Cause for severity of symptoms

[anonymous100]

Hi Terry,

My question has to do with identifying the potential severity of outbreaks in a person. In short, what causes a some people to have no symptoms vs mild symptoms/no lesions vs or severe and recurrent symptoms?

I have read extensively on the subject and obviously know that it depends on a person’s immune system. However, I am struggling with what that means exactly. If I am going to find a potential partner, I would like to do my best to find someone that is more likely to not experience any symptoms. Cleary there is no formula for predicting this, but there should be some things that are are either scientifically proven or hypothetically postulated to help narrow it down. For example, I’ve read if someone already has HSV-1 oral, then symptoms from HSV-2 genital are likely to be less severe. So I am trying to figure out what I can do to figure out how someone’s body might react to HSV-2 and the questions I can ask that will help determine how “good” someone’s immune system is.

It is mind boggling to think that the same virus can cause virtually no symptoms in some people vs. cause extreme pain in others (stories of people going to the hospital ER for days). Is that latter mainly in extreme cases where people have have compromised immune systems such as autoimmune diseases ? I’ve read different statistics, but based on your extensive knowledge and research, of those infected with HSV-2, what are the percentage (i) have no symptoms or very mild (ii) have one outbreak and (iii) have recurring multiple outbreaks?

I myself do have HSV-1 (oral) and HSV 2 (genital) but am nearly asymptomatic (no lesions or outbreaks, very minor sensations I think are psychosomatic and neuralgia). I like to think my immune system is generally good, say a 7 or 8 on a scale of 1-10 but thats an arbitrary number – I am pretty healthy and don’t get sick often. If someone is lower on that scale, say get sick a lot and is 4 out of 10, does that mean they are more likely to experience worse symptoms? I pretty sure I got HSV-1 when I was a child since I remember having a cold sore on my mouth before so maybe that why I’ve never had a true primary HSV 2 infection (I read that HSV-1 has pre-existing immunity to HSV-2 such that it helps reduce the severity of the HSV-2 symptoms). Its stuff like this that is helpful to know yet isn’t really talked about in pamphlets.

Is it even true that the severity of symptoms has more to do with the person’s genetic make-up and immune system rather than the type of HSV-2 strain (not HSV-1 vs. HSV-2, but the serotype within HSV-2 as I’m sure there are many variations)?

[Terri Warren]

The main thing we know about that helps people be less symptomatic with new infection is prior infection with HSV 1, as you already know. The immune response is similar enough to suppress symptoms but not infection. Other than that, we don’t really know exactly why some people have severe outbreaks and others don’t but you are correct that it probably has more to do with a person’s immune system than the strain of HSV 2 that they acquire. I have seen study subjects who do daily home swabbing for viral shedding turn up with more than one strain of HSV 2 in their swabs, but they have no more outbreaks than anyone else.

Personally, I think trying to identify who might be a good partner for you based on some characteristic that will keep them from having severe outbreaks is pointless. we don’t know enough yet. And even if we did, I think you would be better off finding a partner who is gracious and loving and appreciates who you are enough to accept the possibility of getting herpes from you, then dealing with the infection if and when it happens. Finding someone who already has HSV 1 would be nice too. And if you are really worried about this, you could identify partners through dating sites set up for people with herpes. But I would encourage you to keep looking for that gracious, loving, accepting person because in the long run, that’s really what all of us need. Someone who accepts us as we are, warts (haha) and all.

Terri

[anonymous100]

I understand that the immune system is complex and there a million variables, but it still gives me comfort to try and be as educated as possible. Here are some things I found and please let me know your thoughts:

– Allergic reactions: Allergies May Reactivate Herpes Viruses and Cause More Severe Symptoms
http://www.prweb.com/releases/2013/5/prweb10712994.htm (<– could be a marketing scam). Even if this is not a correlation, i have also heard that allergies are often a common trigger for an outbreak.
– CDaa8 cells: Scientists identify immune cells that suppress genital herpes: http://www.fredhutch.org/en/news/releases/2013/05/immun-cells-suppress-genital-herpes.html
– Those with autoimmune disorders

I’m not suggesting these are facts, but still think its good to know what research is out there (and definitely not suggesting I would try to figure out how many CDaa8 cells someone has!) just trying to gather as much info as possible to understand things.

My concern is less of finding someone that loves me for having HSV-2 and rather is more about me looking out for the health of my partner. So even if someone does accept me, I may still decline if I know that they may be better off health wise with someone else. Everyone has their own opinion, but I’d rather let someone go if they are more susceptible to harsh symptoms, EVEN if they were willing to take the risk, I might not be want them to.

Also, where can you buy daily swab testing for use at home? If this is available, why wouldn’t patients be able use this as a method of prevention (to help determine when they are shedding and thus decrease the rate of transmission)?

[Terri Warren]

I am well aware of the research regarding CD8 cells, yes. Good research. I was not aware of the allergy issue and can’t speak to that.
You cannot buy daily home swabs – they must be ordered through a provider who then sends them to the lab. The reason they can’t be used as you describe is because results are not immediate, they take a day or two to get back and then the shedding could have changed.

Everyone is entitled to their opinion about the issue you discuss. I tend to let grownups make their own decisions about their health and their risk rather than trying to make those decisions for them. Each to their own.

Terri

[anonymous100]

I tested positive using herpeselect immunoblot, which doesn’t have a range of values just a positive or negative (in addition to the initial HSV-2 IgG score of 4.8). I already know its highly unlikely that this is a false positive since the former is pretty close to accurate, but want to take the western blot anyway, unless you don’t think its worthwhile. do you offer that / how can i get it done (i am located in Los Angeles)?

Also, based on your knowledge and expertise, of those infected with HSV-2, what are the percentage (i) have no symptoms or very mild (ii) have one outbreak and (iii) have recurring multiple outbreaks?
Thx

[Terri Warren]

We definitely can arrange the western blot for you to be drawn at a Quest lab near you. We have actually had several people now not confirm over 3.5 by western blot.

I don’t have the statistics on your last questions, sorry!

Terri

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