[Question #5990] I know I have Molluscum contagiosum, do I also have genital HSV1?

17 months ago
At the end of May I had unprotected oral sex . Around mid June I developed lesions above my genitals, on the left shaft of my penis,  left scrotum and on my medial left thigh. Never had pain, never had tingling , never had “flu-like” symptoms and the lesions were more pimple like than vesicular.  They progressed rapidly and cleared  on my scrotum and shaft but stayed longer on my medial thigh.  No oral lesions. Standard STD tests  negative.  Two HSV-1,2 PCR’s a month apart are negative.  A biopsy of one of a suprapubic lesion was stained for HSV1 and 2 immunohistochemically and was negative.  Final biopsy last week from a thigh lesion confirmed M. Contagiosum.  Negative twice for. HSV2 IgG (End of June and July) and  IgG positive twice for HSV1 (3.38 end of June and 2.54 end of July) (Quest Diagnostics).  I am fairly certain that I had a cold sore when I was a small child. One of my parents has gotten cold sores  on a few occasions when I was growing up.  Besides repeating PCR swabs every so often is there anything else I can do to confirm for sure that I don’t have Genital HSV1? (Western blot?)
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago
It is clear that you had molluscum contagiosum.  I'm kind of shocked that whatever clinician was seeing you couldn't sort that out by visual inspection - they look pretty classic in their presentation.  I would not suggest doing any further testing at all.  I would guess that your history of a cold sore as a child and a positive HSV 1 serology indicate that you do have oral herpes, so welcome to half the population that has this infection.  Please let me know what other questions you may have

Terri
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17 months ago
Thank you Terri for your reply,

After a foolish indiscretion I’m in the process of reconciling with my spouse  with the hope of becoming intimate again. Thus I’m very motivated to “leave no stone unturned” with regard to HSV1. Does the magnitude of my IgG levels give any useful information? Would you expect them to be higher if the infection was acquired less than a month previous? Would a negative Western Blot test rule it out once and for all? I’m willing to instruct my doctor to submit one if it will provide useful info. Other wise I plan on doing PCR swabs.  


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago
Yes, a negative western blot could be completely relied upon.  The IgG levels are confusing because in our study virtually everyone with an index value of >3 confirmed by western blot for HSV 1 but you also have an index value below.  So I'm not 100% clear.  If you had a cold sore as a child, that would fit with a positive HSV 1 result.  But the western blot is NOT going to tell you where you have HSV 1, only whether you have it or not and I'm not sure that's really what you need?  I can say that if you did have orally as a child, it is extremely unlikely that you would then at some future point acquire it orally.

Terri
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17 months ago
Thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
17 months ago
you are most welcome

Terri
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