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To: drgian@stdweb.com
Subject: HSV1
Hi Dr. Gian,
Thank you for taking the time to read this. I hope that you have time to answer my questions, or to give me advice. I do apologize for this being lengthy.
About 17 months ago, I was dating this guy. He performed oral sex on me, and we started to have protected sex. Since I was not lubricated enough on my own and after trying to have sex, he used KY Warming Liquid on me (which had burned my genitals right away). We started to have sex, but the irritation was too much, we had to stop because it was too painful. Six days later, I was getting out of the shower and I noticed and felt some burning in my genital area. I looked at myself with a mirror, and I could see open sores (about one big one near my labia, and one right in the corner of my vagina). I called my gyn. and made an appt. to come in that day. My Dr. took one look at my sores, and said that I have herpes. I was mortified! He did not give me a culture swab that day (which I did not know he should have). He put me on Valtrex which may have helped, but I forget how long it took for the sores to go away. The sores were a clear white color, almost grayish in apperance. I also had one on the top of my urethea. I thought that maybe I had an allergic reaction to the warming liquid, but the Dr. insisted that it was a recent infection of herpes. I also thought that this could have been from older, previous relationships in which I sometimes had unprotected sex. The guy I was dating at the time insisted he did not have herpes. The guy did not have any open sores on him (since I also performed oral sex on him, nor did he have any cold sores on his mouth). I realize now that he may have had herpes, and did some asymptomatic shedding (and I now have herpes). However, I do not develop any coldsores on my lips, or in my mouth. If he had shedding, would I have gotten oral herpes?
About 4-5 days later, I insisted that a viral culture performed so I would know for sure. A test was done, and it came back negative. However, both the Dr. and nurse stated that since I was on Valtrex for a few days, the culture would come back negative. I still was not satisfied so I had a blood test. I am not sure what type of test was used, and how reliable the results are. Under Type it has S
Test Result Limits Lab
HSV I/II, IgG/Rfx Type II IgG
HSV I/II IgG 7.0H index 0.0 – 0.8 MB
Negative < 0.9 Equivocal 0.9 – 1.0 Positive > or = 1.1
Note: Negative indicates no antibodies detected to either HSV -1 or HSV -2. Eqivocal may suggest early infection. If clinically appropriate, retest at a later date. Positive indicated antibodies detected to HSV -1 and/or HSV -2.
HSV I/II IgG Interp Positive Negative MB
HSV II IgG, Type Spec (underlined) Negative 0.0 – 0.8
Neg. < 0.9 Equiv 0.9 – 1.0 Pos. > or = 1.1
Note: Neg. indicated no antibodies, equiv. may suggest early infection (same as above) Positive indicates antibodies det. to HSV – 2; coinfection with HSV 1 cannot be excluded.
Then it is handwritten on the bottom
Type I – positive
Type II – negative
May have Type I below the waist
When I asked my dr. about the results, he told me that the 7.0 was a recent infection, and it was not from a past sexual experience. I have HSV -1 genitally according to the dr. The last sexual encounter I had previous to this guy was about 6-8 weeks earlier, in which it was unprotected and with a different guy. I thought maybe it could have been from him, but my dr. said no, it was from this recent past experience.
Here are my questions:
1. Would you be able to explain the results to me – I thought that in order for antibodies to develop, at least 4-12 weeks were needed. Do you think I had acquired the virus earlier in life, and an outbreak occurred with the sexual encounter I had?
2. I have never had another outbreak since, and I do take 500 mg. of lysine a day. Would that help prevent another outbreak? I also have been under stress with my job for the past year (off and on). Why would stress not trigger another outbreak?
3. I am confused as to how I could have received the virus when he had a condom on, and no outbreaks of any kind. Unless he has the virus and was shedding asymptomatically.
4. Could I have HSV 1 and it be a result of having chicken pox from when I was a child? I had a severe case of it when I was about 9 or 10 years old. I had the chicken pox in my mouth, on my vagina, and even inside my vagina. The doctor did not think of anything being wrong, just that I had a bad case of it. I am 27 years old now. From what I have been reading, HSV has to be either genital-genital or oral-gential contact, for a person to contract it. But I am wondering if the chicken pox virus had triggered the outbreak I had, and if the guy had asymptomatic shedding, also trigger the outbreak?
5. I may be pregnant and I find out next week for sure. I am concerned with my child also getting herpes. My boyfriend is not aware of this possible condition. He told me that about 20 years ago, he had sex with a woman who told him afterwards she has herpes. He got tested a year later, and it came back negative. Is that result for certain. He has not had an outbreak. Do you think I should be re-tested? Is it possible that I do not have herpes, or is it pretty definite?
I would appreciate if you have the time to answer my questions and concerns. I have obsessed with this for a while now (on and off), and I have done lots of research on the internet, but I am not sure what is true and what isn’t. I want to tell my boyfriend about this, and I know I should have (but I feared that no guy would want me), and I realize that this is not fair to him. I need some advice about this.
Thank You.
Respectfully.
Hi,
your description of the skin sores is a bit atypical for a herpes lesion and it is unfortunate that your Doctor did not perform a Herpes culture or a PCR at the time of your visit.
Your Herpes antibodies tests allow us to say only, and I want to underline ‘”only”, that you have had exposure to Herpes type 1 virus. One cannot make time related assessment by the index of the antibody test. One can only say that the type 1 exposure has probably occurred two weeks or earlier not because if the antibodies index level but because it is known that seropositivity for IgG requires at least a couple of weeks and most usually 2-4-months.
You have not ruled out Herpes type 2 exposure yet since the test was done only few days after the contact. and IgG ( Immunoglobulin G) start appearing 2 weeks to 4 months after exposure. A blood test for IgM followed later on with an IgG would have been more appropriate IgM antibodies may show up few days after exposure but are not specific and may also show some cross reactivity with other herpes viruses. So the final answer for type 2 would be: retest 16 weeks after exposure.
Now it is possible that the sores were due to Herpes type 1? May be. Type one serology follows a similar behavior to that of type 2 herpes. Check with your partner about history of fever blisters or ask him to do an antibody test also. HSV1 is a very common and benign infection occurring to 75-80% of the population and it is appearing every more often in the genitalia, a situation where it assumes a different social acceptance meaning.
In conclusion your diagnosis rests, in my opinion, exclusively on the visual inspection of your Doctor, a situation diagnostically weak. I do have some doubts on the correctness of the diagnosis and I base this on your description of what happened during the sexual contact, of the type of sores and on the response to Valtrex.
I hope this is of some help to you.
Dr. Gian