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HSV-2 'Reactivation' and Viral Load and RPR
Jan 27, 2013

Dr. H, Thank you, first, for all of your work in the community in answering questions related to our issues and concerns.

My most recent labs (1/18/13) had an unexpected viral load increase from not detectable for 3+ years to 63 (I know it's low on it's face). At the same time recent CD4s were: ------------------ 01/18/13 - 2040 , 11/12/12 - 1644 , 07/20/12 - 1770 , 04/12/12 - 1203, 01/18/12 - 1230 , 10/06/11 - 1449. -------------------

Since about July or August I've been dealing with an ongoing pustular dry very itchy rash, and am awaiting a second skin biopsy result (the first showed an "unspecified hypersensitivity"); about a week before the 01/18/13 test developed what appeared to be genital lesions (my doctor rx'd a 10 day course of valacyclovir) and had never been tested before for HSV, so a lab was ordered at the same time and revealed [Reference ranges I've placed in square brackets]: ------------------------------ HSV 1/2 IgG Type-Specific Ab: HSV 1 Specific IgG < 0.90 [<0.90, Index] HSV 2 Specific IgG 10.39 [<0.90, Index] Interpretation: < 0.90 Negative 0.90 - 1.10 Equivocal > 1.10 Positive ----------------------- HSV IgM <1.10 < 1.10 Negative > =1.10 Positive ------------------------- With the bulky data out of the way and explained, it leads me to the first of two interlinked questions.

Can the HSV "reactivating" (I've never before had symptoms or signs and havent had sexual contact of any kind in 6 months) have caused a blip in the viral load, in conjuction with the rash going on?

Second would be that I also had a serofast RPR at 1:1, now showing 1:2. I know they say a two-fold increase is a 'new' infection here, but isn't the RPR somewhat interpretative as well, or should I consider reading the penicillin IJ again, and could this be ljnked with the other symptoms (pustular rash, genital lesions, etc.) or likely just coincidental?

Thanks so much for easing my confusion.

Response from Dr. Holodniy

My interpretation of those lab results indicate past exposure to HSV-2, but not a currently active infection, given the positive IgG and negative IgM tests. In addition, I would have liked to have seen a positive biopsy, culture or smear result of the lesions to indicate that HSV-2 infection was actually causing these lesions. We usually don't get the blood tests to make such diagnoses as they can be confusing, because many people have positive antibody tests indicating past exposure. Yes, active herpes infection could result in a transient blip in viral load, but it's not clear to me that is what is going on here. I am also not concerned by the change/increase in RPR. A two-fold increase or decrease would not be considered significant.



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