Correlation of HSV2 score and viral load

[midwest guy]

I’m a 58 year old male. I began dating a then 50 year old woman in late 2021, and had our first sexual encounters (unprotected intercourse and oral sex) in December 2021. In January 2022, she admitted to me she had HSV2, acquired in 2013. She assured me I was not at risk unless she was symptomatic. She took heavy Valtrex doses upon outbreaks, but she did not take them in a suppressive manner. I took her word for it and we proceeded with unprotected sex until we split up in February 2023.

I honestly didn’t think much of it because I’ve never experienced (at least knowingly) any kind of outbreak. It wasn’t until I met someone new recently, with whom I would like to start a physical relationship, that I suddenly began to have different thoughts on this. So this past week I decided to do a battery of STD tests (Labcorp). All were negative except the herpes tests—my HSV1 was 50 (my Dr suspects this goes all the way back to my childhood) and my HSV2 was 4.16. The latter was a surprise, but as I’ve studied up, I’ve learned that HSV2 can be transmitted without symptoms present.

I’m awaiting results from the supplemental/reflex HSV2 test (Quest) for confirmation. I’ve also this week begun a 500mg/day Valtrex routine.

While I’m hopeful for a false positive on supplemental test, I know the odds are low given my 4.16 score falls above the noted 3.5 threshold. So I am resigning myself to the fact that this is my fate. My questions:

1) Given that 4.16 is still considered “low positive,” does that make the risk of transmission lower? Is that what my Dr means by “viral load”–ie, the lower the number, the lower the risk of passing it on?

2) Given that I’ve had no visible symptoms over nearly a 2 year period, a 4.16 score and a new Valtrex routine, what are the rough odds of transmission (both protected and unprotected intercourse)?

3) Should I worry about the high HSV1 score? I believe this has been in my system forever, as does my Dr.

Thank you

[Terri Warren]

1) Given that 4.16 is still considered “low positive,” does that make the risk of transmission lower? Is that what my Dr means by “viral load”–ie, the lower the number, the lower the risk of passing it on?
Your doctor is incorrect. The 4.16 is not a viral load – it is an index value obtained by a test that uses optical density to measure an index value. The index value is not related to transmission or viral shedding. And it could be a false positive as well.

2) Given that I’ve had no visible symptoms over nearly a 2 year period, a 4.16 score and a new Valtrex routine, what are the rough odds of transmission (both protected and unprotected intercourse)?
Well, I guess we are assuming that this is a true positive, which I would not necessarily believe. Condosm reduced transmission by 96% and the daily antiviral meds by 48% so both together is very safe.

3) Should I worry about the high HSV1 score? I believe this has been in my system forever, as does my Dr.
No need to worry, just recognize it.

Terri

[midwest guy]

Thanks for the reply Terri. Yesterday, I received my supplemental/reflex scores. Very relieved:

HSV2 IGG screening index 2.52
% Inhibition 33.8
Inhibition Interpretation-NEGATIVE

So my follow up questions:
1) Would you still recommend a western blot or is there generally enough agreement with the results of the supplemental/reflex test? Is my score good enough to substitute for it?

2) Back to my forever positive HSV1: how should I handle with a new partner given that this diagnosis is very common? Presuming she is negative for both herpes versions, is it ok for her to give me oral sex, but not ok for me to return the favor, knowing it could morph into genital herpes for her? Should I stay on Valtrex in order to minimize any shedding associated with HSV1? Is this concern even an issue or am I in overkill land now?

Thank you.

[Terri Warren]

1) Would you still recommend a western blot or is there generally enough agreement with the results of the supplemental/reflex test? Is my score good enough to substitute for it?
There is good agreement between people who get a negative inhibition assay and subsequently get a negative western blot. And those with values above 4 who are just accepting that they are infected should read this and get a blot!

2) Back to my forever positive HSV1: how should I handle with a new partner given that this diagnosis is very common? Presuming she is negative for both herpes versions, is it ok for her to give me oral sex, but not ok for me to return the favor, knowing it could morph into genital herpes for her? Should I stay on Valtrex in order to minimize any shedding associated with HSV1? Is this concern even an issue or am I in overkill land now?
Given that half the population has HSV 1, and probably higher in your age group, many of your future partners will also be infected, though many won’t know it. My OPINION is that before you give oral sex to a partner, you should tell them that you have the cold sore virus and let them make up their mind about taking the risk of acquiring it.

Terri

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