Jack101

I wouldn't bother with the prior numbers. I few months ago, I would say a number of 5 was a definite positive. However, recently I have seen individuals with numbers of 4,5, 8, and even 14 not confirm. I believe that an antigen has recently entered the environment that bears close homology to the site of glycoprotein G2 they are using for HSV-2.

@Ruiner, Sorry to hear that your symptoms are bad. The lesions in a first outbreak generally last about 2-4 weeks and at times a second crop of lesions can occur. You should be on acyclovir to shorten the outbreak. Once you have your diagnosis and type of HSV (I believe you are likely to have HSV-1) further management can be decided. Please have the doctor swab the lesions to determine the type. If you have oral lesions, they should be swabbed as well. In addition, you should know that your life is not over. As you are fairly young it may take you a while to get some prospective, but anyone that does not want to be with you because of HSV is not worth being with. In addition, due to your age, I was wondering if you had received the HPV vaccination. If not, I recommend it for you. HPV is currently not routinely tested for and actually is now the number #1 cause of head and neck cancer in men. On a side note, for anyone here feeling a social stigma I have good news for you. I expect a test for HPV antibodies will be made available soon and all the people you feel that are judging, will soon join the STI camp.

Hello I am a laboratory medicine physician and would like to know what test did you take and what was the IgG titer level. There have been an increased number of false positive results with the Herpes-Select test and with no symptoms you may represent a false positive.

@lostandconfused99. It is hard to be sure. The most common blood test the herpes-select misses approximately 30% of HSV-1 infections. So while a positive result may confirm infection, a negative result does not exclude infection. May I know your index values to ensure the result does not represent a false positive. In addition, I am assuming you have kissed someone in the last seven years which could be a source of oral herpes. What are your symptoms? Herpes with the possible exception of post-herpetic neuraglia (which in my opinion is to often diagnosed to without investigation) is a episodic disease with flares and remissions. It is not a disease where you occasional feel something in the morning, afternoon, and then the next few days on a continuous basis. In your case, unless a lesion develops you simply have a HSV-1 infection with indeterminate location and that is all you can disclose to your partners. While you think you are in the minority you are not. 63% of women that have had children are seropositive for HSV-1 and 22% are seropositive for HSV-2. In fact only 28% are HSV seronegative in some studies. In general, I think people are going about disclosing there herpes status the wrong way. In my opinion, both parties should be STD tested before any disclosure as your partner likely already has HSV-1 and does not know it. Ignorance of an infection is not equivalent to absence of an infection.

@ lostandconfused99. No, they can not do a culture or PCR if there are no lesions. They can attempt a random swab to test for asymptomatic shedding, but that is only done in research settings. If you were diagnosed by blood test, confirm it was a IgG test and not IgM. I am a medical professional and I am shocked that nobody went over your results with you and the possibilities that they represent. You likely have HSV-1 orally otherwise known as the cold sore virus. If you do not remember a outbreak, it likely occurred as a young child and you simply have no knowledge of the incident. That is the case with the majority of people who do not know they are infected with HSV-1. The only reason to do HSV-1 blood tests in the absence of lesions is to confirm that you are not suspectible to genital HSV-1 infection. You do have herpes, but you likely do not have genital herpes which is what lay people associate with herpes. What you should know is, if you perform oral sex on a person who is HSV-1 negative, they may contract genital herpes. So you and your partner may choose to infect them orally by kissing for a few months before intercourse.

@lostandconfused99. How were you diagnosed with herpes. If you were diagnosed by a blood test for HSV-1 and have never had symptoms, you likely have oral herpes and were infected in childhood. Over 67% of the world's population is infected with HSV-1 orally and most of the men you meet will have oral herpes. Even if you have genital herpes, you do not have to worry about effecting people with HSV-1. As such, 6-7 out 10 people with have HSV-1.

@artgal101 from your above values (I am assuming the test was a Herpes-select) your original test with a HSV-2 value of 0.5 would have been negative, not positive. In addition, you current values of HSV-1:13.2 and HSV-2: 1.65 indicate you are likely infected with HSV-1. The HSV-2 value of 1.65 is just above the threshold and has a greater than 50% chance (in your case, it may be over 90% due to the extremely low value) of representing a false positive. I would inquire with my physician about obtaining a Western Blot for confirmation. Though you have herpes, the type will determine how you proceed in relationships and what protection you have to use. HSV-1 has very few outbreaks, less than 1 per year (sometimes, it never reoccurs) and the majority of the population is positive for HSV-1 (orally or genitally)[some studies indicate greater than 60-70 percent of the population]. If you are in a relationship with someone that is HSV-1 positive (whether orally or genitally), you need not worry about infecting them with the virus again. Not to insult your method of dating, but when you are disclosing your HSV-1 status with your prospective partners it may be useful for both of you to get a STD panel before you disclose. I say this because the majority of individuals are unaware of the high rate of HSV-1 infection and assume they do not have it, as they were infected orally as a small child and do not remember it. Just by the numbers more than 7-8 out of 10 will have either HSV-1 (6-7 out of 10) or HSV-2 (1 out of 5) or both. I feel you may be putting yourself at a disservice, disclosing your status to partners that do not know there status. In fact, you should assume 8 out of 10 people have HSV-1. Unfortunately, you and the doctor were one of the few people that were negative for HSV-1.

Thank you for sharing your story. I wish more were as courageous as you in coming forward. It is my wish that the CDC and other medical groups would get rid of the term STI/STD. They are simply infections that can occur in a multitude of situations. In addition, I wish herpes testing was included on the standard STD panel with oral/genital herpes having equal equivalence and greater education provided about this condition to the public. With greater than 90% of the population infected with herpes it makes no sense for individuals to suffer a stigma when only 10% of the population is not affected. I look forward to hearing about your test results. I favor that you may have contracted HSV-2 from him as the only way his former partner could have been diagnosed with genital herpes from a blood test would have been to have HSV-2 antibodies (as HSV-1 antibodies in a blood test are considered non-specific for site of origin).

I am sorry about the situation. Misinformation about herpes is widespread and the old doctrine has been that you can not spread herpes unless you are having a outbreak. Your physician friend was likely in denial about his break outs believing if he didn't have any lesions, he could not spread the disease. I am slightly concerned about this situation as I believe there may have been a misdiagnosis on your original report and further testing may be warranted. Though you have herpes it is uncertain whether it is type 1 or type 2 or both. My fear is that your original report for HSV-2 that demonstrated a low level of involvement was a false positive, given that you had no symptoms and a extreme reaction after the sexual experience, and in fact, may only be infected with one strand of herpes virus. This is important, as you may still be suspectible to the other strand. May I know the timing of your herpes blood test in relation to the incident, the type of test used, and the values of the results. Further testing may be warranted based on these values.

Hello Fonda, I have a lot to say on your situation and management. First, I am slightly concerned by your physician's knowledge of herpes testing and you may need to receive a second opinion. You should not have received a Herpes IgM test. They are in fact worthless and a waste of money, as they cannot reliably distinguish between IgM for herpes type 1 and type 2 and may exhibit cross reactivity with other members of the herpes family (herpes zoster, EBV) (and remember, by the age of 30 a majority of individuals will be positive for HSV-1). These tests have long been rejected by the Centers for Disease Control and Prevention and many labs have pulled these tests from the menu. In addition, your negative IgG tests for HSV-1 and HSV-2 do not mean you have not been infected with HSV-1. The most popular test for Herpes, the Herpesselect ELISA misses about 30% of HSV-1 infections (false negative). Given your history of condom use and unprotected oral, you are most a risk for HSV-1, assuming you have not been infected as a child orally. You should have had a PCR swab done of the lesions to confirm HSV infection. As for the diagnosis of post-herpetic neuralgia. That is a diagnosis of exclusion. It is too soon to say, as you don't have a definitive diagnosis of herpes only a clinical presentation that is highly suggestive. I am physician and I would like patients to understand, that diagnoses of exclusion should really only be rendered after an exhaustive diagnostic work-up. In addition, that diagnosis is made after the lesions and rash have abated and pain still persists. According to you, your rash is still present. All to often, physicians render the diagnosis to avoid further work-up. As far as Mycoplasma genitalum goes, it is unlikely due to the fact that you used a condom and the oral cavity has not been definitely found to habor mycoplasma genitalium (though other mycoplasma species have been found). However, it is odd that the physician is ordering a test for a cause of NGU, when according to your above statement he does not believe it to be non-specific urethritis. I do think the test will be low yield, but is worth performing. I am also concerned that your physician thinks symptoms equate with infection. A good majority of these infections can be asymptomatic including gonorrhea or present with an atypical presentation especially if they are from normal oral flora not typically associated with a STD. The majority of the bacteria present in the oral tract will not be grown on normal culture nor or they included in the standard STD panel. I was wondering if you had a swab done of your urethra surrounding the inflammation, and the proximal and mid portion of the urethra to look for inflammation under a gram stain. I would assume this was the case as you were told you do not have NGU and inflammation of this mucosal area would indicate you in fact have an inflammatory process. This should be done before first morning voiding if possible, as urine often dilutes/removes the inflammation in the urethra. In addition, urine testing for HSV-1 is not standard, but can be done and is no more expensive than swabs for PCR. The standard treatment of NGU is azithromycin (1g) or doxocycline 100mg bid for 7 days. These antibiotics do have side effects, but are generally considered safe. In addition, there are also side effects for ametriptyline. I agree these antibiotics should not be given without evidence of inflammation, but from your post, no definitive test was performed to exclude urethral inflammation, beside visual inspection. In short, you may have herpes with postherpetic neuralgia or chronic pelvic pain syndrome/chronic non-bacterial prostatitis. However, a further work-up needs to be performed before rendering long term diagnoses with no cure and chronic management, if a condition that can be treated is simply overlooked. I would like to stress that just because you are infected with one condition, does not mean you are not infected with other. Oral sex is particularly associated with atypical presentations of NGU that often reveal no organisms. With the increase in oral sex, medicine may need to consider testing for oral pathogens in the standard treatment of STDs.

There are many causes of hair loss; however HSV is not one of them. There have been reports of alopecia following acyclovir therapy. HSV can cause a sore throat if infected orally; however, this can occur with any virus or bacteria and the symptom of a sore throat has no specificity for HSV infection.

I concur with HikingGirl; only in your particular case the sensitivity of the test is not the issue. We are performing the Western Blot do to its increased specificity (though it is more sensitive as well). Another way to understand in the context of medical tests is that sensitivity is the extent to which true positives are not missed/overlooked (so false negatives are few) and specificity is the extent to which positives really represent the condition of interest and not some other condition being mistaken for it (so false positives are few).

Lostandconfused99 and HikingGirl how have you been diagnosed. By swab or blood test.

Hello AF429, I am a laboratory medicine physician and may be able to help you. I have joined this forum to hone my skills in answering questions concerning STD transmission and dispel common myths. Before we begin, i need to know the brand of test, the values given ,and your symptoms (duration, a brief description, color, and changes). Thanks!

Hello Fonda, what you are describing is known as urethritis. There are two forms, non-gonococcal and gonococcal. HSV is a rare cause of non-gonococcal urethritis (usually HSV-2). However, it is rarely the cause of persistent urethritis, more often it is the cause of recurrent urethritis. In addition, herpes should burn with urination. Your findings are not typical of herpes and I suspect you have been coinfected. How did you acquire your HSV (oral, anal, genital) and what type is it. Your first step should be to go to a STD clinic or your doctor to be checked for the standard STDs ( syphilis, G/C, trichomonas, Ureaplasma and mycoplasma). In addition, your urine may need to be checked for HSV by PCR to see if you are in fact shedding. If none of these yields a result, due not fret. Approximately 50-60 percent of non-gonococcal urethritis has no identifiable cause. This may be due to the mode of acquisition. People often forget that the mouth is full of bacterial organsims and only about half can be grown or detected by non-PCR methods. You may need to be put on an empiric antibiotic for NGU.

Sorry, I am confused about your experience and I am commenting in order to ensure people reading do not get confused about herpes and you understand that you may in fact not have received herpes from your relationship. I am also a physician so please don't think I am trying to defend him. You stated, you had low levels of exposure to HSV-2 before you started in a relationship, but did not have any outbreaks. Unfortunately, there is no such thing as having exposure, but not being infected if you are basing it off serologic tests. You are either negative or have the disease. The test could have been a false positive, but I would like to dispel the notion that you can have the antibodies, and not be infected. As such, if you had a positive test before the outbreak you in fact already had herpes. In addition, it is unlikely he gave you HSV-1 from the outbreaks on his penis. Given the frequency you describe of his outbreaks, they sound like HSV-2. HSV-1 rarely re-occurs in the genital region (greater than 90% of recurrent outbreaks are HSV-2). Did you have a negative blood test for HSV-1 before the incident (you should know that the common ELISA test misses approximately 30% of HSV-1 infections)?

He may contract the disease and not be asymptomatic

I agree with you hippyherpy that hsv 2 genitally is a very manageable condition for the majority of individuals. However, it is important to know your true status. If he falsely believes he has hsv2 and enters into a relationship with someone wwith hsv2 and doesnt take the proper precuations

Living Light, I would not disregard the possibility of confection, your symptoms of herpes are not classic. You should not have constant burning. That would indicate you have lesions all the time with no healing with is not hsv1, unless you are immunosuppressed. Your telling me you had oral, even further makes me believe you are coinfected. I am not sure how your gyn ruled out an infection. Let me guess, they did a urine culture and a standard std panel. As there is no standard std panel, what specifically was looked for. Unfortunately, that is not good enough. The main problem is your gyn is looking for a std or standard uti. Not normal flora of the mouth. Over half the bacteria in the mouth cannot be grown by culture. Have you taken any antibiotics since your diagnosis?

Sorry, my last comment did not convey the intent of my question. There are multiple sites available online that will help you distinguish an ingrown hair from herpes. A google search should reveal abundant information. The most obvious is to look for a hair follicle protruding or soon to protrude (creates a shadow) from the lesion. You can use a mirror or your phone to take a picture of the lesion and magnify the lesion for better viewing. What a meant to state is that atypical herpes lesions by nature are difficult to define and rare herpes lesions can involve a hair follicle, hence the term asymptomatic shedding (is there really such a thing or are the lesions just too difficult to define). In addition, the transmission rate for GHSV-1 by genital to genital sex is less than GHSV-2 due to a number of factors, including over 67% of the global population is already infected with HSV-1. Of note, one of the reasons postulated for the increasing number of GHSV-1 infections is the decrease in the sero-prevalance of HSV-1 orally. It is noted that those with HSV-1 orally can catch GHSV-1 genitally, but it seems uncommon. In addition, it is hard to know if those that catch GHSV-1 genitally actually had HSV-1 orally. Many people often confuse cold sores (HSV-1 and rarely HSV-2) with angular chelitis giving them the false impression they have HSV-1.

1. Based on my numbers, 3 doctors have told me it is likely that I already have HSV-2 b/c of the fact that 7 days after my incident is when I took the blood test. (I agree that if these results are accurate, you did not get HSV-2 from her; however, these results may not be accurate and may represent a false positive. Though the test claims to be type specific, there is cross reactivity with HSV-1 or other possible antigens [what was your HSV-1 result]. It is quoted that numbers above 3.5 are over 90% accurate. However, that has no bearing on individual results. You are either positive or negative. Think of it this way. If i told you that you had a 90% chance of having a sarcoma of the leg and had no symptoms, would you cut off your leg based on chance, or obtain a confirmation test. If a million people have a result over 3.5; 100,000 will be false positives [not a small amount in my opinion]. You have also probably read that HSV-2 can be asymptomatic. While that is true, the test can also be wrong. In addition, a portion of these people that are counted as clinically asymptomatic may actually not have the disease, since a lot of these studies are not solely based on the gold standard of the western blot. 2. What happens if my friend has her IgG test come back positive, would the first test still be moot b/c of the 7 days? (Yes) 3. If both are negative should I take the western blot test (Yes; however, if both are negative and you have only slept or dry humped with two negative people, the only way you would have contracted this disease, would have been from child abuse or from your mother at birth. Of note, if a infant gets HSV-2 at birth there likely would have been major complications and your mother would know this) 4. If my wife is negative and my friend is positive, is that why I should wait the 12-16 weeks or so to take the western blot (You should only take the western blot now, if you can confirm that your friend has not been with anyone for the last 5-6 months and is negative; otherwise, she could have the disease and still not have sero-converted.) Of note, I recently took an Herpes-select test. It came back positive for HSV-2 at 3.66 and 3.99. My primary care doctor also told me that I was infected. However, this logic made no sense as my only partner was negative. I would like to stress this, you cannot catch HSV-2 or any other disease for that matter, if the disease is not present to be caught (i.e. negative partners, regardless of what any test results demonstrate).

HSV-2 is rarely transmitted by oral sex (HSV-1 is more likely) and you may already be infected with HSV-1 (over 50% of the population is infected orally in childhood). Performing oral sex on a person's genitals infected with genital HSV-2 can transmit the virus to the oral cavity. However, HSV-2 does not like the oral cavity and will rarely even have asymptomatic shedding or a break ever again. In fact, people that are in a HSV-2 discordant relationship often infect themselves orally in order to develop antibodies to prevent genital infection. In addition, your symptoms appeared rather fast for HSV, and are not classic for the virus, and likely reflect other viral etiology (common cold). Condoms also are rather efficient at preventing HSV transmission. I would advise you get tested now for HSV-1/2 by serology. If you are positive, you will know that it did not come from this encounter. However, be warned that HSV-1/2 serology test can demonstrate false positives. You will need to be tested at 12-16 weeks if you are negative on the first test to ensure you are in fact negative.

Herpes is a very common condition. Some studies show that over 90% of the planet have some combination of herpes (oral/genital/skin). Herpes cannot evolve into HIV, though Genital HSV-2 can increase the possibility of transmission due to ulcerations and increased T-cells in the area. In addition, you say you have HSV-1 and HSV-2. Was this determined by serology or swab of a lesion?

Hmm, those symptoms are odd for herpes. Do you have GHSV-1 or GHSV-2 and how did you catch herpes (oral, anal, or vaginal/penile)? I ask because often times herpes is not the only bug that hops along for the ride. It is human nature to often forget that several things can happen at once and individuals at times attribute all of there symptoms to herpes, when in fact they are co-infected.

Why do you feel the need to get retested? Is there a reason you don't believe the culture test? Retesting is necessary if you are negative, but not for a positive culture or PCR result, if there are no questions concerning the integrity of the test. Whether this is a ingrown hair or not will be difficult to say. GHSV-1 does not often reoccur, with some people never having other outbreak again so this may not be herpes, but simply a ingrown hair. May I ask why does it matter, if it is a ingrown hair or atypical herpes lesion?