GHSV-1 Questions

[tadp2022]

Hi Terri,
I am 27F who was in a new relationship with a 27M last year. Our first sexual encounter was Aug 20th. I started experiencing what I thought were yeast infection symptoms on Sept 3rd, 14 days later. In those 2 weeks, we had genital and oral sex about 5-10 times evenly spaced out between. My recent sexual partners before him were June 2022 and Feb 2022 – no positive STD tests, but unsure about HSV-1 status for either.

On Sept 6th I tested positive for COVID with moderate symptoms – body aches/chills, fever, sore throat with cough.

After a couple days I noticed the yeast infection meds were ineffective and the symptoms (itchiness, inflammation, painful urination) weren’t going away. I took a closer look and noticed what looked like herpetic lesions on my vagina, so I decided to get an STD test on Sept 8th. The results came back positive for HSV-1 with an IgG of 18.20. My lesions and symptoms cleared up with 1 week of valacyclovir.

I haven’t ever had a cold sore that I’m aware of and although I naively didn’t get a swab when I had the lesions, I’m pretty positive this is GHSV-1.

1. When I informed him, he basically said “that’s weird I don’t remember having any outbreaks”. How likely is it that this partner gave me hsv-1? I have read that ghsv-1 typically has an initial primary outbreak and it happening to me within 14 days of sex with him makes me think I got it from him.
2. Obviously my IgG level was high at 18.20. Does that indicate a more long term infection, or could it be because I was having the primary outbreak when I got tested that the value was so high?
3. If I do have a longer standing infection, is it possible that me having covid at the same time weakened my immune system and led to my primary outbreak?
4. If that was in fact my primary infection, it has been 6 months with no recurrence. What is the likelihood of transmission from me to a partner genitally or orally at at this point if they are neg for hsv-1?

Thanks for your time

[Terri Warren]

1. When I informed him, he basically said “that’s weird I don’t remember having any outbreaks”. How likely is it that this partner gave me hsv-1? I have read that ghsv-1 typically has an initial primary outbreak and it happening to me within 14 days of sex with him makes me think I got it from him.

First of all, the antibody testing that you had done was done too soon after the contact to be able to pick up a possible new HSV-2 infection. You should retest about 6 to 8 weeks down the road and see what you get. You’re a positive HSV one antibody test suggested that’s an old infection not a new one and we have no idea if the lesions that you had were due to HSV one or HSV two.
2. Obviously my IgG level was high at 18.20. Does that indicate a more long term infection, or could it be because I was having the primary outbreak when I got tested that the value was so high?
It is high because it is a longer standing infection.
3. If I do have a longer standing infection, is it possible that me having covid at the same time weakened my immune system and led to my primary outbreak?
Because you have a longer standing infection, this was not a primary outbreak if anything it was a recurrence. And that could happen because of Covid, yes. However, it could also be a new HSV-2 infection and you would not have antibody yet.
4. If that was in fact my primary infection, it has been 6 months with no recurrence. What is the likelihood of transmission from me to a partner genitally or orally at at this point if they are neg for hsv-1?

I think you are making a big leap year to decide that this is HSV one. We just don’t know that. You need to repeat your IgG test and make sure that you don’t have HSV two. If you only have HSV one then transmission to partners in the future is unlikely. What should have happened is that a swab test should have been done of the sores, not an antibody test

Terri

[tadp2022]

Understood, thanks.
I took your advice and took another IgG test and it was negative (<.90) for HSV-2.
This means my outbreak was due to HSV-1, correct? And likely just manifested because of the COVID or chance? It just seems really coincidental that I experienced symptoms approx. 2 weeks after sexual interactions with this person, yet my IgG for HSV-1 suggests a longer standing infection. What do you make of this? Is it possible that my HSV-1 could have been genital from the start and I was just asymptomatic until 6 months ago?

[Terri Warren]

I think the most likely explanation is that the Covid infection reduced your body’s ability to respond immunologically to other things. Sometimes your immune system just juggles a bunch of balls, and when it’s challenged by something as significant as Covid, it can drop a ball, like HSV one, and allow an outbreak to happen when previously it has not
. I think it’s absolutely possible that your HSV one was genital from the start and you were not symptomatic until recently.

Terri

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