having a fever blister and I have never had a bad one.

The swab test was 2.g days after I first noticed an issue - not 5.

I don't understand your statement, "So in terms of what to do next, I would suggest that your partner get an HSV2 IgG test now.  If she is positive, that strongly suggest that this is no infection for you".

My partner has a blood a HSV 2 blood test performed and is waiting on the results.  But, if she is positive, how can that meant no infection for me?

I do appreciate all of your help.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
26 months ago
No, a well established HSV 1 could not cause HSV 2 - only HSV 2  can cause HSV 2 to be present in the swab test.  What I was saying is that people who are infected with HSV 1 can often have a mild new infection with HSV 2 - the antibody present to HSV 1 helps to keep symptoms minimal when someone contracts HSV 2.  Is that a bit more clear?  I am happy to clarify if needed
"So in terms of what to do next, I would suggest that your partner get an HSV2 IgG test now.  If she is positive, that strongly suggest that this is no infection for you""  This was dictated and clearly did not get my accurate point across, I'm so sorry.  What I meant to say is that if she is positive, then this strongly suggests that this is NEW infection for you. 
If she is positive, and you were negative, then the fact that you have a positive swab test strongly suggests that this is a NEW infection for you. 

Clearly I need a new dictation app!  So sorry

Terri


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