High HSV-1, Low positive HSV-2

[rmayer]

Hello, I’m hoping you can provide me some clarity here. First some background. I’m a single bisexual man. In the past 18 months, have had several encounters with men which included unprotected oral (giving and receiving), unprotected frottage but NEVER anal sex. I have not had sex with a woman in that time frame. In December 2013, I tested very high positive for HSV1 with a Labcorp Igg test and negative for HSV2. In late April 2014, I again tested very high positive (almost 40) for HSV-1 but also positive for HSV-2 (2.10). In May 2014 i retested for HSV2 only and received a 1.50. I have never had any physical symptoms of HSV2. I get cold sores 2-3 times per year so I’m fairly familiar with what a herpes outbreak looks and feels like. I suppose my only risk could come from frottage with a shedding partner or receiving oral from a partner with an oral infection of HSV2.

Given the possibility of a false positive, I contacted your office last summer and had a western blot test done 16 weeks after my last sexual encounter. Unfortunately the results were indeterminate (I forget the exact term used). I was encouraged to have a retest but I declined given the lack of symptoms and what I believe to be fairly low risk behavior. To this date I have not had an outbreak of HSV2. I have had maybe 3 or 4 encounters since August 2014 of the nature I describe above and with men I believe to be STD-Free.

A week and a half ago, I did have a cold sore and did take Valtrex (my last dose was on Apr 5). I was tested for all STDs on April 9th and again my HSV1 was high (over 50) and my HSV2 was 2.18. I have not had a sexual encounter in almost 14 weeks.

Given my sexual activity, lack of symptoms and testing results history, would you advise me to have another western blot? What percent chance is it that I’m a false positive?

Thank you

[Terri Warren]

So the guidance now from the University of Washington is that if you have two indeterminate western blots with six months between them, you are very likely NOT infected. If you do run another western blot, you should have them run side by side so they can be compared. I think there is a reasonable chance that this is a false positive result, yes.

Terri

[rmayer]

Thank you. I’m dying to ask you to quantify “reasonable chance” given my history but I take it to mean 50/50. Am I close? Do most people taking a second western blot receive different results from the first test? Am I correct in understanding the only way I could have been infected with genital hsv-2 is from 1) receiving oral from someone with hsv-2 in his mouth (which I understand to be rare) or 2) unprotected frottage which I also understand to be on the safer side. Again I’ve never had penetrative sex since I tested negative in December 2013.

[Terri Warren]

If you have not had penetrative sex since 2013 there is, in my mind, a way better than 50/50 chance that you are not infected. Sometimes people do have a change from one result to another with the indeterminate, but I would say that about 70% of the time, it stays the same. And yes, the only ways to acquire HSV 2 is from receiving oral sex from someone with HSV 2 in their mouth (low risk) or a penetrative sex or really vigorous and unprotected rubbing which again I think it is on the safer side of things that you can do sexually. The indeterminate results are always very difficult for people because you have no way of knowing for sure where you stand. We see the most commonly in people who have those low positive results so suggest that there’s some protein that’s part of your make up that is tripping the test artificially versus a real herpes infection. I would love to tell you that we can be 100% certain either way that is I think you know by now that’s not possible.

Terri

[rmayer]

Hi Terri, thanks again for your help. I have an appt scheduled with you for tomorrow afternoon. I’d like to have the WB done again.

[Terri Warren]

OK, sounds good.
This subscription has been fulfilled, but we’ll take tomorrow if you have other questions.

Terri

[rmayer]

Terri, I received the good news from the WB test that I’m in fact negative for HSV2. Thank you so much for your advice and counsel. I can’t tell you how much it means to me to have clarity on this subject.

[Terri Warren]

I’m very pleased for you! Thanks for letting us know.

Terri

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