STD Question - Primary or Secondary Genital Herpes

DO I HAVE PRIMARY OR SECONDARY GENITAL HERPES?

I have recently been diagnosed with genital herpes. I had a PCR and EIA serology test done a week after the believed exposure and symtoms started. The PCR was +ve for HSV2 and the serology was +ve for HSV1 IgG and -ve for IgG HSV2 and -ve for both IgM. Due to the consistent denial by the other person that they have never had genital herpes (it is very likely they haven't even been tested I must note) I went and had a western blot test to know for sure if it is an old or recent infection. This test was done 4 weeks after initial symptoms. It has come back IgG +ve, IgM was not tested for. I have already had 2 recurrent outbreaks with less than 2 weeks between the end of one and the beginning of the next. Could my IgG be the response to such frequent and acute activity or is it conclusive of a past infection. I must note that I had not been with anyone for about 18 months prior to this contact and symptoms only came about after the 2nd contact
Elizabeth, 32 years, London.

REPLY

Elizabeth,
It is very difficult to be accurate about whether a genital herpes infection is primary or a reactivation of a previous undiagnosed infection(secondary). But the main guidelines are:

Primary infection: IgM positive and IgG negative at the time of the first symptoms.
First episode by Reactivation of old infection: IgG positive for one of the two viruses(HSV1or2) with IgM antibody to the other.
Previous infection: IgG positive for the virus and IGM negative.

Since your IgM was negative 1 week after the first symptoms, I believe that your infection is a reactivation of a past infection. The IgM level may rise even after a flareup of a past infection but not to the extent of a primary infection.
I hope this helps. Please feel free to ask a follow-up question if you need more information.

FOLLOW-UP

If the symptoms started as flu like symptoms after the first contact another 2 weeks before (one medical professional thought this to be the case) would this have any bearing on my IgM and/or IgG levels during the first test that would have been then taken 3 weeks after initail infection?

REPLY

IgM levels start rising within 4 -6 days of the intitial exposure, peak at around 3 -4 weeks and then decrease steadily to become undetectable at around 4 - 6 months.
IgG levels on the other hand will be negative the first weeks after exposure and then gradually becomes detectable to reach an easily detectable level at 12 weeks. This time frame may vary from person to person depending on his or her immune system.
If you had got the first test 3 weeks after the initial exposure, then your IgM levels would have been positive and the IgG levels negative.
Your symptoms do suggest that this is a primary infection, since it is usually only in a primary infection that flu like symptoms followed by blisters and ulcers appear.
In flare-ups, the flu like symptoms are rarely present and even the blisters and ulcers may be less severe than that of the primary episode.
But, although the tests are not 100% accurate, your tests show that this is a flare up of a previous infection.

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