[Question #7611] STI testing accuracy, time frames, and the use of PID

2 months ago
Last year I had a previous partner test positive for HSV 2 by swab after an outbreak long after  (6 months) our relationship ended.  At that time her igg blood test was negative.  She was in a new relationship with a partner with unknown status.  This seems to fit the scenario of her acquiring a new infection with her current boyfriend, and likely was not infected from me or had it while we were together, because at the time of her testing- she had not yet seroconverted, and was the first time she ever noticed an outbreak, and  the outbreak was significant and lasted a while.

Although my relationship with her was brief, likely only having sex less than a dozen times with condoms, I got myself tested for HIV and Herpes, roughly 8 months after our final sexual encounter.  Negative for HSV-2 (by University of Washington WB and IGG) and HIV.  

I researched the HSV WB sensitivity here:
https://www.mdedge.com/obgyn/article/150341/gynecology/genital-herpes-diagnostic-and-management-considerations-pregnant?sso=true

And found that the WB misses about 8% of HSV2 cases, which is a bit concerning.  How should I feel about such a number, and is there a way to test more accurately?   Fortunately, it appears HIV testing is around the 99% sensitivity mark?

Another concern is I am on a TRT regiment and have used anabolic PIDs/steroids for several years as an athlete.  This is a practice I am slowing down on as I approach my 40s.  I stopped all drugs for 6 weeks before my Western blot.  I did not stop for my HSV IGG or HIV test.  I know corticosteroids can impact testing, but any concerns about anabolics?
Edward W. Hook M.D.
Edward W. Hook M.D.
2 months ago
Welcome to our formula. Thanks for your thoughtful questions. I’ll be glad to comment.  Your questions touch up on several different topics. I will try to answer them separately.

1.  Herpes.  It is my opinion that it is unlikely that you acquired herpes from your previous relationship. I say this upon consideration of multiple pieces of evidence which include: the Fact that you have not had symptomatic outbreaks; your condom use and the brevity of your relationship; the timing of your previous partner’s diagnosis; and the results of your herpes blood tests. The University of Washington western blot test is the gold standard for herpes diagnosis and had you recently acquired infection you likely would have developed a positive test.  While there is no perfect test, and all tests miss a proportion of infections, the University of Washington test is the best there is. Considering all of these variables together, it is most likely that you did not acquire genital herpes from your previous partner. I would urge you to move forward without continuing concern.

2.  HIV. Your risk for HIV is even lower than your risk for herpes. It is statistically unlikely that your partner had HIV and current HIV tests, Which test not only for antibodies to the virus but for the virus itself are amongst the most reliable testing all of medicine. I would urge you to believe the results..

3.  Anabolic steroids.  The data and experience with the effects of anabolic steroids on immunity are mixed. Some laboratory studies suggest that anabolic steroids may cause modest immunosuppression while others suggest there is no effect or even possibly slight immune stimulation.  In your situation however the major effect of steroids would not be to prevent an immune response but to simply delay it.  I would see no reason to doubt your HIV test results. I also feel the same way about your herpes test results although admittedly there may have been some modest affect in terms of a delayed antibody response.  I would point out, that had the steroids had an immune suppressive effect on you, at least on a theoretical basis it is more likely that you would’ve had symptomatic outbreaks if you had become infected. 

I hope the information and explanations I have provided have been helpful to you.Personally at this point I see no reason for further testing and would encourage you to move forward without concern.  If there are continuing concerns or if any of my comments are unclear please feel free to use you were up to two follow-up questions for clarification. EWH


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1 months ago
Thank you for your thorough and extremely helpful response, Dr. Hook. Your team and this site is a tremendous blessing.
I took a lot of time to let your words sink in, as I work to alleviate my concerns.  Since it's possible my immune response was delayed, I had hoped that waiting the 7-8 months post-exposure to be tested instead of the usual 4-6 months would reasonably recoup test accuracy?
A couple added health questions, that may or may not be related, have come up that I hoped you could clarify for me...
I recently had an anal skintag and 2 polyps removed during colonoscopy for biopsy.  These were the results:

Your Value 
A) Cecal polyp, biopsy: - Lymphoid aggregate. - Negative for dysplasia or malignancy. 
B) Transverse colon polyp, biopsy: - Tubular adenoma. 
C) Anal skin tag, biopsy: - Anal skin tag. - Negative for dysplasia or malignancy.

My understanding is that anal skin tags are not the same as normal skin tags or acrochordons (my doc feels that i may have had a bulging hemorrhoid that caused it) and also have no association with HPV/warts?  Is this accurate, and would the biopsy have identified/spotted HPV/warts without specific testing? Is it safe to assume this is all completely unrelated to any STIs?
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
I’m glad you returned.  It gives me the opportunity to clarify my earlier response as well.  I answered your questions about herpes too quickly.  The paper you referred to used the UW Western Blot as the gold standard.  The test it was compared to missed about 8% of infections, not the Western Blot.  Be confident that you do not have HSV.

As for your biopsy results, if HPV has been present, it would have been diagnosed.  Neither skin tags, nor the polyps discovered in your colonoscopy are in any way related to HPV, or any other STI.

Hope this helps.  EWH 
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1 months ago
Thank you, Dr. Hook, for the clarification and the additional info.

I am concerned I may have gone down a rabbit hole.  I read on this forum:

[Question #7217] New Data about HPV and skin tags
That it looks like you and Dr. Handsfield and another colleague collaborated on, about the possible connection of HPV with skin tags, which is what raised my concern.  
Perhaps I am getting far too out of the box here, but are Acrochordons (normal skin tags) and Anal skin tags developed from prolapsed skin after a regressed hemorrhoid even the same animal?  I'd really like to know if they share the same make-up physically/biologically... 

I'll be honest, I had a bit of a hard time understanding the verbiage in that question 7217.  What did your colleague mean when she stated:
"If so, it seems less likely that HPV plays a casual role.  I agree with Ned that they are unlikely to be an important source of transmission..."

Just hoping you can make this all a bit less murky for me, and I apologize if I have taken this thread off the rails.  I try to make informed, responsible decision with sex and health, but there is just so much new and novel data out there, it can be overwhelming. 
Edward W. Hook M.D.
Edward W. Hook M.D.
1 months ago
I think you may be going down a rabbit hole here.  Limited data now show that some rectal lesions identified as skin tags have HPV DNA in them.  Even in those situations, such lesions do not recur after removal and play little or no role in forward transmission of HPV.

I am not a proctologist and cannot comment on similarities/differences between shin tags and hemorrhoid remnant.  From what you say however your lesions were removed and inspected microscopically.  This should resolve what the lesions were and if they were warts, the pathologist would have said so.

Your statements about being overwhelmed and wanting to make a “responsible decision” seem to be misplaced when we are taking about and widespread largely inconsequential and vaccine preventable infection which can be readily managed by following sexual health maintenance guidelines.  EWH 
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