[Question #7355] Confused

4 months ago
Hello! 
This is a follow up to question 6711 & 6978.  I had previously been neg for hsv1 & 2.  I had a new sexual partner in 8 months ago, and within several days experienced 2 different types of genital bumps.  One was determined to definitely be yeast (it was swabbed and was neg for hsv & pos for yeast), the other wasn't swabbed and I was unsure if it was herpes.  Four months later I had the same sort of bumpy/lesion-y area show up on my lip, and it really seemed to go through a herpes type progression (scabs), though the lesions themselves were very very small (each one the size of a pin, clustered together, in total the area was half the size of a dime or so).  At that same time I got tested for hsv1 & 2 igg, 16 weeks post exposure, and it was negative.  I now am experiencing extreme itchiness on my nose--on/inside one nostril, some swelling, and what seems like blistery bumps.  Dr wont swab it. I am concerned that it is herpes.  I haven't had any new partners.  Is it possible that my primary outbreak could have been genitally 8 months ago, then I had an oral outbreak 4 months later, and a nasal outbreak 4 months after that (now)?  This seems unlikely but I also don't know what to make of these recurrent symptoms that seem related.
Thank you!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
Yes, all of that is possible, and I cannot imagine why a doctor would not swab what you are describing.  You should have a swab if the things inside your nose look like blistery bumps.  The IgG test for HSV 1 misses 30% of infections, compared with the gold standard western blot.  If your doctor is refusing to swab test it due to the negative IgG test, that just doesn't make sense, in my opinion, since the IgG test is quite poor.

Terri
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4 months ago
The dr couldn't see them which is why they wouldn't swab, but they didn't seem to be looking very closely.  That was the same case for the lesions on my genital area initially.  They are very small so hard to get a doctor to pay attention to. 
Also, the new sexual partner was eventually tested and was neg for hsv2 and equivocal for hsv1, at something like a 1.3 or so (it was a while ago and I don't remember, but it was very close to the cutoff).  How likely is an hsv1 test just over the cutoff to be false positive?  If he has had the infection from childhood does this make a very very low positive like this more likely (but a true positive)?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
The duration of infection wouldn't influence it being a low positive, no.  The only time that would be a factor is if someone gets a new infection and initially, their value would be lower.
1.3 is not equivocal but positive  - low positive.
Generally speaking, if one has lesions so small that they are not easily visible to the naked eye, they are unlikely to be herpes.  Obviously that's not 100% but usually true.

Terri
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4 months ago
Thank you!
Just to repeat this one part of my question: How likely is an hsv1 test just over the cutoff to be false positive? I think I have seen statistics for this with hsv2, but I was wondering if there is information on this for hsv1?
The lesions are very small, but do seem to clearly be following a herpetic progression.  Yesterday they appeared after immense itching as many tiny white bumps, and today there are lots of little cut type ulcers where the bumps had been.   This is similar to what had happened on my lip.  Does this sound like herpes to you?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
4 months ago
There is information about HSV 1 and false positives as well, but nowhere near as many as with HSV 2.  If a person tests in the range of 1.1 to 2.0, there is only a 20% chance that this would be a false positive.  If you have lesions currently, you should have them swab tested right away.

Terri
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