High Positive HSV2 test result, could it still be false?

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Terri,

My husband and I have been having unprotected sex for 8 years. The morning after our last sexual encounter (intercourse) on December 5, 2015, I noticed a cluster of fluid-filled bumps surrounded by red inflamed skin at the top right of his groin area. I freaked out a little because it looked like it could be a herpes outbreak. I pointed it out and he said it never occurred to him that this could be herpes because it didn’t hurt and he didn’t have any other “classic” symptoms. He says he has NEVER had any symptoms that would indicate he also carries HSV and I have also never seen any visual indications in our 8 years. He agreed to get tested.

His blood test result came back HSV 2 Type Specific AB >5.00 H. All other test results were normal. He was able to get a doctor appt a few days later and the doctor chose not to swab the area because everything was “dried” up and would likely not be conclusive. She said that, in her opinion, the test result did not indicate an infection that was recent. Maybe because the value was so high? Anyway, she said to come back and get a swab if the condition resurfaced.

I immediately blood tested and all of my results were normal. I understand that if I was recently exposed, it’s highly likely that my results would be normal. However, I wanted to establish a base-line so I could re-test in 6 months if I never get symptoms of an outbreak. I am now past the “normal window” of establishing symptoms if this was indeed an outbreak.

My questions are numerous:
1. If he has had this for a long time (maybe 8 years or longer), how in the world could I not have become infected to this date?
2. Is it POSSIBLE it could be false positive although the level was >5.00?
3. Does it make sense to try and arrange a WB test to check? We are abstaining from sexual contact until we feel we KNOW what is really going on?

Really confused, disappointed and frightened for him, myself and our future.

Thank you,

[Terri Warren]

1. If he has had this for a long time (maybe 8 years or longer), how in the world could I not have become infected to this date?

I see this all the time – long term couples where on is infected and the other not and they stay that way, for many many years. Some people just shed more often than others and when they don’t shed often transmission just doesn’t happen.

2. Is it POSSIBLE it could be false positive although the level was >5.00?
I seriously doubt that, especially because he had classic symptoms

3. Does it make sense to try and arrange a WB test to check? We are abstaining from sexual contact until we feel we KNOW what is really going on?

No, I don’t think that a WB is necessary at all. I am assuming perhaps he has had sex with other people in his lifetime, before he married you? Is your concern here that he has had a new partner recently and is newly infected? Nope, his IgG value is too high for new infection.

My guess here is that he’s been infected for years, has had outbreaks but didn’t recognize them as such and you just haven’t gotten infected. And the longer couples are “discordant”, the less likely they are to transmit the virus. The uninfected person appears to develop some sort of immune response that makes infection less likely.

So tell me what is your main concern here? Physical symptoms, infidelity, stigma?

Terri

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Terri,
First, thank you for responding on a Sunday. I did not expect to hear from you until Monday and this issue is causing me significant anxiety so I appreciate your care and concern.

I am encouraged that it is possible for one person to have the virus for a long time and not transmit to partner over so many years. I am not as encouraged that a false positive is likely. I do want to clarify that we are not CERTAIN he had the classic symptoms this time either. The doctor who looked at the area said she wasn’t sure but was relatively confident that IF this was a small outbreak, it did not seem to indicate an initial outbreak which would also correspond to your theory that he has had outbreaks in the past but did not recognize them.

He has had sex with a few partners before me. He says he has not had other partners while with me and I choose to believe him. Will the question linger in my mind? Yes, but your comment about the IgG level being too high helps reassure me as well.

My MAIN concern is how to move forward with a “normal” sex life and not contract the virus myself. I am one of those anxious people who would be mortified if I became infected and it would really mess me up emotionally and psychologically (not to mention the fear of a painful outbreak). I want to still be intimate with him and continue our normal life. I know abstaining during outbreaks is a MUST and condoms are strongly recommended (I don’t like them). Given that I’ve dodged the bullet for 8 years, what is my real risk factor here (if you can even answer that question)? You said, ” And the longer couples are “discordant”, the less likely they are to transmit the virus. The uninfected person appears to develop some sort of immune response that makes infection less likely.” Is it likely that I may never become infected? How mandatory are condoms and how effective are they really if his outbreak area is not on the genitals? Can it be passed through semen? I’ve read conflicting information.

[Terri Warren]

Assuming he has been faithful, and I think you would have had some sense of that if he had not, then you’ve been having a “normal” sex life for eight years. One thing that might help ease your mind is if he started taking daily antiviral therapy. This reduces the risk of transmission by half. Having said that, yes, you may never become infected. And how is your marriage? Are you worried about it lasting? If you actually did get herpes and you both now have it, there are no worries. But I know you may not see it that way. Condoms also reduce the risk of transmission by half, or so.

I think your risk is low, given you’ve gone all this time without getting herpes.
I would also encourage you to be absolutely certain that they test you had done is an IgG test, not an IgM. And please be certain it is a type specific IgG for HSV 1 and 2 separately.

And yes, fluid filled blister on a reddened base is absolutely the classic presentation of herpes.

Terri

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He asked the doctor about daily antiviral therapy and she did not want to prescribe any medication until he had another outbreak that she could confirm with swabbing the area. I don’t understand that since the test came back so strong. Is this standard protocol? It would GREATLY reduce my anxiety if there is a drug therapy that cuts the risk in half. If he truly has had this for a very long time, and it seems this is the case, it could be months or years until another outbreak. It seems a little cruel of the doctor to place this on a wait-and-see basis. Should he see a different doctor maybe?

Every marriage has bumps, mostly due to raising his two daughters without the biological mother’s support or involvement, but we have worked through them and his daughters are both now adults. We plan to stay together if I can get myself past this recent bump in the road.

This was definitely an IgG test and it was type specific for HSV 1 & 2 separately. He was negative for HSV 1. The brand name was HerpeSelect.

Thank you so much. You have given me some much needed peace of mind and valuable information.

[Terri Warren]

I have to strongly disagree with his doctor on this one – strongly. He has an index value greater than 5, that should be enough. Here’s what I would suggest. There is an article in the New England Journal of Medicine (that ought to be good enough for her) demonstrating the benefit of suppression. The first author is Larry Corey and it was published in 2004 (I am also an author). Here is the link:
N Engl J Med. 2004 Jan 1;350(1):11-20.

Once-daily valacyclovir to reduce the risk of transmission of genital herpes.
Corey L1, Wald A, Patel R, Sacks SL, Tyring SK, Warren T, Douglas JM Jr, Paavonen J, Morrow RA, Beutner KR, Stratchounsky LS, Mertz G, Keene ON, Watson HA, Tait D, Vargas-Cortes M; Valacyclovir HSV Transmission Study Group.

I would advise that you get the entire article or even just print out the abstract and make an appointment with your doctor and talk about it again, article in hand. if she still won’t prescribe then yes, you may need to consider another more provider, more educated on this topic. You can also print out the section in the CDC STD treatment guideline that addresses this issue in the section on herpes. While suppression is not perfect, since you are so worried about this, I think it would be good for your marriage to do this. You can get past this, really you can. You’ve likely been living with this for years – you just didn’t know it. Nothing is really any different now except your knowledge of his infection.

Terri

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Terri,

Thank you VERY MUCH for your opinion regarding the medication and the back-up information from the New England Journal of Medicine. I will look this up and obtain the article.

I have been relaying much of the information you provided to my husband and he is very grateful that you are here to help us navigate this situation. That said, he is having a very difficult time wrapping his head around the possibility that he has been carrying this for 8 years or longer with no symptoms that he can recall all, except for what I pointed out on 12/5 that prompted the testing to begin with. He is 100% confident he did not contract HSV 2 during our relationship as we have both been monogamous and I am currently testing negative with no symptoms. Despite your respected professional opinion that a Western Blot is probably not necessary to confirm or disprove his current lab results, he would still like to go through the process anyway.

My questions are as follows:
1. Do you perform the Western Blot test at your facility in Oregon? If not, would this testing be available at the University of Washington Virology Lab. We have the means to travel to either location in lieu of having a kit mailed and finding a lab that will release blood taken back to him to mail back, etc. He feels the test result would be more reliable without the Fed-Ex process.
2. If you DO perform this test at your facility, would you accept an appointment with him? If so, how do we go about making those arrangements?
3. Would UofW accept an appointment to perform the test if Westover Heights does not?
4. If he is going to get the WB test, would taking valacyclovir prior to getting the test impact the results? If not, should he begin taking it as soon as possible?

Thank you for your patience and kindness.

[Terri Warren]

1. Do you perform the Western Blot test at your facility in Oregon? If not, would this testing be available at the University of Washington Virology Lab. We have the means to travel to either location in lieu of having a kit mailed and finding a lab that will release blood taken back to him to mail back, etc. He feels the test result would be more reliable without the Fed-Ex process.

it is not necessary to come to the lab. Our clinic would arrange for the test to be drawn at a Quest lab near where you live, and they would handle to shipping to UW appropriately, no need to worry. They’ve been doing this many many years and so have we. It does go to the UW lab.

2. If you DO perform this test at your facility, would you accept an appointment with him? If so, how do we go about making those arrangements?
we do not

3. Would UofW accept an appointment to perform the test if Westover Heights does not?

They rely on my clinic to get them these samples as well as a few other practices that know about this test. They do not see patients themselves.

4. If he is going to get the WB test, would taking valacyclovir prior to getting the test impact the results? If not, should he begin taking it as soon as possible?

I do not think taking Valtrex at this point, since he has a well established immune response, would make any difference at all, no.

Terri

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Thank you again. To confirm I understand your answer to #4, taking Valtrex PRIOR getting the WB test should NOT affect the results, correct?

Thank you.

[Terri Warren]

That is correct. If he had a negative antibody test and lesions consistent with herpes, that would suggest new infection and I would NOT want him to take Valtrex prior to testing but that is definitely not the case with him. It’s fine to take the Valtrex now.

Terri

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