[Question #8326] HSV2 testing

46 months ago

3 weeks ago, I had a single hair follicle on the shaft of my penis that had a bump that looked like was forming a pimple after grooming. It was painless with no redness. I then popped it with normal white sebum coming from the small 2mm pimple. This area scabbed over after popping it. It got irritated and painful with sex. After a week it healed. I have never had any lesions previously and didn’t consider this to be one given it looked like a classic sebaceous pimple. Around the day after this area had healed, I got my COVID booster. That night, I developed an onset of malaise and mild bilateral neck and unilateral inguinal lymphadenopathy. I thought it was likely a reaction to the booster. The inguinal lymphadenopathy worsened. I decided to get labs and include an STD panel given the enlarged inguinal nodes and being sexually active. My labs including STI’s were normal except my HSV2 IgG with Rflx was 1.66. This was through labcorp. They did an HSV2 supplemental IgG test that was positive. I am sexually active and have had multiple partners, using condoms only some of the time. I had never been tested for HSV previously. I recently had been sexually active with approximately 3 different partners intermittently only using condoms some of the time within the last 5 weeks. I am trying to find out if I should get additional testing to confirm my diagnosis and before considering antiviral therapy given that my symptoms (? lesion and now resolved lymphadenopathy) have resolved

Terri Warren, RN, Nurse Practitioner

46 months ago

Yes, you definitely need confirmatory testing. The supplemental test at LabCorp is often wrong so I wouldn't necessarily believe that one.

Normally herpes lesions don't have white substance inside, they are most often water blisters instead so this lesion is likely not herpes, but you could still have herpes.

The issue here is timing. If you test too soon with the best test, the western blot, it will be falsely negative. UW, who runs the test, recommends that you wait 12 weeks from any concerning encounter to do the test to allow sufficient time for a full antibody panel to have been made. If you are continuing to have sex then the timing is always going to be an issue, but at some point, if you do the blot, it will tell if you were infected 12 weeks ago and back before then. If you take antivirals now, they can give you a false negative on the blot, if you have new infection now. There are lots of moving parts here. Please ask me more questions until you have what you need here.

Terri

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46 months ago

Thanks for your response. I had no concern about the lesions appearance and they did not match typical lesion appearance. My main concern was the lymphadenopathy that prompted my testing. Would there be a role for repeating the IGG test or is the western blot 12 weeks from my last encounter the only recommendation for testing? If the timing of contracting HSV is unknown, how far back into the past do you recommendation disclosing these results to previous partners. Should this be disclosed prior to follow up studies given possible false positive results?

Terri Warren, RN, Nurse Practitioner

46 months ago

Anything that is happening from about the waist down can cause the groin lymph nodes to become enlarged - an ingrown toenail, a cut that becomes infected, another kind of infection, several things. So I wouldn't jump to herpes as necessarily the cause. Genital herpes would not cause the neck lymph nodes to increase in size

You could repeat the IgG test and if the value dips into the negative range, would you feel settled that the low positive was a false positive? I've gone through this with patients before who repeat and come out negative - some accept that and move on and for others, the low positive remains a concern and they do the blot. And you can order the HSV 2 IgG on your own on several websites without a clinician order. Most of these services use Quest or LabCorp. You might want to try one that uses Quest to see if the result is the same. These two labs use different brands of IgG tests.

Terri

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46 months ago

I retested the following week using Quest labs since my initial test was with labcorp. The result was HSV2 IGG of 3.26. No current symptoms. Consulted with the testing company provider who said to not worry since it's a low positive unless I have active lesions for a swab to confirm. They said to consider this a false positive and practice safe sex practices. This does not necessarily give me a lot of confidence moving forward.

At this point would you recommend the Western Blot?

Should I tell all or recent previous partners to get tested or wait for a confirmation results?

Terri Warren, RN, Nurse Practitioner

46 months ago

OMG, it would not give me confidence either. And yes, get the blot. You are on the high end of the false positives, but certainly worth doing considering this is a life long infection. I can help you with this at westoverheights.com or you can work with your own provider.

Terri

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