HSV-1 31.8–Is this a sign of an old infection?

[EP621]

Hi Terri,
I’ll start this by saying I’m really thorough about my own testing, and have always requested type specific IGG tests for HSV 1 and 2. They have always come back negative. I test before and after each new partner, and I have made all 6 of the men I have slept with in my lifetime get tested for herpes as well. All were negative, except one ex who was positive for HSV1. I have still tested negative for type 1 for many years after the relationship. I started dating a new guy in June who I also made go through the same testing process. He came back IGG positive on a type specific for HSV1, with an index value of 31.8 from Quest.
We’ve talked about it and tried to determine the site of the infection, since he’s never had an outbreak genitally or orally. He’s never had a cold sore, but says his sister does get them. He’s kissed plenty of people, but to his knowledge no one got a cold sore after. He’s also had sex including oral with plenty of partners, but no known transmissions. If I were to bet, I would say without hesitation he has it orally.
My question–based on my results I’m likely truly negative. We have had oral sex many times now recently, and I realize I’m playing with fire and can’t fully shake it. I always run to the bathroom after and shower.
My questions:
1. With an index value of 31.8, is it likely he’s had this infection since childhood? He’s 32.
2. If he’s had it since childhood, these really really old long established infections, is there any chance or anecdotal data you’ve seen in practice that they don’t shed the same amount as a newer acquired infection?
3. Does my washing immediately following oral help at all? Or is it once the saliva is on a mucus membrane that’s that?

[Terri Warren]

1. With an index value of 31.8, is it likely he’s had this infection since childhood? He’s 32.
There is simply no way to know that unless he reports having cold sores as a child, which he is not saying, correct? He didn’t get it last week or the week before that – he’s definitely had it for a while but there is no way to know how long or where.

2. If he’s had it since childhood, these really really old long established infections, is there any chance or anecdotal data you’ve seen in practice that they don’t shed the same amount as a newer acquired infection?
Generally speaking, people shed less over time, that is correct, but we have no numbers on that for HSV 1.

3. Does my washing immediately following oral help at all? Or is it once the saliva is on a mucus membrane that’s that?
We really don’t know the answer to that question, but it can’t hurt. I hope you know that the IgG test does miss 30% of HSV 1 compared to the western blot and it misses it repeatedly. You probably don’t have HSV 1 but we can’t be certain.

Terri

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