Chafing or Herpes

[JJ601]

Dr,
Nearly four months ago I had unprotected sex with a woman multiple times. A close mutual friend later claimed that the woman has gential herpes. This is just a rumor however and I had not asked the woman herslf. I tested negative at 9 and a half weeks past exposure and again at thirteen and a half weeks past exposure for type 2 herpes (I have type 1 and I dont know how long I've had it). The test was a type specific igg through labcorp. Around the time of my second test I developed a rash on my upper inner thigh. Reason tells me this was just chafing because I noticed it after a four mile run and not before. I also noticed irritation from my boxers (I usually run in something a little tighter) during the run. The rash was red, maybe an inch and a half diameter and very painful with a burning sensation the first day but there was minimal pain the second day. On the third day the rash was essentially gone. The difference between this rash and other likely chafing rashes I have had was that it healed in a blotchy manner (i.e. turned into spots that gradually decreased). The skin was never raised and there were never any blisters. Another difference was I have never noticed chafing in the upper thigh area during many years of running. Anyway, since the rash healed I haven't ran in that particlar boxer/running shorts combination and have had no more rash. Had I not developed so much anxiety about herpes I probably wouldnt have thought twice about the rash but I am having difficultly getting over it. Furthermore, it has now been 16 and half weeks past exposure and I was wondering if taking another test will grant me any more certainty. The non profit testing company I used that tested through labcorp was adament that my first test (9.5 weeks) was sufficient.

[H. Hunter Handsfield, M.D.]

Your rash doesn't sound like herpes, both because of the description itself and the location.  The first episode of genital herpes in men almost always involves the penis itself; the chafing appearance would be very atypical for herpes; and herpes cannot heal in only 3 days -- 10-14 days is the minimum.  Further, the blood test results are highly reliable.  Although it can take 3 months to develop a positive blood test, around 90% of newly infected people would have a positive result by 9.5 weeks.  Taking all factors together -- i.e., the negative test result and the nature and location of the rash --  comes to strong proof you weren't infected.

I hope this helps.  Best wishes--  HHH, MD

[JMilkman]

I'm not so much concerned that I have been infected; I really wanted to know the likelihood of a false positive for my partner and how great the risk is of becoming infected if she never shows any signs whatsoever of an outbreak.  I don't know exactly what the numbers in the HSV test refer to and I'm troubled by her doctor's statement that she "has a few antibodies to HSV 1."  I know that below .92 is negative, but .92 what?  What do the numbers mean exactly.  Thanks for your help.

[H. Hunter Handsfield, M.D.]

Type specific HSV tests often use a technology called enzyme linked immunosorbent assay, or ELISA (or sometimes just called enzyme immunoassay, or EIA).  The outcomes often are expressed as an ELISA (or EIA) ratio, i.e. the strength of the reaction in the patient's specimen devided by the strength in a negative control specimen.  In other words, it is not measuring an actual antibody level, just the strength of a chemical reaction.  For the most commonly used type specific HSV-1 and HSV-2 ELISA tests, ratios below 0.9 are negative, 0.9 - 1.1 are officially considered equivocal.

You don't say what your partner's HSV-1 test result showed.  If it is positive, there is no chance she will acquire your presumed HSV-1 infection; she would be highly resistant to catching a new HSV-1 infection, anywhere on her body.  If her HSV-1 test is negative, then there is at least a theoretical chance you could infect her by kissing her or performing oral sex on her.  But even in that situation, most partner of infected people never catch it themsevles.

The interpretation of HSV blood tests has been discussed in great detail, and many many times, on this forum.  Use the search link if you need more information.

[JMilkman]

I'm sorry. I accidentally made my response to a reply in someone else's thread.  Thank you for your reply though; you've basically answered my question, but for clarification, I was concerned about contracting HSV 1 from my girlfriend and not the other way around.  Her doctor seems clueless about reading herpes blood work and I tried to get her to get a copy of the lab results, but she is so upset about the whole thing, she just wanted to let it go for now.  Eventually, I'd like to see the results because it's quite possible she was equivocal and may not be infected at all.

[H. Hunter Handsfield, M.D.]

I didn't notice the wrong username.  I'll just say the risk probably is just as low in either direction.  But I'll let Dr. Hook respond to your follow-up question in the correct thread.