Asymptomatic HSV1

[PaloozaRob]

(30 Male Straight) So I had unprotected oral and vaginal sex with a few different partners over the span of 2021 (which I know was foolish), so I decided to get a random STD screening. My last sexual contact was 12 weeks before my screening, and the only thing that came back positive for HSV1 at an index of 3.51; my HSV2 came back at a .7. First of all, does a lower or higher positive index mean anything? Like does a score of 3.51 indicate it’s a recent acquisition? I’ve read if some people having an index in the 50’s. Although I’ve never had any blisters on my mouth OR genitals, and I’ve been told by quite a few different doctors, a dermatologist, and a urologist that asymptomatic oral HSV1 is quite common in the population and I most likely acquired HSV1 as a child and just never developed any cold sores, I still have spent the last four months since my STD test in absolute panic, wondering if today is gonna be the day I see a blister pop up on my genitals. It’s been driving me insane, every new little redness, tingle, or pain sends me into a fit of anxiety. The fact that it can lie dormant for YEARS has me absolutely terrified and I’m really hoping to find some closure. So my questions are this:

1) Does an index of 3.51 mean I recently acquired this?

2) I’ve read that genital HSV1 almost always pops up with blisters with a primary infection, is that true?

3) Can canker sores be part of HSV1? I had a few of those growing up on the inside of my lips.

4) Is it really most likely that I’ve acquired this during childhood and am just an asymptomatic case?

5) Should I expect a blister on my genitals any day now?

I’m sorry for so many questions, this has been wracking my Brian for months and I’ve heard of you and your reputation and I’m hoping to get some answers. Thank you so much for your time.

[Terri Warren]

First, most people who acquire an index value of greater than 3.0 on the IgG test for HSV 1 confirm as positive by western blot, we are seeing more false positives on the IgG test than we have in the past.

1) Does an index of 3.51 mean I recently acquired this?
There is simply no way to know that, no.

2) I’ve read that genital HSV1 almost always pops up with blisters with a primary infection, is that true?
I wouldn’t say that is necessarily true for everyone, but is often true, yes

3) Can canker sores be part of HSV1? I had a few of those growing up on the inside of my lips.
Nope, they are different

4) Is it really most likely that I’ve acquired this during childhood and am just an asymptomatic case?
Well, you are clearly asymptomatic. We know that about 70% of those infected with HSV 1 don’t describe symptoms associated with that infection. But it’s not quite that simple. Sometimes people have symptoms that they don’t associate with herpes until someone tells them about it – for example with oral herpes, many people have HSV 1 in the nostril, not on the lip. Or on the chin.

5) Should I expect a blister on my genitals any day now?
I don’t think so. IF you have HSV 1 genital infection, it will recur very infrequently, for most people anyway. If you are infected genitally (and oral infection is more likely), you may never have an outbreak that you recognize.

I’m sorry for so many questions, this has been wracking my Brian for months and I’ve heard of you and your reputation and I’m hoping to get some answers. Thank you so much for your time.

Your welcome. Remember that about half the population between 14-49 has HSV 1 so its very common indeed.

Terri

[PaloozaRob]

Thank you so much for the swift reply, I guess my concern is if I have oral HSV1 that’s fine, I’m just terrified of it being on the genitals. So are you saying that typically if you have an index greater than a 3 IGG it’s typically proven positive by western blot? Or is there a possibility that I’ve received a false positive IGG result? I guess my main concern is that the virus entered my genitals and is dormant and will pop up any day now or even the next time I get sick. I’ve had some tingling/pain in my back, arms, around the testicles, and on my inner thigh for the past two months (also my semen has been more watery than usual), but I’m not sure if that is herpes related. I have been diagnosed with a back injury so I’m not sure if it’s a pinched nerve or something.

[Terri Warren]

There are some false positives on the IgG test for people who test positive with an index value greater than three. So yes, there is a possibility that this is a false positive. Genital HSV one would not cause tingling or pain in your back arms and is unlikely to be the only symptom of genital HSV one with tingling or pain around the testicles or inner thigh.
it would certainly have no impact on the consistency of semen. Statistically, your infection is more likely to be oral then genital but without a lesion in either location, it isn’t possible to say where this infection is, if your test is accurate.

Terri

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