Confused over HSV-II test results

[khergg7]

Thank you for taking my question! I am a 51 year old male, and I had sex with 3 different women earlier this year. Always with condom, although I did perform oral on the women. Previous STD tests always negative, but did not include HSV testing. I got tested for STD’s one month my after last sexual encounter. Did not have any symptoms, and have never had any symptoms ever. So, All tests except HSV 1 and 2 came back negative. HSV type 1 IgG Ab had value > 5, HSV type 2 came back with 1.12. I know I had cold sores, so HSV 1 was not a surprise. HSV 2 was! Repeated just the HSV tests 3 weeks later, HSV 1 came back > 5, HSV 2 was 1.28. So I again repeated two months after this last HSV test, but this time just the HSV 2 test. This time a different lab, and the HSV 2 (officially labeled “HSV 2 IGG HERPESELECT AB” showed 0.34, thus < 0.90 – hence a negative test! This last test would then be 3 months after last sexual encounter. I do occasionally feel a slight burn on the penis (like a lild sunburn)on the left side base (wondering is that yeast/fungal?) but no signs of lesions as per internet, as per my facial HSV 1. I also had a huge herpes 1 outbreak on my face 4-5 months prior to the first set of HSV tests. Regardless I am now super paranoid and examine my penis every day for any signs of lesions, but nothing noted. I do occasionally take the valacyclovir for the HSV 1 on an as needed basis, but I was taking it pretty regularly after second positive HSV 2 test (paranoia?), and taking a gram a day. New partner on the horizon, she has tested negative across the board on all STD’s. So…this pattern of results – typical? How would you interpret it? Suggestions? Repeat again in a month? Of course I will tell potential partner beforehand but don’t know what to say about these results – so if you could let me know as soon as you can I’d appreciate it! Thanks!!

[Terri Warren]

Just as the person who posted previous to you, I would bet lots of money that you are NOT infected with HSV 2. At these low level positives (and now you have a negative), it is extremely unlikely you are infected with HSV 2. It is likely a slight cross reaction with HSV 1, I suspect. If you were newly infected with HSV 2, I would expect subsequent values to be higher, not lower or negative. I doubt that retesting with the ELISA test is going to help you sort this out. I think your latest negative test is accurate. However, sometimes in this kind of situation, people worry, they perseverate about the previous low positive. In your case, the only thing I’m worried about it the dosing of the antiviral therapy. How much have you taken since any worrying encounter (which would be any of the three partners). If you take enough, it can interfere with antibody development.

Overall, if I were you, I probably get a herpes western blot because I am a worrier, but many people would not, probably most people and be happy with the negative.

Let me know about the meds.

Terri

[khergg7]

Thanks for the response! The first dose of valacyclovir I took was right after getting the firsts positive test with value of 1.12 – thus one month after last sexual encounter. But that was the typical dose I would take if I felt the tingle on my face for the HSV 1 (2 grams in morning, 2 at night) as I would always carry those around. But then I took no medications until a month after the last positive HSV 2 test (the 1.28 value), where I again took the 2 gram dose, and I’ve been taking that dose quite often over the past month (let’s say about 5 days in a week), and I am about to shift to the daily 500mg dose (I have told my Dr. over the phone more out of concern for the HSV-1 as I have to do some photos for some business things and I have been under huge stress – above and beyond this herpes thing, which is adding to it alot so I very vulnerable to a face breakout. This is a problem because when I get a major breakout (about once every 4 years, with minor outbreaks once every year or two)- it shows quite vividly on my face (lips and nose!). I will show these results to my Dr. when I see her for my annual check up in three weeks, but I have done these tests outside my insurance (but these confidential testing (stdcheck) are done at reputable labs like quest diagnostics) as I was a bit embarrassed about this sort of stuff, as previously I was in a long term 20 year monogamous relationship until the past year so getting back into dating people again was weird, and this sort of business with the unusual results has certainly added to it. So given this dosage history, your opinion?

[Terri Warren]

Well, that’s quite a few days of antiviral therapy. If I’m reading this correctly, if you are taking the meds 5 days a week, then you are on it about 80% of the time. But also if I’m reading this correctly, you went a month with almost no meds, right at the beginning, right? I think because you had that month basically off meds, they are unlikely to impact your test results. Besides, you used condoms, which is great and is definitely a help to reduce the risk of transmission.

I understand that you need to take the medicine to avoid massive cold sores – I do the same.

The tests you’ve had done are being done by reputable labs and I have no problems with doing the test ordering yourself. I’ve seen doctors order IgM tests (which are terrible) and are often falsely positive and people worry for months! So at least you ordered the correct test (IgG) and I doubt that your doctor will mind at all when you tell her about this.

I would recommend that you get a western blot confirmatory test if you were not on daily valacyclovir, just to put your mind at rest. But if you are going to do that, I would think being off the meds for a couple of months would give you the most reliable results. I would do this ONLY if you continue to worry.

Yup, coming out of a long term relationship and doing the dating thing again can be interesting, for certain. Let me know if you have other questions.

Terri

[khergg7]

Yes, you have it right. Just the past month has been the 80% of the time on valacyclovir. But, outside of one single 2 gram morning, 2 gram evening dose, taken after first ‘positive’ test (which was the HSV 2 IgG Ab = 1.12 figure above) which was one month after last sexual encounter, that was it for the first two months post last encounter (the other encounters were earlier that that). So no more valacyclovir until one month after one day dose. Thus, over the two month period after the last sexual contact, one single day (out of 60 days) that had a 2 gram morning, 2 gram evening dose. It is only in the last month (which is the 3rd month post contact) where I have hit the appx 5 days per week valacyclovir dose. (and again, that assumes it was the last encounter that was problematic, my other 2 encounters were a month or longer before my last encounter, so those are 4 or more months ago, with no valacyclovir involved except where I just noted). I will discuss with Dr. and see what she says. But now that you have more complete info, does that sound like it would skew the test, given the fact that there would have been at least a one month incubation, then the one dose, then another full month of possible incubation, prior to the more consistent dosage? And last question – on oral sex male on woman – hard to do that ‘safe’..(dams, yes I know). What are the odds of transmission that way? Does alcohol kill the virus? And given this is my last follow up, let me please say that you are an absolute GEM – what you do is so great, useful, and helpful and I THANK YOU!!!

[Terri Warren]

If you had almost a full two months off drug, then I would believe the last negative test that you had done.
Males giving oral sex to females is not completely risk free but lower risk for sure. Plus you have oral herpes already so if you happened to contract HSV 2 orally, which I don’t think you did, but let’s say you did, you wouldn’t be able to tell the difference between that and cold sore and it would essentially vaccinate you against getting it genitally. But again, I don’t think that’s what happened.

You are most welcome, glad to be of help.

Terri

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