Asymptomatic Herpes Recurrences: Symptoms and Testing Insights

Q: Asymptomatic Herpes Recurrences: Symptoms and Testing Insights

Hello： 1) For urethritis, if there are multiple episodes in a short period, medication should be taken for 10-14 days, and only after a follow-up visit with normal urinalysis results can the medication be discontinued. <br>Lifestyle recommendations can be referenced from various

Symptoms of recurrent herpes infection?

Hello Doctor: I am the person who asked about the simultaneous infection of HSV-1 and HSV-2 and the related testing issues yesterday (#153486).
Thank you for your prompt response.
I would like to ask further questions because I have not experienced any skin or organ blisters or itching symptoms.

Yesterday, I inquired about the following: 2.
It is highly possible to be infected without symptoms, but does "recurrence" mean that there must be symptoms to be considered a recurrence? Or can recurrence occur without symptoms, with only fluctuating antibody levels? Additionally, can both types of herpes virus recur simultaneously without any blister symptoms? Your response indicated that there could be only mild symptoms rather than none at all, or that a weakened immune system might increase the chance of an outbreak.
I would like to ask again: 1.
When we refer to mild symptoms, does that specifically mean mild blister symptoms, or could it also mean symptoms like urethritis? If there are no blisters, but I have experienced urethritis about three times within three to four months, could this indicate a herpes recurrence? However, I did not have any symptoms of urethritis before the end of October last year.
Since the end of October until the end of February this year, I have had three occurrences of urethritis, particularly after having sexual intercourse with my husband, after bathing, or just before my menstrual period.

2.
In the test report from February 21, the results were: HSV-1 IgG (+) 2.89; (-)<0.9 and HSV-2 IgG (+) 3.11; (-)<0.9.
The results from the test on March 5 were: HSV-1 IgG (+) 83.5; 16-22(+/-) RU/mL and HSV-2 IgG (+) 49.2; 16-22(+/-) RU/mL.
HSV-1 IgM (+) 0.10; 0.9-1.1(+/-) and HSV-2 IgM (+) 0.22; 0.9-1.1(+/-).

If I undergo another IgG test around March 20 and the index shows an increase or decrease, what interpretations could be made from those results? Thank you very much for your assistance!

hen jiao lv, 20~29 year old female. Ask Date: 2020/03/10

Dr. Du Shixi reply Urology

Hello: 1) For urethritis, if there are multiple episodes in a short period, medication should be taken for 10-14 days, and only after a follow-up visit with normal urinalysis results can the medication be discontinued.
Lifestyle recommendations can be referenced from various hospitals' guidelines on urinary tract infections, such as drinking plenty of water and maintaining a light diet.
It is essential to adhere strictly to these recommendations.
Additionally, soaking in hot springs should be avoided.
Herpes recurrence in the urethra is difficult to diagnose.
2) It is advisable to have tests done at the same hospital, as reference values may differ, which could lead to variations in IGG levels.
An elevated IGG may indicate a recurrence, while IGM levels typically do not rise, as per the clinical guidelines for sexually transmitted infections, IGM is usually elevated only during the initial infection and remains elevated for about seven weeks.
Most individuals are infected during childhood, so elevated IGM levels in adults are uncommon.
As for my case, I do not have symptoms such as skin or organ blisters or itching (according to the previous text, many infections in children are asymptomatic).
3) Upon retesting, the physician can explain that if the same hospital shows elevated levels, it may indicate a period of recurrent infection with changes in IGG levels.

Reply Date: 2020/03/10

More Info

Understanding asymptomatic herpes recurrences can be quite complex, especially when considering the nuances of symptoms, testing, and the nature of the herpes simplex virus (HSV). Let's break down your questions and concerns regarding HSV types 1 and 2, their symptoms, and the implications of your test results.

Asymptomatic Herpes Recurrences
1. Symptoms of Recurrence: It is essential to understand that herpes can indeed recur without the classic symptoms of blisters or sores. While many individuals associate herpes outbreaks with visible lesions, some may experience very mild symptoms or none at all. This phenomenon is often referred to as asymptomatic shedding, where the virus is active on the skin or mucous membranes without causing noticeable symptoms.
2. Definition of Recurrence: Recurrence typically refers to the reactivation of the virus after a period of dormancy. While many people experience noticeable symptoms during a recurrence, it is possible to have a recurrence without the typical blistering. This could manifest as mild discomfort, itching, or even urinary symptoms like urethritis, which you mentioned.
3. Simultaneous Recurrence of HSV-1 and HSV-2: It is possible for both types of herpes to reactivate simultaneously, although this is not common. The immune response can be influenced by various factors, including stress, illness, or hormonal changes, which may lead to the reactivation of both types.

Urinary Symptoms and Herpes
You mentioned experiencing recurrent urinary symptoms, specifically urethritis, following sexual activity or during certain times of your menstrual cycle. While these symptoms can be indicative of a urinary tract infection (UTI), they can also be associated with herpes.
- Mild Symptoms: Mild symptoms could include discomfort during urination, a feeling of urgency, or slight irritation. If these symptoms have occurred frequently after sexual activity, it may suggest that the herpes virus is reactivating in a subclinical manner, leading to inflammation in the urethra.

Interpretation of Test Results
Your test results show significant IgG levels for both HSV-1 and HSV-2, indicating past infections. The IgM results are not elevated, which typically suggests that there is no recent primary infection.
- Rising or Falling IgG Levels: If you were to test again and see an increase in IgG levels, it could indicate a recent reactivation of the virus. Conversely, a decrease might suggest that your immune system is effectively managing the virus. However, IgG levels can fluctuate due to various factors, including stress or illness, and do not always correlate directly with active symptoms.

Next Steps
1. Monitoring Symptoms: Keep track of any urinary symptoms or other mild symptoms you may experience. If they become more frequent or severe, it may be worth consulting a healthcare provider for further evaluation.

2. Follow-Up Testing: If you choose to retest your IgG levels, discuss the implications of the results with your healthcare provider. They can help you interpret the significance of any changes in your antibody levels.

3. Consultation with a Specialist: Given the complexity of your symptoms and the nature of herpes, it may be beneficial to consult with a specialist in infectious diseases or a urologist who can provide more tailored advice and management strategies.

In conclusion, while asymptomatic herpes recurrences can be confusing, understanding the nature of the virus and its potential symptoms can help you manage your health more effectively. Always consult with a healthcare professional for personalized advice and treatment options.

Similar Q&A

Understanding Recurrent Genital Herpes: Symptoms, Treatments, and New Vaccines

Hello Dr. Du, Last March, I had unprotected sexual intercourse, and two weeks later, I developed symptoms. Initially, I experienced itching, followed by redness, swelling, ulcers, and crusting, which lasted about a week before I recovered. I went to the urology department for a...

Dr. Du Shixi reply Urology
Hello: Regarding your skin changes being considered as herpes, please note the following: 1) It may not be herpes. 2) Frequent recurrences indicate that your immune system may be weakened and the virus is active. 3) You should seek medical attention and get checked for any other ...

Understanding Unexplained Genital Herpes: Causes and Solutions

Hello Dr. Chang, Last year, I experienced my first outbreak of herpes near the vulva, accompanied by a high fever of 39 degrees Celsius for 4-5 days. I went to a large hospital for examination, initially visiting the obstetrics and gynecology department. The female physician who...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, based on the situation you described, I recommend that you consult an infectious disease specialist for further evaluation. Thank you! Wishing you safety and good health. Dr. Chang

Understanding Asymptomatic Herpes: Symptoms, Healing Time, and Safe Practices

Hello doctor, today when I went to the bathroom, I noticed a few very small blisters on the inner side of my foreskin, about 5 to 8 of them. They are completely painless and itch-free, and when I touch them with my fingernail, fluid comes out. I suspect it might be a recurrence o...

Dr. Du Shixi reply Urology
Hello: It is possible, but there will likely be pain due to the wound. Recovery usually takes more than a week, so it's important to rest, as immunity is crucial. Wishing you good health.

Understanding Recurring Ulcers: Herpes Diagnosis and Testing Accuracy

Previously, frequent masturbation led to a skin tear below the coronal sulcus (without ulceration). On February 5th, after confirming that the skin tear had healed with no wounds, I engaged in unprotected sexual intercourse and noticed that the previously injured area had torn ag...

Dr. Li Xinyi reply Urology
Based on your description, the sexually transmitted infection (STI) tests are mostly negative. If there are deeper ulcers, the primary concern is likely a bacterial infection (which may also be accompanied by a viral infection). If there is also dampness, such as in the case of n...