[Question #7984] Herpes with negative antibody test
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50 months ago
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In September of 2020 I had a risky sexual encounter. In early June 2021 I started experiencing painful urination. Went to the doctor who gave me antibiotics, and gave me a full STD panel test. After several days I broke out in what looked like HSV sores all over my foreskin, and the painful urination continued (and worsened). I was then informed that everything was negative on the test (chlamydia, gonorrhea, syphilis, HSV, etc....). My HSV-2 igG antibody test showed a value of .13 (clearly negative). I came in a second time to show the lesions and the doctor said its herpes and took a scraping. I am awaiting those test results.
To my question: My current partner of many years (not the risky partner from September) has cold sores, which I assume is HSV-1. I also assume I gave them to her because she never had them before me. She had a cold sore about a week prior to my symptoms, and we did oral--I was unconcerned because I thought I gave it to her. We have also been having unprotected sex since September.
My question is which scenario is most likely:
1. I have HSV-2 from an encounter in September 2020 (or earlier), but tested negative for antibodies in early June around my primary outbreak
2. I never had HSV-1 (I have never had a cold sore and tested negative for it, after all), and my girlfriend transmitted HSV-1 to me.
I'm worried that I acquired HSV-2 from the sexual encounter in September (or one even further back), but got a false negative igG antibody test. This outbreak seems quite severe, which I have heard signifies HSV-2, not HSV-1. I have had repeated negative igG tests for HSV-1, but I have heard that those are less reliable. Ultimately the tests will tell, but I'd like some clarification on the antibody test, and how often people carry herpes but not antibodies. Thank you.
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Terri Warren, RN, Nurse Practitioner
50 months ago
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1. I have HSV-2 from an encounter in September 2020 (or earlier),
but tested negative for antibodies in early June around my primary
outbreak
The Igg test misses 8% of HSV 2 infections compared to the gold standard herpes western blot. It also misses 30% of HSV 1 infections compared to the western blot.
2. I never had HSV-1 (I have never had a cold sore
and tested negative for it, after all), and my girlfriend transmitted
HSV-1 to me.
The timing much more strongly suggests that you got this from her but if think you gave it to her, then this doesn't hold water. Did anyone do a swab of the lesions for herpes? What did the provider who saw you think what was going on?
A blood test done too soon is going to be falsely negative. But you had plenty of time between September 2020 and June of 2021 to make antibody to HSV 2. My opinion is the second option.
Terri
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