[Question #6097] Hsv2 response to # 5950

18 months ago
Terry,

Further to our initial corrwspondance to 5950

- currently week 8
- nil genital lesions noted
- second swab of oral ulceration came back for negative pathology
- partners blood test positive to hsv1, negative to hsv 2.
- my blood test gave a positive result for hsv1, negative for hsv 2.(7 weeks)


We are due to try falling pregnant early next week( 5 days). 

Would you just commence surpression(start 2-3 days before) and revisit this once post pregnancy(avoiding sex in last trimester giving 3 month window for igg/western blot)  

or 

Would you  have unprotected sex and retest at  3 month mark and avoid surpression until serological confirmation?

Furthermore, given the contact I had, if this oral lesion was a primary lesion- wouldn’t you expect some lip lesions from oral sex as it is transmitted via skin to skin contact. How would it locate on the palate as a primary lesion?

If this lesion is new, given the low risk genital contact  I had wouldn’t there be lesions at point of contact on penis ie penis shaft?(very brief contact of hand on penis after digitally masturbating vagina)

Let’s assume this is an old lesion, given my partner is hsv2 negative, wouldn’t the likelihood of transmision, givennthe the 10 year history of unprotected sex, is low?  

Is this all fair logic?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
18 months ago
I went back and reviewed your previous post.  All of your current logic makes sense but we are left with a positive HSV 2 swab with no explanation of why you have it. 
It could have been mis-typed, I have seen that in the past.  But how to sort it out.
I don't think I would advise starting suppression now as you will not be able to get an accurate western blot if you do that.
Does she know about this other contact or not?
One strategy would be to use suppression very briefly during her ovulation time but not continuously after that so as not to mess with the test.  After ovulation time, use condoms for sex. 
Then do the western blot at 12 weeks out from the contact.  In this pregnancy scenario, you really need to know if you have HSV 2 or not.
What do you think about that possible plan?

Terri
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18 months ago
Hi terry,

Ye that sounds great and sounds like a plan.

She does not know about the other contact but she is very aware of the mouth lesion.- 

Interestingly I rang the lab about the mouth swab. I couldn’t get very far other than a response saying that there are strict creditations and if there was some sort of mistake it would be taken seriously. My doctor rang them also  and they stated that a pcr swab is very accurate and that they stand by it.

Just out of curiosity, in your practicing career, have you ever had a false positive from a pcr swab? Also, some labs advise of definitive testing after 6 weeks?

So how would you advise medicating exactly? Say if we were to have unprotected sex on the  Monday to Saturday- Assuming we r having sex every day? When would you start? Furthermore, how would this not distort antibody readings for the 3 month test?

Finally is it worth me quickly retesting at the 8 week mark and is it a problem if you do not use the same lab? Is it best to be consistent?

Thx again terry.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
18 months ago
I have seen one false positive PCR in my career, yes.  But I seriously doubt that is what is going on here. 
You could test at 8 weeks and be reassured with probably 80% certainty that the HSV 2 is negative, or even higher.  But 6 weeks for 100% accuracy is way off.
I think the dosing schedule that you suggest would be fine.  Five days of antiviral medicine is not really enough duration to make a difference in the testing.  You've had plenty of time to at least get a great start on making antibody during this time.
If you are going to retest at 8 weeks, I would use the same lab, yes. 

Terri

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18 months ago
Terry, 

So it’s too late to test at 8 weeks( today!), so I will test again at 3 months. 

Just to confirm, are you saying you start medication on the day of or the day before 
sex? I have a script of Valtrex- and I was advised to have 1 tablet a day.

With regards to the Western blot, as I am from overseas, what would be involved exactly?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
18 months ago
In order for the drug to be fully effective, it should be started about five days in advance of when you want to have sex.  So that would be 10 days of antiviral medicine which, at this point, I still don't think is enough to interfere with the test.
We have people ship their samples to the US for western blot often.  You will need to identify someone who will draw and spin your blood and you will also need someone to order the test for you - I can do that and if you want me to, you will need to set up an appointment at westoverheights.com on the home page, there is a video conference button.

Terri
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