Clarity

[lm123]

Hello Terri and thank you for providing this service. I have already spoken to Dr. Taulbee but am following up with you as I have since received the results of my blood work which is:

Serology
Herpes type 1- IgM – weakly positive
Herpes type 2- IgM – negative

Herpes Serum type 1 – IgG – positive
Herpes Setum type 2 – IgG – negative

From what I know and have been told by the Dr. who did the blood work, I am HSV1 positive. It is genital. My initial genital outbreak was 15 + years ago. I don’t recall having any such repeat of this as I never again had the lesions, etc…The IgM “weakly positive” means that I may have had a recent outbreak without knowing due to very mild symptoms or asymptomatic shedding. As I have not been sexually active in 15 years, that must be the only explanation for such an evasive result. The Dr. said it was unusual as he either sees that test come back as a positive or negative. I am now taking Valtrex 500mg daily as suppression therapy because I am recently in a new relationship. He told me that the chances of my passing this to my partner are less than 3% and coupled with using a condom, even less than that. I haven’t told my partner about the HSV primarily because I was waiting to know exactly which strain to know what I am up against in telling him this horrible news. I also know HSV1 doesn’t choose location so does that mean if I am contagious at the time and he is performing oral sex on me, he could get Oral HSV1 or would he get genital?
My intial question really is what are the chances I could pass this on to him based on the combo suppression and condom usage?

Thank you for your reply.

[Terri Warren]

Can you get me the index values that go along with these test results please? They are specific numbers, not just positive negative.
Were you diagnosed with HSV 1 genitally by swab test that was typed as HSV 1? You may never have another outbreak of HSV 1 genitally if you’ve not had an outbreak in 15 years. That’s great. There is an 88% chance you will not have another genital HSV 1 outbreak again.

The IgM test is completely worthless and has frequent false positives and should never done to aid in the diagnosis of genital herpes, in my opinion.

If you do indeed only have HSV 1 genitally, the odds of you passing it to your partner via intercourse is way less than 3%. The transmission rate for HSV 2 with no treatment from female to male is 4% per year, half that with treatment. So with the HSV 1 is a fraction of that. Has your partner had an IgG antibody test to determine if they are indeed negative for HSV 1? Over the half the population has HSV 1. Ask if he has ever in his life had a cold sore. If yes, then he doesn’t need testing (different from canker sores). If says no, then he needs testing to clarify as most of those infected with both HSV 1 and 2 don’t know they are infected. If he gives you oral sex and acquires your HSV 1, then he would get it orally not genitally. And the chances that he would get infected if he isn’t already while you are on suppression is really small.

Terri

[lm123]

I can email you the lab report but would prefer to do it not via the forum as I cannot blank out my name…

[Terri Warren]

Does the lab report form list the index values on it? It would be something like 1.76 or 6.63, and it should be there for both HSV 1 and 2. You can just post those numbers here.

Terri

[lm123]

Hi Terri, I have called the lab and asked them for the specific index values pertaining to me. It was requested when I asked for the blood work but they seem to have sent me the industry standard i.e.

Less than 0.90 index- negative
0.90-1.10 index – equivocal
Greater than 1.10 index – positive

I should have been more clear regarding the diagnosis. I had an original diagnosis 15 + years ago because after being with my partner who had genital herpes, I contracted it. I had vaginal lesions, difficulty urinating, etc…I went to the nearest STD clinic and they prescribed a course of medication and that was that. I do not recall if it was visual or swab, nor do I recall anything from what they said to me re hsv1 or 2. I was in terrible shame and denial. Irresponsible I know. Nevertheless, because I am now involved with someone after literally 15+ years of celibacy I wanted to face my reality. Because of not knowing anything about my case, I decided to get a blood test done. The results are above. It was recommended that I do this by Dr. Taulbee. They couldn’t do a swab because there wasn’t anything to swab. The only certainty I guess now is that I am absolutely negative for hsv2 based on the above.

[Terri Warren]

It does sound like you acquired herpes years ago, but without a typed swab we can’t be 100% certain that you have HSV 1 genitally, we only know that you do have HSV 1 and given what you describe it sounds reasonable to assume you have genital HSV 1, which is far less contagious than oral HSV 1. And yes, the great news is that you don’t have HSV 2 infection. Good for you for breaking through this difficult barrier and beginning again. Given that 56% of the US population has HSV 1 so you are certainly not alone.

You have one final question if you have something more you would like to clarify

Terri

[lm123]

Thanks Terri, when you say transmission with hsv1 is a “fraction of that” compared to 2% of people with hsv2 taking treatment – what are we looking at in actual percentages? Do I even need to tell my partner if it is so low?

[Terri Warren]

I would say maybe a third of the risk of HSV 2 or lower.
Do I think you need to tell your partner if he tests negative for HSV 1? I do. I know you don’t want to hear that, but you actually have been diagnosed with genital HSV 1 so I think you do. But the chances are high that he has HSV 1 already and you won’t need to worry about it!

You’re reached the last of your three questions. If something more comes up that you need help with, you can purchase either two or three more questions where you became a subscriber the first time.

Terri

[lm123]

Thanks Terri for all your feedback. I wonder if I subscribe to more questions, will you be able to give me a point by point of what to say and how to say it re: disclosure? I guess I want to be confident in my description on numbers and why it isn’t as bad as hsv2, etc…but I’m not getting a clear idea of the differences when telling someone from the Internet.

Thanks again,

[Terri Warren]

Yes, I can help you with that.

This was your final question using the initial subscription.. Thanks for using this service at Westover Heights Clinic

Terri

[lm123]

Hi Terri, I finally received the index values from the lab that you requested. They were sent from Montreal to Quest in California…test name Herpeselect.

HSV 1 IgG type specific ab 2.75
HSV 2 IgG type specific ab <0.90

To me it’s still a positive on the HSV 1 and a negative on the HSV 2.

[Terri Warren]

So your HSV 1 is considered positive, yes. However, your index value is in what we call the low positive range. We define the low positive range as 1.1 to 3.5. About 50% of the people who test positive in this range have tests that are falsely positive. The closer the value is to 1.1, the more likely it is to be a false positive. Yours is a little more than half way to 3.5. If you were our patient at Westover Heights Clinic, we would send your blood to the University of Washington for the herpes western blot. When someone is diagnosed either with HSV 1 or HSV 2, we like to be absolutely certain we are correct and this western blot is considered the gold standard of herpes antibody testing. You can get this test either by ordering a test kit from UW or we can order the test for you at a Quest lab near you. Given your history, you may choose not to confirm, but if I was in your situation, I would definitely do it.

Terri

[lm123]

Thanks Terri,
Oh my, more grey area and more confusion. Truly though, what else could those lesions have been since my ex partner did have genital herpes. It would be wonderful if it weren’t the case but I fear the bottom line won’t change. It took me a great deal to even find a clinic here in Canada who would even do the tests I asked for. Not sure why but it was a hard sell to convince them I wanted the test not to mention it cost me $300++ to do it. How much is the western Blot going to cost and where in Montreal would I go to do it?

[Terri Warren]

Well, your partner had genital herpes but 15 years ago, most of that was HSV 2, not HSV 1 though it could have been HSV 1. If it was HSV 1, the transmission rate of HSV 1 through intercourse is low but now zero. I agree there is much room for confusion. I am horrified that it cost you $300 for an IgG antibody test that would cost perhaps $50 in the US. You can ask the UW to send you a test kit, have you blood drawn and send it back to them. I think it is about $200. I doubt you can get it done in Canada. I would google herpes western blot Canada and see what you get. Lots of people in Canada manage to get it, but aside from getting the test kit and returning it, I’m not sure how they do it.

Terri

[lm123]

Actually he had it before we met and I probably got it more like 18 years ago. Does this mean I might indeed have HSV2 even if that tested negative? I am petrified now to even consider any sexual relations whether oral or intercourse.
Yes, I was horrified too at the cost. That didn’t include the Dr’s consult and prescription for the blood work…tack on another $250. Outrageous!

[Terri Warren]

No, I am not concerned about HSV 2! What I”m saying is that you only test technically positive for HSV 1. If your partner had genital HSV 2, and you do not have HSV 2, then maybe what you had was not genital herpes. If he was also the giver of oral sex to you, then it is possible that you got HSV 1 from his mouth and not from having intercourse. This is all conjecture since we don’t really know if your HSV 1 is a true positive.

Let’s say you do have HSV 1, just for the sake of argument. The majority of the population has it also. If you have a partner in the future, you can ask them to test for HSV and if they have HSV 1, there is no issue. I think it’s possible that you are overly worried about having HSV 1. However, I would suggest you manage to confirm your HSV 1 status.

Terri

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