In 2004, I had gential blisters (specifically on the head of my penis), accompanied with sever sore throat and swollen lyph nodes (both in the throat and groin area). Went to the doctor and he suspected "Chigger/Insect Bites". A few days later - no remission. Went back to the doctor and he ordered an HSV Igm Blood test. Results came back positive, but the "professionals" were unable to determine if it was type I or II.

When the doctor's nurse gave me the test results, I was under-informed and uneducated as to how HSV I and II work. She informed me that because of my symptoms, it could be surmised that it was type II. I was informed at the time that I should use precautions (condoms) with my fiance/later wife during period of outbreaks.

Since my intial O/B in 2004, I have yet to have another occurence in the gential area. However, from time to time (since my divorce in 2006), I get swollen glands (in the throat), sore gums and isolated instances of cold sores on the back of my lips. This cycle may appear for few weeks or may only be a few days. I do notice that it typically comes as at the onset of stress or fatigue. This has happened a total of approximately 6-7 times in the last 6 years. On another note: I have yet to "be" with another women following my divorce in 2006.

Q1: Considering my symptoms, is this typical of Type I?

Q2: I have read on this website and the CDC's that it is uncommon for Type II to have recurrences in the oral region, and the same theory applies for Type I in the gential region. Does this reinforce that what I have in my mouth is Type I?

Q3: I am most concerned because I have recently kissed a good friend. Not having an exact analysis of what is going on in my mouth, should I have informed her of my condition, prior to kissing her?

All of this has built a great deal of axiety and it would help to gain some practical insight.

Q1: Considering my symptoms, is this typical of Type I?

Herpes reacts differently in folks, of course, and it's hard to say what's the most likely cause of what you're experiencing.

Swollen glands are not the most typical symptom with herpes, and when they do occur with an outbreak it usually relates to a first episode (called a "true primary") in a person who has no previous immune response development to either HSV-1 or HSV-2...so this usually means someone who never had oral herpes/cold sores gets genital herpes and the first outbreak is relatively severe. Swollen glands, flu-like symptoms, etc. can all be part of that. Subsequent outbreaks are typically less severe, so having swollen glands way down the line is not typical. Have you talked with a health care provider recently about your symptoms and, if so, what did they tell you?

Q2: I have read on this website and the CDC's that it is uncommon for Type II to have recurrences in the oral region, and the same theory applies for Type I in the gential region. Does this reinforce that what I have in my mouth is Type I?

Hmm, well, HSV-1 is probably what you'll find in 80%-90% of oral herpes infections. I don't know beyond that.

Q3: I am most concerned because I have recently kissed a good friend. Not having an exact analysis of what is going on in my mouth, should I have informed her of my condition, prior to kissing her?

I don't think many experts would tell you to worry if you smooched someone without first discussing a history of cold sores, and it sounds as if in your case you don't have a definitive diagnosis of oral herpes anyway. Of course, during times of having symptoms don't kiss or perform oral sex.

If your only test was an IgM blood test, you might consider having a newer, type-specific blood test that looks for IgG antibodies. For more on this go to http://www.ashastd.org/pdfs/HerpesBloodTestGuide.pdf.

Hope this helps.

Best,
Fredo

_________________
ASHA Moderator

Thank you Fredo! This puts my mind at ease - I will discuss this with my doctor during my upcoming physical (I had my blood drawn today for the IgG test). I certainly appreciate your insight and consideration. I have been suffering great anxiety over this and your advice brings me peace of mind.
Best regards,
abitlessconerned.

FYI, in regards to Q2, here is an excerpt from an article entitled "GOOD VIRUS / BAD VIRUS" on Herpes.com website:

"A third factor influencing the frequency of HSV -1 and 2 outbreaks is whether the virus is established in its site of preference. While HSV can infect both genital and oral areas, both types cause milder infections when they are away from "home" territory. Outside their site of preference, both type 1 and 2 lose most of their punch.

For example, most people infected with HSV-1 in the genital area have few, if any, outbreaks after the initial episode, far fewer than is typical with either oral HSV-1 or genital HSV-2. While experts estimate that some 30% of genital herpes infections in the United States may be caused by HSV-1, only 2- 5% of recurring genital outbreaks are caused by HSV-1. Research conducted by Lawrence Corey, MD, and colleagues at the University of Washington in Seattle shows that genital HSV-2 recurs 10 times more often than genital HSV-1.

According to a study by Wald et al. (New England Journal of Medicine, 1995), among 110 women with genital herpes, the average number of recurrences per year for those with genital HSV-1 was zero. Other studies have shown an average of about one outbreak per year (Benedetti, Annals of Internal Medicine, 1994).

Similarly, HSV-2 infection in theoral area-outside its site of preference-very rarely causes problems. First of all, oral, HSV-2 infections are rare, for reasons discussed below. But even when an infection occurs, recurrent outbreaks are uncommon. In one study (Lafferty et al., New England Journal of Medicine, 1987), oral HSV-2 recurred an average of 0.01 times a year in newly infected people. "I've never convincingly seen an oral type 2 recurrence," says Spruance.

A possible fourth factor affecting recurrence rate is viral type. According to the Lafferty study, genital HSV-2 infections were the most frequently recurring herpes infections, followed by oral HSV-1, genital HSV-1, and last of all, oral HSV-2."

At this point you certainly need to pursue more accurate herpes igg blood testing. I can help you with your blood test results when you get them from the test it appears you had done this week. Even if you do test + for hsv1, which odds are you will, that doesn't mean that your repeated oral symptoms you described are due to oral herpes. They could be due to many things and typically oral herpes recurrences don't present with those symptoms. I'd certainly suspect other causes of your oral symptoms and would start keeping a diary when you have them. Include any other illnesses, all foods you've eaten ( including chewing gum ), what toothpastes you are using/mouth washes and also what you've been drinking in general. That's the best way to rule out triggers for canker sores, allergic reactions and other illnesses. It's a lot of work but helpful for follow up with providers.


You could've contracted hsv1 genitally and orally but without a recurrence of genital symptoms to culture, no way to confirm that at this point. You didn't mention rashes on other body parts with your original genital symptoms but honestly the odds of you having insect bites just in the genital area and not anywhere else is incredibly low.

I'd also make a dermatology appointment to start a work up about your oral symptoms too regardless of your herpes igg blood test results.

betsy

_________________
ASHA Moderator

Thank you for the advice, Betsy. I will get back with you following the result of my IgG test. Best regards, abitconcerned.

Got my test results back today - However, I will not be able to consult with the doctor until next week. I am hoping that you will be able to assist me with the lab results (the lab folks refused to discuss this with me). I will excerpt what appears to be the results (written verbatim from the sheets).

M1: Herpes Simples IgG I&II result: SEE BELOW
HSV Type 1/2 Combined Ab, IgG 16.90 H <=0.89 IV
REFERENCE INTERVAL: HSV Type 1/2 Combined Ab SCREEN, IgG
0.89 IV or less.......................Negative-No significant level
of detectable HSV IgG antibody.
0.90-1.09 IV.........................Equivocal-Questionable presence
of IgG antibodies. Repeat testing in 10-14 days may
be helpful.
1.10 IV or greater..................Positive-IgG antibody to HSV detected which may indicate
a current or past HSV infection

M2: Herpes Simplex IgM I&II result: SEE BELOW
HSV Type 1/2 Combined Ab, SEE BELOW
0.45 IV
REFERENCE INTERVAL: HSV Type 1/2 Combined Ab SCREEN, Igm
0.89 IV or less.......................Negative-No significant level
of detectable HSV IgM antibody.
0.90-1.09 IV.........................Equivocal-Questionable presence
of IgM antibodies. Repeat testing in 10-14 days may
be helpful.
1.10 IV or greater..................Positive-IgM antibody to HSV detected which may indicate
a current or recent infection. However, low levels of IgM
antibodies may occasionally persist for more thatn 12
months post-infection.

I am not sure, but when comparing the two charts, it appears on the IgG test that there should be another row started after the "HSV Type 1/2 Combined Ab, IgG 16.90 H" and followed by the comment "SEE BELOW" as it was done on the IgM test. This would make the next line "<=0.89 IV", indicating a negative test. Am I high, here? Does the 16.90 have some level of signficance that I am unable to discern? Or are my results negative?

Any feedback would be greatly appreciated. Regards, abitconcerned.

this was combined herpes testing which was of no use. you need type specific testing done.

betsy

_________________
ASHA Moderator

Thank you Betsy. I specifically told this to the person whom was drawing my blood and was coding the test. She indicated that she was "sure" this was the correct test.......Augggggh! I will get back with you when I have the correct test completed. Thank you for your consideration. Regards, abitaggravated.

have your provider call to see if they still have the blood to run the type specific testing for you. I'd also ask them to credit you for this test since it wasn't the correct test.

betsy

_________________
ASHA Moderator

I called the facility that drew my blood work - she recalled the confusion during the coding last week and recommended that I get another test done. When I was called back to have my blood drawn for the second time this morning (but prior to drawing my blood), I asked the nurse if these tests were going to be for individual HSV Type I IgG type-specific and HSV Type II, IgG type-specific test and she could not anwer. I immediately requested to speak to a supervisor to confirm which test was going to take place - THEY WERE GOING TO PERFORM THE EXACT SAME TEST THAT WAS CONDUCTED LAST WEEK!!!!!! After some thorough conversation, the supervisor reviewed her labatory codebook and found where the two test were listed separately, not combined. She assured me that this was going to coded correctly now.

I certainly hope that I requested the correct test (there was another type-specific test which combined the HSV/I and HSV/II. If you shed some light on the correct test(s) required, I would greatly appreciate it. Best regards, abitconcerned.

Ok Besty, if your invitation to analyze my test results is still open, I appreciate your input on the following:

Test #1:
Herpes Type I IgG Specific result: SEE BELOW
HSV 1 Glycoprotein G Ab, IgG 5.78 IV
Interpretation: HSV 1 Glycoprotein G Ab, IgG

Test #2:
Herpes Type II IgG Specific result: SEE BELOW
HSV 2 Glycoprotein G Antib SEE BELOW
0.08 IV
Interpretation: HSV 2 Glycoprotein G Ab, IgG

My doctor declared me free of HSV II. However, he did not understand how I tested positive for the previously posted (combined) Igm test results. He basically told me that I knew more about these tests than he did at this point.

Q1. Do you concur that I can rest easy about the HSV II being negative and that I am only positive for HSV 1?

Q2. If you agree with Q1, it can be surmised that my initial case of HSV in the genital area was indeed type 1. Do I need to be concerned about spreading HSV 1 to a potential mate from genital-to-genital contact during intercourse? What if I were to receive oral sex? Is this something that I need to discuss with a potential mate?

As always, your insight and input is much appreciated.

Best regards,
abitconcerned

Q1. Do you concur that I can rest easy about the HSV II being negative and that I am only positive for HSV 1?

yes! glad you finally got the right test done!

Q2. If you agree with Q1, it can be surmised that my initial case of HSV in the genital area was indeed type 1. Do I need to be concerned about spreading HSV 1 to a potential mate from genital-to-genital contact during intercourse? What if I were to receive oral sex? Is this something that I need to discuss with a potential mate?

It's unfortunate that a lesion culture of your symptoms wasn't done initially. It would've given you confirmation that what went on was indeed genital herpes. A visual diagnosis is wrong 1/3 of the time which is why lesion cultures are so helpful. At this point when discussing this with a potential partner, definitely talk about being hsv1+ but best you can do is say you don't know if it's oral, genital or both. Your partner will also need to know their status since you can still contract hsv2 genitally and you can't make educated decisions about what precautions to take unless you know who has what. Should you ever get a recurrence of your genital symptoms you can get them cultured to confirm genital herpes. With hsv1 genitally though recurrences are few and far between so confirming this isn't something you are likely to be able to do quickly. I know it's really grey but best you can do at this point. odds are from the sounds of things you do have hsv1 orally and genitally both with the symptoms you had originally but you'd need cultures to confirm for sure.

betsy

_________________
ASHA Moderator

the herpes igm test has a high false positive rate and most of them aren't type specific either so we don't recommend them being done. you can purchase the herpes testing toolkit from asha for under $3 in their online bookstore to give to your provider as an early christmas present to better educate them on herpes testing

you can transmit your hsv1 to a partner either orally or genitally but the risk of your genital hsv1 being transmitted to a partner overall is low. hsv1 orally sheds more and is more of an issue transmissionwise than your genital hsv1 would be. Knowing a partner's status helps you to decide if any precautions are necessary or not.

betsy

_________________
ASHA Moderator