Confused about test results

[needanswers101]

Dear Terri,

I am a female with a history of genital HSV2 but have fortunately been asymptomatic for two decades (only had a couple outbreaks at the very beginning of infection). I started a new relationship with a man who has had long time oral HSV1 (though asymptomatic for 5 years) and fairly recently diagnosed HSV2 (which we assume is genital though he has never had symptoms). Along with the positive HSV2 result he tested positive for HSV1 (oral for sure but no way to know if also genital). Despite having history of cold sores he said this was the first time he ever tested positive for HSV1. Anyway about 12 days after we became intimate for the first time I developed symptoms of BV and was treated with antibiotics. Though I had no lesions/blisters I was still concerned about possibility of also having contracted HSV1. I did develop symptoms of post herpetic neuralgia which lasted for several months which is why I was concerned. I read PHN could be from HSV2 being reactivated after being dormant so was hoping it was from that and not from a new HSV1 infection. I got tested and to my dismay I did test equivocal then positive for HSV1 over a period of months with the following IgG results:
1 month <0.9
2 1/2 months 0.96
3 1/2 months 1.37
7 1/2 months 1.19
My questions:
1.What is the possibility that these positive HSV1 results are false positives given my history of GHSV2 (would it be protective to some degree against contracting GHSV1?) and the fact that the positive results are so low? Despite not having any lesions I did take acyclovir for several months due to the post herpetic neuralgia.
2. Should I get a Western Blot test to confirm the positive HSV1 results or just test IgG again say in another 3 or 6 months?
3. Should my partner get Western Blot test to confirm his positive HSV2 result since he said he’s never had any genital symptoms? And what are the chances he contracted genital HSV1 when he already had oral HSV1?

Thank you so much.

[Terri Warren]

Once someone has HSV 2, they odds of getting HSV 1 subsequently, is something like one in 50,000. I don’t think that’s what’s going on, though you may have HSV1 – hard to say from this testing as the IgG test misses 30% of HSV 1 infection.

I am concerned about your partner’s HSV 2 diagnosis – was that from lesions or an antibody test? From your post, I’m thinking that was the case. Depending upon the index value from his result, he may benefit from a western blot, yes.

If he has oral HSV 1 he will not acquire HSV 1 genitally.

Terri

[needanswers101]

I will ask my partner what his HSV2 index was and go from there.

As for me would you suggest a follow up IgG test in a few months for me to help determine whether I contracted HSV1 from him or do I need a Western Blot test? I really need to know once and for all for my peace of mind. I have never had a cold sore and did not have sores before developing the PNH. If you are saying it’s very unlikely to get HSV1 with my already having HSV2 nor likely that my partner contracted GHSV1 could I still have contracted it from his oral HSV1? He has been asymptomatic for 5 years and takes daily suppressive antiviral. What would the odds be for me still get HSV1 from him in that case? Why would my IgG for HSV1 be elevated if I don’t have HSV1?

Thank you much

[needanswers101]

Forgot to mention my partner has never had any genital outbreaks. The HSV2 diagnosis was strictly from antibody testing. But it was kind of odd that for the first time he tested positive for HSV1 as well when he’s had oral HSV1 for years. Will find out what that index was as well.

[Terri Warren]

If he has had oral HSV 1 for years, he would naturally test positive for HSV 1 antibody, most certainly. I’m confused about why that is odd?
Again, if you have HSV 2, I would not suspect that you have new HSV 1 infection acquired from anyone.
If you have HSV 1, you had it before him. And that is possible.

Terri

[needanswers101]

Thank you for your response.

The reason I suspected that I may have contracted GHSV1 was because on day 12 after becoming intimate with my partner I developed pretty severe symptoms. Though there were no lesions I had red swollen painful labia, vaginal discharge and later on neuralgia. These symptoms seemed worse than just having BV which I’d had before but never like that. So that is why I went and got tested for HSV1. I am going to go ahead and get a Western Blot and still hoping it will turn out negative but have to adjust to the possibility I may be the one in 50,000 that you referred to which is pretty depressing.

If my partner gets either a Western Blot or Quest’s HSV2 confirmation test does he need to be off of his antivirals for 12 weeks prior to either of these tests for best accuracy or just for the Western Blot?

Thank you again!

[needanswers101]

One more thing. I acquired the HSV2 in my first sexual relationship so could not have acquired GHSV1 from anyone prior to it.

[Terri Warren]

It would be best to be off antivirals for 12 weeks at some point after acquiring an HSV 1 infection – it doesn’t have to be now. I would strongly advise against any other confirmatory tests – we are seeing lots of false positive inhibition assays now, which is a problem.
The thing is, you could have acquired HSV 1 in childhood and had no symptoms and could be positive for it on a blot.

Terri

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