New or Old HSV1 infection

Hi,

Thanks for getting back to me. Re the pcr, that was for hiv hep b and c sorry not for herpes. The doc said as i wasnt displaying any herpes sores they couldnt do any swab tests. The only confirmation ive had was the igg blood test at 4 weeks which was positive. The doc confirmed the uti from swab test at 2 weeks and its still present at 5 weeks after antibiotics. Just unsure if ive not had any visible sores on my genitals whether this could be a primary hsv1 genital outbreak, or whether its likely an oral hsv1 from years ago ive not known about. Confused

How did he confirm uti? Nearly always done by urine culture, not swab. If he tested for it properly, he should be able to tell you the bacteria and prescribe the most appropriate antibiotics. I have had bacterial utis a few times before, and that's what is always done, so I'm not sure what your doc did.

Herpes can cause urethritis, which mimics a uti, but without the more frequent urination, so only the burning, which is caused by acidic urine passing over the lesions *inside* the urethra. Antibiotics won't help, obviously. Five weeks is rather long for herpes, however. Did you rule out gonorrhea and chlamydia?

Hi

When I went the clinic the first time they took water blood and urine, so I guess it could have been on the water or swab but i guessed at swab. Also, i should say they called it 'nsu' for non specific urethera infection, they said it was bacteria but definitaly not chlymidia or gono. That was at 12 days and also at 4 weeks when they run the same tests. The clinic have confirmed there is a bacteria infection there the two times Ive been from either the water or swab theyve taken not sure which. The uti or 'nsu' isnt my main concern at the moment though, im more worried about whether the recent igg positive could be from a recent hsv genital infection. Would you say most people with primary hsv1 infection at genitals would be aware they had caught something?

If this is the first HSV infection you've ever had, yes, you would usually expect and notice the typical presentation of herpes with the first outbreak, which includes lesions.

I am only focused on your uti, because that is a common misdiagnosis when it comes to herpes. But if your doc has confirmed it's bacterial, then I guess it's not due to internal lesions. I would ask for a copy of your lab tests, if I were you, just to know exactly what they tested for and what were the results.

Fyi, NSU can be caused by chlamydia, trich or herpes, etc.

Hi Felis,

Thank you again for your feedback. I will certainly speak to the Dr at the clinic again and ask them to clarify my results. My blood results from the igg test confirmed my HSV1 positive status but my concern was it was contracted recently. But in the absence of any obvious genital based symptoms i'll have to hope it was a pre-existing infection.

Well, "UTI" can be a symptom of herpes and indicative of internal lesions, like I said (and sometimes it is the main symptom, like with me and some others), which is why I think it's good to better understand your doc's diagnosis of UTI, what tests were actually done, and what was found, etc. Once you have that info, you can update here! Also, regarding your IgG at 4 weeks, what was your count value (number)?

Hi

Not sure what the igg results were specifically, just that it was hsv1 positive. Does the result for igg raise significantly for a recent infection do you happen to know? I thought the igm negative at 3 weeks might have indicated a non recent infection but unsure. Still having symptoms of uti such as inflamed urethera on back of penis. How long did your uti's usually take to clear Felis?

If it is an older HSV infection, the number would be relatively high. If very new, then low, but it probably goes from low to high in 3-4 months, so not too useful, depending on when you tested in relation to when you were infected.

Maybe you can test again in a month or two to reconfirm your result and see if there's much change. Good to get a copy of your lab results for your reference, too.

My UTIs can be very severe (which is why I thought it weird and suspicious that my HSV "UTI" was comparatively mild), so not useful for you to compare with. I would probably bleed to death if my UTIs didn't resolve by two weeks, lol! No joke. Much worse than HSV, but fortunately temporary, curable and not considered an STD...

The correct antibiotics should normally start to work on an uncomplicated UTI (even my severe ones) within 1-2 days.

I will speak to the clinic tomorrow and ask what my igg results were specifically, what would you consider to be a relatively low or relatively high result to be? My igm at 3 weeks was less than 5.0 so they said that was negative, but my igg at 4 weeks they didnt give me number just said positive so will double check, will be re-assuring if it is higher if that possibly means older infection.

Re the uti clearing aftee 1-2 days, this is another of my concerns. I am currently taking my third set of antibiotics to clear the nsu and as of today 3 days into 3rd course it still doesnt feel any different, still sore throat still mild discomfort when urinating some anal itching (sorry i know that sounds gross). They've given me three types of ab's, doxycycline was first course, then azithromycn 2nd course, not im on azithromycin along with metronizadole for a week. Just want to clear the nsu infection so i can calm my anxiety down

IgM is useless for HSV, btw, since it can test pos for both a new infection and a recurrence and isn't type-specific.

Looks like your doc is treating you with and for everything, which makes me wonder even more if he knows the cause of your UTI! I'd definitely want to know how and what they tested you for, if I were you. I always make it a habit of asking for my lab results regardless, but that's just me, lol.

The first ab you were prescribed seems to cover gonorrhea, chlamydia and other bactetia, the second chlamydia and other bacteria, and the third is usually for trich. Most simple UTIs (in women, at least) are caused by e. coli, so amoxicillin normally works. Might be different for men (not sure how common e. coli is the culprit).

All I know in my case is that a urine culture will not only identify the bacteria, but also the ab it is sensitive to, which makes it easy for the doc to prescribe the correct ab.

Thank you agaim Felis, youve been most helpful. Would you happen to know, if it was a new HSV1 infection, if id contracted HSV2 at all at 4 weeks would you be expecting igg to also show positive for both HSV1 and 2? Just wondering if I need to continue testing at 6, 8 weeks for HSV2 through igg? Cheers

Both HSV types have the same test window, which is 3-4 months from exposure (recommended). 6-12 weeks may catch a fair number of those infected, but will miss some. 4 weeks may miss many, but catch some. Each person produces HSV antibodies at a different rate, hence the variation.

I would not test so frequently as you mentioned. Try to relax, get your various lab results if poss, sort out the UTI/NSU, and re-test at 3-4 months from the last exposure. If you want reassurance in between, maybe re-test at 8 weeks, but not 6 as well. IgG only.

Regarding NSU, I have read that a cause may not always be identified and that it can take up to 3 weeks to resolve, even with the correct ab! Quite different to a UTI (and not considered the same), but still good to see your results to see if they identified a specific cause or not. Fyi, a neg urine culture indicates NSU.

The first two ab you were prescribed are the norm for NSU, and UTI in some cases (*both* ab actually cover gono and chlam, btw, plus more). Didn't one ab clear it up, before it returned? Which was that? Wonder if you just needed to stay on it longer?

Anyway, avoid sex until recovered, especially with the person you suspect, since NSU can pass back and forth, depending on the cause. Interested to know your lab results, if you get them. Hope it clears up soon!

Hi Felis,

Still waiting on my lab updates so will post once received. In the meantime was wondering if I could update you with some more symptoms in having and wondered whether you think it sounds more like the NSU or if it could be the hsv1 genital I was worried about? So last Sunday would be 5 weeks since possible exposure. Still not had any obvious outbreaks on genitals in this time. However yesterday and today had really bad naseua and fatigue, I put this down to combination of strong antibiotics course I am just finishing today. Anyway, not had any pain in genitals only very mild sting when first urine comes out, but this evening ive had an intense burning on back of penis, not like a tingling more like a burn. Checked area an its not red and no inflammation obvious. I guess what im asking is, at 5 weeks post exposure with Herpes, would you be expectint a possible recurrence of flu symptoms similar to when first infected, followed by burning sensation on back of penis but no lesions or blisters? Back at clinic tomorrow for more tests for NSU

Nearly anything is possible with herpes! However, what you described with the recurring flu-like symptoms is not typical, nor is the fact that the NSU has persisted for this long. If I had to say, I would guess that your HSV-1 is old, probably oral, and that all your genital symptoms are from the NSU.

NSUs are strange, surprisingly not like a UTI at all, the cause is not always known (only in half of all cases), and as in your case, they can be persistent and difficult to treat. Since read a couple of things, so I'm now convinced that's all you have. I suspect your doctor did not find a cause, and only ruled certain things out (you'll be able to see from your results), which would explain the trial and error approach to your ab meds.

Either way, do follow up when you have an update or new info, and look after yourself! Must be frustrating to be unable to rid yourself of the NSU after so many weeks and different meds, but that isn't uncommon, so hang in there.

Hi Felis,

Thank you so much for your previous reply, really cheered me up when reading it. Been waiting for some updates on my diagnosis before replying and had some today. So got my igg results confirmed, 2.99. I asked the doc his opinion on whether that would mean a new or old infection, he suggested that as the igm I had done at 3 weeks coupled with the igg score he believed the infection to be old. Have you any thoughts on 2.99 being old or new?

Also, bettee news about my NSU, been the clinic today and tests confirmed thats cleared so no more antibiotics

The doctor recommended testing igg again at 6 weeks for hsv2 if i'm still anxious about it so will book on this week as its the sixth week, still not had any outbreaks or blisters downstairs but noticed what looks like coldsores on my bottom lip today, which i've never had before so dont know what to make of thar really.

Anyway, hope you are well I look forward to your reply as always

Hi James, good to hear from you!

That's great news about the NSU!! So, no more burning or soreness? Who knew NSUs could be such a pain (literally) to get rid of? I had to read up on that, so you helped teach me something new.

Anyway, that must be such a huge relief, because almost 6 weeks is long! Taking ab meds all the time sucks, too. And I think now you can pretty much relax about herpes, so an extra bonus.

Your IgG test value is mid-range, I would say. Not very high, but not so low (but more low than high). Each person produces and maintains their own level of IgG antibodies, so it's hard to compare, and the numbers can fall off somewhat after many years. With no previous IgG test as a benchmark, it's hard to say much, other than it's probably an old infection, like I thought and what your doc thinks.

The bumps you have now, if cold sores, could have been brought on by the stress, NSU and ab meds. Just remember, canker sores (in case your bumps are on the inside of your lip) are not herpes. Good to re-test for HSV-2, too, btw, since peace of mind is important. 6 weeks is doable as an early heads-up, but for a conclusive result, re-test at 3-4 months. I'm sure you'll test neg again.

Yay, again, about the NSU!!

Hi Felis,

Thank you kindly for your previous reply, you always speak so much sense. Unfortunately since my last post my anxiety has gone back through the roof for a few reasons. Was wondering if you can offer any advice on the following please? Any feedback would be grateful.

So, this week like I said in previous post, i developed some pretty small coldsore looking bumps on my lip on Wednesday. Then Thursday and Friday I then developed what look like ulcers on my tongue, several of them. I was at the doctors getting igg test done yday and he said looked like a standard simplex outbreak in my mouth.

Then last night i started to feel a tingling sensation in my penis and what felt like a burning sensation but in my legs from knees downwards. Today, i have noticed what looks like a single pimple looking spot in my pubic area, not on the penis. The tingling is still there but less prominent. I know by now that all of these can be thought of as symptoms of genital herpes.

I was just wondering what your thoughts are regarding the timing of this? If i'd caught herpes 6 weeks ago genitally, would it be plausible that in that time I could have spread it from genitals to oral, an had a primary outbreak orally this week and am now experiencing my first minor genital outbreak? To be honest if I wasnt looking for it (the pimple on genital) i wouldnt have noticed it, so dont know whether it is something or nothing. The tingling is definately real but dont know whether that is the nsu still clearing. What I do know is I cant rememer having mouth sores on my tongue similar to what I have this week. Just so confused and worried that I caught genital hsv1, spread it to my mouth and now am having first outbreak.

Look forward to hearing from you

Oh no about the oral outbreak! I don't suppose there's any point in getting it swabbed, if your doc thinks it looks like oral herpes.

Regarding your question, if you felt you had contracted it genitally then passed it to your mouth, that would mean a primary genital infection, which you would expect to have obvious symptoms (including lesions, which would normally be *on* your penis for a first outbreak) in 2-12 days, up to possibly 20, but you did not. The only problem you had was apparently confirmed to be an NSU.

If you had contracted primary oral herpes only 6 weeks ago, you would also expect the same orally. But then you don't recall having ever had something like this orally, so it's a strange one. Perhaps being run down with the NSU caused a recurrence orally and you somehow missed the first outbreak because it was mild?

The tingling could still be from the NSU, since you had that before, although I wouldn't expect it in your legs. Also, genital herpes usually causes tingling before recurrences rather than before the first outbreak. Based on this and the above, I would not assume anything genital at this point.

Btw, autoinoculation, though possible, is not super common and more likely with a lesion.

I hope your oral outbreak isn't too painful and clears soon. You've been through a lot, what with the persistent NSU as well!

Thank you for replying Felis,

Im just hoping that the single red spot is something simple like an ingrown hair or just a spot, there wasnt a previous blister or lesion in that area in the previous 6 weeks but dont know if that matters at all.

I read somewhere that a reccurent outbreak would usually take 3 months at least? This would be 4 weeks from first symptoms for NSU and 6 weeks from exposure so am praying it would be too soon for a recurrent outbreak.

All of this is really getting me down its all I can think of. Im worried about passing genital hsv1 on to future partners, if thats what this is. What are your thoughts on how easy it is to pass this on to a partner? I heard that if theyve had coldsores before it is much more difficult to pass genital hsv1 on? Do you know if thats correct?

Understandable! I've been there, too, except I definitely have it and the nasty type to boot.

If they have had cold sores before, they should be immune, but exceptions exist. Type 1 genital herpes recurs and sheds much less for most people, so is not nearly as infectious as Type 2, especially once it's established. Male to female transmission is less than 10% per year (not per sex act) if only outbreaks/prodromes are avoided. With condoms as well, less than 5%. Daily antiviral meds are not usually necessary for Type 1, but if that as well as the rest, then less than 2-3%. This assumes a discordant couple that's established, monogamous and hetero, with full disclosure.

Recurrences can occur at any time. I have not read that there is a grace period before the first one and have read examples where a recurrence occurred before 3 months. I think I had a very mild recurrence at around 2 months myself! But don't jump the gun. Without anything definitive, it's probably safe to assume it's only oral and that you missed the first (presumably mild) outbreak.

P.S. I have made a website if you're interested. Search for "Gen H Central". I cover everything that I've read so far from various legit sources. Meticulously researched the lot! Just a couple of sections still to do.

Hi Felis,

Wow, your site is really good. Very informative. I can see you've spent a lot of time gathering the info on there, i could really relate to the parts about questions questions and more questions, thats certainly been my predicament of late.

How are you feeling since your last outbreak? Was the second one much milder than the first? Are you expecting the ob's to drop off significantly after the first few?

Thanks, James! That has been my little project these past 3 weeks. Figured I may as well share all of the info I found out for myself! Many sites only mention some things, but there's lots of other useful info hidden in different sites, studies and expert forums, etc., so I dug around and tried to consolidate the lot. Btw, there is a section on sexual transmission that may interest you, given your questions the other day. Not sure if you saw that or not.

I have Type 2, unfortunately, so it may well recur often. I have already had two possible recurrences (recovering from the second as I type), but luckily they have been very mild (just a single lesion/bump, barely sore/noticeable, no other symptoms), so I at least hope they remain that way! In fact, they were so mild, I wasn't even sure that they were recurrences, lol. The first I think I may have triggered by partying late, and the second may be due to an allergy flare-up, so let's see.

Thats good glad to hear that your second ob could potentially have not been an ob, if you get me. Hopefully it was a mild one and each one (if any more) they get even milder each time. Its worrying at first reading some posts about herpes from different sites, people get really upset, myself included, but when you think of how little physical effect it could have in a few years time then theres much worse things to be diagnosed with I guess 😊

Thanks. Yeah, I'm hoping they stay mild and hopefully not to frequent, mainly because I don't want to be infectious so often. My biggest concern at the mo is not knowing for sure what's a recurrence or prodromal sign, and it seems like I'm not the only one! Every itch, bump is now suspect, lol. How's your oral outbreak, etc.? Is it getting better, worse, the same?

I can definately relate to that, i'm currently fixated on aching pains in my groin area which i'm convinced must be coming from my lymph nodes. Was at the clinic yday and the Dr said Lymph nodes arent raised and pimple I suspected at the weekend is an ingrown hair folicle. Still, the aching pain in pubic area is causing me anxiety.

Had 6 week igg results back yday also, still HSV1 pos HSV2 neg so i'm trying to (unsuccessfully) convince myself it will stay that way. Ive read varying reports for igg accuracy at 6 weeks, from between 70 to 80% in some material. I probably wont be convinced until its 16 weeks or so. I should really see someone about my anxiety too its bordering on paranoia now 😢.

How is the symptoms for the second ob coming along? Have they completely cleared now? How long did they last in total?

Oral ob has mostly cleared btw thanks, still some small blister type things on my tongue but lips totally clear ☺

Good news about the negative HSV-2 test!! I am sure it will stay that way, but re-test for reassurance at 3-4 months, and until then, only concern yourself with what you know you have (and probably only have), otherwise that's too stressful! Glad your oral outbreak is already clearing, too. That was pretty quick! How small/big are the ones on your tongue? Do they look different to swollen taste buds? Just curious, as I wasn't aware of herpes on the tongue!

My bump is still just the one, no other symptoms, plus I think it's also going away. Seems to have been "unroofed", so i think this was definitely a recurrence in that case (looks just like a lesion from my first outbreak now). Barely notice it, though, not even when I wipe anymore. A super mild one indeed!

Hi Felis,

Yeah the outbreak on lip only lasted about 2 days. The blisters on the tongue lasted about 7/8 days, however the doctor who seen them at the clinic on Monday didnt think it looked like oral herpes, more like a fungel infection, which is contradictory to what the doctor that seen it at its worst last week said. Again, confusing information i'm getting. Not really had swollen taste buds before so not sure how to compare it haha.

How is the website coming along? Bet you're a little relieved now you've had your first recurrence and it was super mild, maybe next one will be even milder.

I'm just trying to not focus on my genital symtpoms at the moment, anxiety is getting the better of me and I need to relax so im not completely stressed over christmas 😕

Ha, so it may not be an oral herpes outbreak after all? If I had to guess, I'd say it's not, too, only because it doesn't "fit" (e.g., it would mean you missed your first outbreak and this "recurrence" is worse). Of course, exceptions exist, but nevertheless... Your other doc seemed so sure, so I just assumed it must be a clear case of oral herpes!

Website is good, thanks! Added a couple new sections and now working on the history of herpes, plus FAQs. Despite the topic of the site, it strangely keeps me distracted, lol. Speaking of which, don't let any of this worry you over the holidays. I do think you're in the clear genitally, so just oral, which appears to be mild, assuming what you have now is fungal. So, relax, enjoy and best wishes for the holidays!! :D

Ha, so it may not be an oral herpes outbreak after all? If I had to guess, I'd say it's not, too, only because it doesn't "fit" (e.g., it would mean you missed your first outbreak and this "recurrence" is worse). Of course, exceptions exist, but nevertheless... Your other doc seemed so sure, so I just assumed it must be a clear case of oral herpes!

Website is good, thanks! Added a couple new sections and now working on the history of herpes, plus FAQs. Despite the topic of the site, it strangely keeps me distracted, lol. Speaking of which, don't let any of this worry you over the holidays. I do think you're in the clear genitally, so just oral, which appears to be mild, assuming what you have now is fungal. So, relax, enjoy and best wishes for the holidays!! :D

Hi Felis,

Long time no speak, hope youre well. Had some bad news today was wondering what your thoughts are. So im 4 months past my original encounter that we spoke of which caused me the nsu. I had another small red blotch appear on my penis last week so thought id get a pcr swab done it, an also get an igg done at same time. Had 6, 8 an 10 weeks iggs done all neg type 2 positive type 1. Unfortunately the 16 week test i had done last week returned positive for both. Type 2 showing 1.48 h. The doctor suggested doing another test to be sue which ive been and had today. Just wondering what your thoughts are on false positives for low scores? Ive still not had any outbreaks or blisters besides the red blotch (pcr came back neg for that). Guess its a long shot its a false pos but living in hope i guess.

Also, from your own research, do you know if prior oral hsv1 infection has any effect on reducing the severity of a hsv2 genital infection?

Hello, and that's not such bad news! Low positives for Type 2 in the presence of existing Type 1 are definitely suspect if tested by HerpeSelect IgG. There's a strong chance yours is false, especially since only one test of several turned out that way, albeit your most recent one. Having oral Type 1 first does generally help lessen the symptoms of genital Type 2, but I doubt you have the latter. By four months, I'd expect a higher positive in the case of new infection.

Hi Felis

Thanks for your reply. What would you think should happen next? I had another test done yday, which is only 5 days since the test which returned pos for type 2. Do you think this is sufficient time for the result to change back to 0.9

how have you been coping since we last spoke? any further ob's? i="" hope="" you're="" right,="" im="" besides="" myself="" with="" worry="" struggling="" to="" cope.="" in="" light="" of="" my="" neg="" igm="" at="" 3="" weeks,="" neg="" igg="" upto="" 10="" weeks="" and="" no="" outbreaks="" of="" any="" note="" im="" hoping="" it="" is="" false="" pos="" but="" cant="" understand="" how="" it="" would="" happen.="" how="" have="" you="" been="" coping="" since="" we="" last="" spoke?="" any="" further=""?>

There are two follow-up options you can take (besides doing nothing). One, you can retest for IgG at 6 months. Two, you can do the much more expensive Western blot via the University of Washington for the most definitive results either now or a bit later.

I have had a recurrence or two since, but very mild (good, all things considered), and retested to confirm my own IgG after several months and my score was practically off the charts! (Not so good, imo, but then my symptoms have been mild to date and I didn't have a recurrence despite a very late night out of drinking, so I'm not sure what to make of that!)

Hi Felis

Thanks again for your reply. Im based in the UK so not sure whether the western blot test is available here? I had an IgG done yesterday but like I said, it was only 5 days from my previous IgG so not sure if it will be any different. Will await the IgG result tomorrow and guess ill have to just accept that result as correct.

When you say your score was off the charts, what was your reading? Is there any link to how high your score is to how severe your symptoms are?

You previously told me about your UTI issues, do you know if it is common for herpes 2 infection to cause a UTI or NSU or are they caused by separate bacteria?

Thanks for your comments again Felis always very helpful and re-assuring

Thanks, James.

The UoW western blot can be arranged from the UK, but it wouldn't be cheap! No point retesting for IgG so soon. Not much would have changed in five days, even if you have it. Better to retest in 1-2 months. If no real change, then you're likely negative, just with a borderline result, probably due to your existing Type 1.

Herpes can cause urethrits, so the same virus, but usually only with the first outbreak. UTIs are typically bacterial. NSUs can be any other cause, excluding gonorrhea. I have not had urethritis since my initial outbreak, touch wood.

My test was different, so the numbers won't make sense, but they were very high. Some experts link that to more recurrences and greater severity, others do not and say it has no bearing, so that's rather confusing! Even worse, there are no studies that look at that. Guess I just have to go by my symptoms, which have been fortunately mild so far. Maybe there is no link after all? Hate that I can't find the answer, though! Lol

Good to hear that your symptoms have been mild so far, are you expecting them to become less frequent and less painful also? Hopefully thats the case, in time you may even wonder what the initial worry was all about? I'm hoping thats the case with me at least.

My main concern now is spreading it to furure partners, and how severe they may get it (if at all). From what ive read, upto 90% of people dont even know they have type 2? Wonder if thats with or without the presence of previous type 1 like i have. I doubt id of known id gotten it without the nsu infection causing me great anxiety. Probably would never have gotten tested for herpes.

Hows the website coming along Felis? You still gathering info?

Wow! Just got my IgG from yday, negative for type 2! Less than 0.5 which is what it was on the other 3 tests! Now i'm confused as to which one is likely to be accurate? Do you think the positive one was just a false positive and the other 4 are likely to be the true result? Bit of a whirlwind of emotion here dont know whether to be happy, relieved or what!

Woo-hoo, and I'd go with negative. I don't believe you ever had Type 2 anyway! If you are still concerned, retest in two months. If no real change, you can relax and stop testing!

Thanks Felis