[Question #8783] Chlamydia Follow up/ HSV 2 Concern

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40 months ago

Hello doctors:


I am reaching out again to follow up on my previous post.  As a summary, risky unprotected intercourse with a Mexican stripper on March 4th. Tested positive for chlamydia on March 23rd. Experienced cloudy discharge in underwear and some potentially unrelated flu like systems (not COVID). On March 26th, I was treated with a shot of rocephin and a seven day course of doxycycline (100 mg by mouth taken twice daily). The cloudy discharge went away on day 5 or 6 of taking the doxycycline. 


Follow up questions:


  1. I am a carrier of g-hsv 1 as I tested positive by swab on a lesion nearly 6 years ago. I am concerned that I could have caught hsv-2 from this encounter in March.  I didn’t notice any lesions and didn’t have painful urination after the March encounter.  However in the last few weeks I have noticed some sensation around my groin similar to minor razor burn.  I have trimmed my pubic area a couple of times in the last month so potentially it could be related to that or maybe it’s in my head. I’ve also noticed random stinging sensations at the tip of my penis.  Maybe once every other day.  Would be curious to hear your thoughts.
  2. My initial outbreak of g-hsv-1 was pretty bad (very painful urination and 2 lesions that were painful and scabbed over. Would it be likely that a new hsv-2 infection would result in similar symptoms?
  3. I haven’t been retested for Chlamydia yet.  It could be possible that I still have this. 
  4. Would you recommend a Western blot test to confirm hsv-2?  
  5. I’ve read that perhaps 40% of females in the states have hsv-2.  I’ve also heard from dr. Hook that it’s difficult to transmit. I’m having trouble understanding how both of these can be true at the same time.
  6. Are there any studies on prevalence of hsv-2 in females from Mexico?
  7. Are there any other diseases I should be worried about at the moment?


Thank you for your time! 

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Terri Warren, RN, Nurse Practitioner
40 months ago
Your infection with HSV 1 genitally that swab tested positive might present in a similar way if you had acquired HSV 2 infection.  Your previous genital infection with HSV 1 MAY make it less likely for you to acquire HSV 2 genitally.  Did you have an IgG test for HSV 2?  The western blot is certainly the best test for HSV 2, but the IgG as a starter might be useful.  But you are pretty early to test for antibody.  At 6 weeks out from a concerning encounter, the IgG picks up about 70% of those who will eventually be positive for HSV 2.  About 25% of women in the US between 14 and 49 have HSV 2, and it is easier for females to become infected from a male than the reverse.  I'm not clear about prevalence in Mexico, but I'm guessing you could find that online.  I think you should have a follow up test after chlamydia treatment, yes, but you should wait  90 days after treatment to do that.

Terri
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40 months ago
Thank you for your response Terri.  

I did not get an IgG test for HSV-2 because Dr. Hook and other sources have said that blood testing without typical symptoms is not recommended due to a high false positive rate. However, I am unsure if they are referring to an IgG test.  How frequently does the IgG test show false positives?  And how long after exposure would you recommend taking it (if it only detects 70% 6 weeks post exposure).  I am am currently at 7.5 weeks post exposure. Is there ever a point when it will pick up close to 100% of those who are actually positive?

Furthermore, if I want to get a western blot test, how long after exposure can the test be taken and be accurate?

Lastly, Dr. Hook mentioned that HSV-2 only transmits 1% of the time when unprotected intercourse happens with an infected female partner. That seems to be a very low transmission rate.  Have you found the similar data?

Thanks in advance for your time!
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Terri Warren, RN, Nurse Practitioner
39 months ago
The IgG test misses 8% of HSV 2 infections compared to the gold standard herpes western blot. 
A study by Quest labs found that in the past three years, 23% of their IgG tests were in the low positive range - 1.1 to 3.0 and half of those were false positive.  That means the false positive rate is about 11%.  The best test is the western blot and if you want to be more certain about your HSV 2 status, you could do that test. 
The study data that we have suggests that if an uninfected male is having sex with an infected female, no condoms, she is not on antiviral medication, having sex about twice per week, never during an outbreak, the yearly transmission rate is 4%.  That means about 4 men out of 100  will become infected.  These are what we call "survivor couples", that is, they have been together for awhile before they enter a trial and have not yet transmitted.  Add daily antiviral therapy for her and it becomes 2%, add condoms, it drops to about 1%.  Perhaps that is what Dr. Hook was referring to?

You should wait 12 weeks after a concerning exposure to do the blot.

Terri
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