HSV-1 and 2 Testing/Exposure

[Oh dear]

Hello,

I received a hsv1 and 2 bloodtest on December 31 2018. I received my results a few days later and was positive for HSV1, no surprise as I have had three instances of cold sores, and negative for HSV2 with an antibody count of less than 0.91. How likely is it that the result for the HSV2 was a false-negative especially since the HSV-1 was accurate in its detection? The test was a type specific ElISA blood test done through STDCheck.com.

Also, before I understood that HSV-1 could be spread orally to genitally, I performed oral sex on my current partner in early December. He has not reported any symptoms and it has been over 2 months. Is it likely that he didn’t have a primary outbreak but is still infected with genital hsv-1? I also have not had any oral symptoms in over two years with my first infection being over 6-7 years ago.

For my last inquiry: I recently had unprotected sex with another woman whose status I do not know. We shared a sex toy and there was skin to skin contact. This was an isolated encounter. When should I get tested to see if I have HSV-2 from the exposure? Prioritycheck.com states they can administer an early detection of HSV-1 and 2 through: “Herpes early detection testing, sometimes called a herpes IgG & IgM combo test, can give you results as soon as ten days after exposure.” As I knew of my status in january of this year, and have had a long term hsv1 infection, is this testing useful to determine if I got hsv-2 from my recent female to female encounter? STD check.com states to wait 6 weeks but I have also heard that it can take up to 6 months for antibodies to be detected. If I do not experience any symptoms and test negative at six weeks with an antibody count of less that 0.91 is it safe to assume that I am HSV-2 negative or should I wait six months to get the Western Blot? Also, is it safe to assume that I only have HSV-1 orally?

Thank you for your help.

[Oh dear]

To clarify, I have had the same partner since late June of 2018, do not suspect him to have either HSV1 or 2, and my last unprotected exposure with a different partner was in May of 2018, and since I had been tested since then I do not suspect I received hsv-2 from either this past partner or my current partner. This most recent unprotected encounter (with the woman) was very recent and is the one I am most concerned by.

[Oh dear]

I also have a few questions regarding autoinoculation and/or concurrent oral and genital hsv1 infection (prior to the establishment of antibodies.) I do not remember having any alarming genital symptoms at the time of what I’m 50 percent sure was my first oral herpes outbreak. I had what I though to be a bartholins cyst as it was a pea sized lump under one of my bartholin’s glands and it wasn’t an open sore and it eventually popped and the pus was watery. I don’t remember it being too painful. During this time, I also had what I’m almost positive was molluscum on my labia majora near my vaginal opening. They were about 3-4 white painless pin sized perfectly circular white/flesh colored bumps that I treated with apple cider vinegar. They did not burst and there were no open sores. They did not change shape or size. There was no pain. They eventually went away within a few weeks to a month. Does any of this sound like genital herpes? Would the lesions, during a primary outbreak, have been more painful? Wouldn’t the popping of the assumed cyst, if it was a herpes blister, have led to the formation of more sores? Also, is it common for a primary ghsv1 outbreak to occur on the labia majora or the mons pubis/thigh regions, and not on the labia minora?And, if this wasn’t my first oral outbreak, would I have noticed genital hsv1 lesions as well as oral lesions during my primary outbreak? Is it also possible that I got hsv1 as a child but only had a visible outbreak as a sexually active teen? I don’t recall there being any intense genital pain during any of my oral outbreaks. Could a primary ghsv1 outbreak have occurred on my cervix or inside my vagina without my knowing? Is it also positive that I could have a ghs1 outbreak on my cervix anytime and never know? If I use condoms could this potential cervical outbreak still be transmitted? Should I disclose to my partner and past partners that I may have genital hsv1 based on the symptoms? Thank you so much!!

[Oh dear]

Sorry for sounding so neurotic but just to clarify, what I’m assuming was a bartholin’s cyst was not a blister with watery pus but rather a lump underneath the bartholins gland that I soaked and eventually popped. None of my genital symptoms ever felt like the cold sores I’ve had.

[Oh dear]

My last timeline clarifications:

(I am a female.)

I had my first cold sore in I believe 2013 when I was in high school. I do not remember how I contracted it or from whom or what sexual acts were performed.

When I performed oral sex on my partner I was not experiencing any symptoms. My last cold sore was in 2016.

If my partner does not have hsv1 already, wouldn’t his genital outbreak have been more apparent?

The first (I think) oral outbreak and the molluscum and cyst occurred in 2013 or 2014. The bumps were not in cluster and there was no pain except for the cold sore.

My main concern is disclosure to partners and the potential risk I may pose due to my previous (undiagnosed) genital symptoms years ago. Since, I know, from the previous blood test, that I most likely do not have hsv-2, and that my hsv-1 is at least definitely oral, based on my cold sore history, do I need to disclose to partners that I I cannot be certain that I don’t also have genital hsv1, even though I have not had any symptoms since (what I’m almost certain) was a bartholin cyst and molluscum?

Again, I really appreciate any and all help. I just want to be responsible about this.

[Oh dear]

I actually just thought of one more thing. I had a non specific case of cervicitis in 2017. I was having pelvic pains and pain during urination. They perforemd an exam and tested for chlamydia, gonnrhea, trich, bv, and yeast. All were negative. They prescribed me zithro (antibiotic) and my symptoms cleared up within a few days. I read somewhere that sometimes cervicitis is the only herpes symptom. My doctor did not see any lesions anywhere. Is it possible that the antibiotics helped with the inflammation caused by a recurrent genital hsv1 herpes outbreak after the lesions from the outbreak had already subsided? Is cervicitis typical of a recurrent outbreak? Or, is it more likely that the cervicitis was caused by a noninfectious source that cleared up with antibiotics. I have not had any problems since and I get rested frequently.

Again, I know I’m coming across as a bit obsessive but I would just like to put this to rest finally.

Thank you for your help with everything. It means a lot.

[Terri Warren]

This is way too many questions. I feel overwhelmed with all of these questions. Please summarize in a list for me

Terri

[Oh dear]

Hi!

I apologize it really is a lot! Here are my list of questions:

1. Per my EIZA bloodtest result which correctly (I’ve had about three cold sores since 2013 or so) reported that I had a well established HSV1 infection and a HSV1 index count of <0.91, are the chances that my hsv2 result was a false negative lower?

2. I recently learned that I can asymptomatically transmit HSV1 to my partner’s gentials via oral sex. The last time I performed oral sex on my partner was over two months ago. He has not reported any symtoms. If he is truly hsv1 negative, wouldn’t he have had a noticeable primary outbreak during this time? What are the chances he has gential hsv1 from that exposure? I did not have a cold sore during this time. My last cold sore was extremely mild, went away with an abreva treatment in a week. This was in 2016. I have not had one since.

3. I recently had an unprotected sexual encounter with another women. There was fingering, contact, and a sex toy involved. She did not have sores at the time but her status is unknown. What are the chances I got hsv2 from this encounter? I have not had any symptoms. It has been about a week.

4. Also, when should I get blood-tested after this exposure? Prioritycheck.com says that they offer an early detection test “sometimes called a herpes IgG & IgM combo test, can give you results as soon as ten days after exposure.”

5. Is this test reliable? What would you advise to your patients after something like this?

6. Will my long-stand HSV1 infection somehow interfere?

——-

[Oh dear]

——
7. Additionally, is it possible I have both genital and oral hsv1?

8. During what may have been my first oral hsv1outbreak (this was a while ago it may have been my second oral outbreak) I had the following genital symptoms that I self-diagnosed and treated successfully (maybe): had what I though to be a bartholins cyst as it was a pea sized lump under one of my bartholin’s gland. It wasn’t painful and there was no blister or sore. I did soak it and eventually popped it. The pus was watery I believe. Is it typical for a bartholin’s cyst to pop? If it was a herpes blister wouln’t the pus have led to more sores?

9. Additionally, I also simultaneously had about 3-4 white painless pin sized perfectly circular white/flesh colored bumps (spread out) that I treated with apple cider vinegar as it looked like molluscum images I found on the internet. They did not burst and there were no open sores. They did not change shape or size. There was no pain. They eventually went away within a few weeks to a month. Does any of this sound like genital herpes?

10. Also, is it common for a primary ghsv1 outbreak to occur on the labia majora or the mons pubis/thigh regions, and not on the labia minora?

11. And, if this wasn’t my first oral outbreak, would I have noticed genital hsv1 lesions as well as oral lesions during my primary outbreak?

12. In 2017 I had a non specific case of cervicitis causing pain during urination, pelvic pain, and pain during intercourse. I tested negative for trick, gonorrhea, chlamydia, bv, and yeast. No lesions were reported suring the pelvic exam. I was prescribed the antibiotic zithromax and the symptoms went away completely within days. Could the cervicitis have been a recurrent ghsv1 outbreak? Would the antibiotics have helped with symtoms?

13. Or, it more likely this was a non infectious bacteria that was cured with antibiotics?

[Oh dear]

14. Is it also possible that I got hsv1 as a child but only had a visible outbreak as a sexually active teen?

15. Could a primary ghsv1 outbreak have occurred on my cervix or inside my vagina without my knowing? Is it also positive that I could have a ghsv1 outbreak on my cervix anytime and never know? If I use condoms could this potential cervical outbreak still be transmitted?

16. Should I disclose to my partner and past partners that I may have genital hsv1 as well as oral hsv1 based on the above mentioned symptoms?

I really do apologize for overwhelming you. Please let me know if this is still too much and I will try to summarize further.

Thank you for all the work do.

[Oh dear]

Clarification: For question#1: The HSV2 was <0.91 (negative).

[Oh dear]

Also to clarify #1: This was done in December 2018, well after my last risky unprotected encounter. I realize my question wasn’t phrased properly. My question is: Because the HSV1 result was correct, are the chances that my HSV2 negative result a false negative lower?

Thank you

[Terri Warren]

I think you misunderstand how this forum works. You can have three total posts for $2o. You have 11. I will answer some of these and if you wish more answered, you can renew your subscription.

1. The false negative rate for HSV 2 is 8%
2. We do not have statistics on the transmission of HSV 1 via oral sex. 70% of those infected with HSV 1 do not know it so it is possible to be asymptomatic for HSV 1.
3. The chances are low that you became infected at the encounter with another woman, given what you described.
4. The IgM is useless. You can test at 6 weeks out and the result will give you 70% certainty of accuracy
5.LOng standing HSV 1 can slightly delay antibody development – I think 12 weeks is plenty of time for greatest accuracy
6. It is possible to have HSV 1 both orally and genitally.
7. It is possible for Bartholin cyst to drain yes. Herpes blisters are normally not filled with pus
9. No
10. Yes
11. Maybe
12. Antibiotics would not help with a herpes infection no, but lesions eventually do go away on their own. This does not sound like herpetic cervicitis
13. It does sound bacterial, yes
14. yes
15. That is possible and condoms would greatly reduce transmission
16. I would see no need to disclose that have HSV 1 genital infection when you don’t know if you do.

This is your final post on this subscription. If you have more questions, feel free to renew.

Terri

[Oh dear]

Hi!

Thank you for your response!

In sum I have paid $60 though, as you mentioned, I am a bit confused on the membership levels. Am I doing something wrong? Should I send an additional $20?

I believe you have answered most of my questions though I would like some clarification on a few.

#1. Does the accuracy of the hsv1 result reflect the accuracy of the negative hsv2? I understand the false negative rate for hsv2 is 8% but is it less likely to be a false negative because the test correctly caught the hsv2? I guess my question is, if it caught one that has a higher false negative rate, wouldn’t it have caught the one with the lower false negative rate?

#2. As I do not have any genital symptoms and tested negative well after 3 months (More like 6) is it safe to assume I don’t have hsv2?

#3. Have you ever seen someone who has a negative hsv2 at 6 months post exposure, no symptoms, and then tested positive on the Western Blot? Or is that mainly for people with positive swab results and negative Elisa?

#4. In your opinion, is it very likely I have both oral and genital hsv1?

#5. I am also concerned about possibly asymptomsticslly infecting someone and that resulting in neonatal herpes in the future for their partners. Is this something I should dwell on?

Thank you again and please let me know if I need to ass additional funds? And if you haven’t already, I would appreciate it if you could answer these as well as the my previous questions you missed before I added sufficient sums.

Thank you again!

[Oh dear]

(For question number 1 I meant “my test correctly caught the hsv1”

[Terri Warren]

#1. Does the accuracy of the hsv1 result reflect the accuracy of the negative hsv2? I understand the false negative rate for hsv2 is 8% but is it less likely to be a false negative because the test correctly caught the hsv2? I guess my question is, if it caught one that has a higher false negative rate, wouldn’t it have caught the one with the lower false negative rate?

No, the tests are separate. You cannot make that connection.

#2. As I do not have any genital symptoms and tested negative well after 3 months (More like 6) is it safe to assume I don’t have hsv2?

It is safe with 92% certainty.

#3. Have you ever seen someone who has a negative hsv2 at 6 months post exposure, no symptoms, and then tested positive on the Western Blot? Or is that mainly for people with positive swab results and negative Elisa?

Yes, I have seen this – that’s how we know the test misses 8% of HSV 2 infection.

#4. In your opinion, is it very likely I have both oral and genital hsv1?

I think is more likely that you only have HSV 1 orally but cannot be certain.

#5. I am also concerned about possibly asymptomsticslly infecting someone and that resulting in neonatal herpes in the future for their partners. Is this something I should dwell on?

No!

I think I answered all your question, but let me know what is left. I’m still only seeing $20 in payment but will look into it further.

Terri

[Oh dear]

Thank you for your response. Please let me know if I need to add additional funds.

I believe you have answered most of my questions. I have just a few more things I would really appreciate getting some clarification on.

#1. I understand you said that many of those infected with HSV1 are asymptomatic and so do not get a primary outbreak but I have also read that it is more common that not that a new genital HSV1 infection results in a primary outbreak. What is your expert opinion on this information?

#2. And, just to clarify, you’re saying it’s possible that I contracted HSV1 orally as a child (my parents both have it) and only get a recurrence as an adolescent/young adult? Do you see this often? Is it common to have an antibody count of 20plus and only been infected several years prior?

#3. Is it common for someone to have contracted both HSV1 orally and genitally at the same time, or autoinnoculated, shown initial symptoms for only one location, and then had a HSv1 reoccurence later in a different location?

#4. Is it more common to be a symptomatic HSV1 oral carrier than an asymptomatic one?

#5. I have read that ELISA testing has a 97% sensitivity and a 98% specificity for HSV2. How does this relate to the 92% accuracy of the HSV2 negative result you mentioned? I think I am missing something.

Again, thank you for all that you do!

[Oh dear]

Additionally,

#6. Does this 8% reflect both those who have and those who have not had recognizable herpes genital symptoms? Or do they account for only asymptomatic HSV2 carriers with false negatives?

#7. Why exactly is it that false-negatives occur?

#8. Does it have to do with the specific individual’s immune response or is the fallibility of the test itself?

#9. What would a herpetic case of cervicitis look like?

#10. Does a prior, long-standing HSV1 infection affect the seropositivity and accurate and timely detection of HSV2 antibodies in an IGG blood test?

(Thank you!)

[Terri Warren]

#1. I understand you said that many of those infected with HSV1 are asymptomatic and so do not get a primary outbreak but I have also read that it is more common that not that a new genital HSV1 infection results in a primary outbreak. What is your expert opinion on this information?

I would agree that more primaries with HSV 1 are symptomatic than first episode infections with HSV 2 in a person with prior HSV 1

#2. And, just to clarify, you’re saying it’s possible that I contracted HSV1 orally as a child (my parents both have it) and only get a recurrence as an adolescent/young adult? Do you see this often? Is it common to have an antibody count of 20plus and only been infected several years prior?

yes, that is possible and I certainly have seen it. and yes, that number could easily represent an old infection

#3. Is it common for someone to have contracted both HSV1 orally and genitally at the same time, or autoinnoculated, shown initial symptoms for only one location, and then had a HSv1 reoccurence later in a different location?

That is possible and pretty common.

#4. Is it more common to be a symptomatic HSV1 oral carrier than an asymptomatic one?

More common to be asymptomatic

#5. I have read that ELISA testing has a 97% sensitivity and a 98% specificity for HSV2. How does this relate to the 92% accuracy of the HSV2 negative result you mentioned? I think I am missing something.

Those number are comparing apples and oranges. In the sensitivity reported by lab kit makers, they are comparing the sensitivity of their test to people who are know to have positive swab tests for herpes. Our study, with the other numbers, is in a screening population – very different.

[Terri Warren]

#6. Does this 8% reflect both those who have and those who have not had recognizable herpes genital symptoms? Or do they account for only asymptomatic HSV2 carriers with false negatives?

Both

#7. Why exactly is it that false-negatives occur?

We don’t know – some sort of test issue as the western blot has picked up those infections

#8. Does it have to do with the specific individual’s immune response or is the fallibility of the test itself?

The test

#9. What would a herpetic case of cervicitis look like?

ulcerations on the cervix

#10. Does a prior, long-standing HSV1 infection affect the seropositivity and accurate and timely detection of HSV2 antibodies in an IGG blood test?

Prior HSV 1 can slightly slow the development of HSV 2 – perhaps by a few weeks.

You have posted 15 times and paid for 9. You owe $40.

Terri

• This reply was modified 3 years, 11 months ago by Terri Warren.

[Oh dear]

Hi Terri!

I deposited $60. ($40 for what I owe and another $20 for three additional posts.) I apologize for not depositing the amount sooner!

I just have a few more questions that I would really appreciate your input on.

#1. Is it more likely that this first recognized oral outbreak, given how mild and with the absence of flu like symptoms, was a reoccurrence rather than a primary outbreak? Could it possibly have had something to do with a weakening of the immune system? Do most children that get infected have primary outbreaks? Or do they usually present symptoms later in life? Is there anyway to know?

#2. If someone was to get infected with HSV1 through direct contact with an active lesion, are they more likely to have a primary outbreak than someone who was infected via viral shedding during an asymptomatic episode? Does contact with a lesion ensure infection?

#3. And so anyone that has a known case of oral HSV1, unless they have not received oral sex, and even then, may also have a concurrent genital HSV1 as well?

#4. And if the false negatives for HSV2 are due to the fallibility of the test itself, and not the biology and immune response of the individual, why wouldn’t retesting with a new IGG provide a greater chance at picking up the antibody?

#5. Additionally, in your experience, does retesting with the IGG ELISA at a later date, perhaps giving the antibodies more time to develop, result in a decreased chance of false negative?

#6. I guess I am just wondering why the test would consistently miss an infection in a specific person if it has nothing to do with the biological disposition of the specific individual. Are people with a positive HSV1 more likely to have a false negative for HSV2 even after more than 6 months post potential exposure?

#7. How common is neonatal herpes? Why don’t doctors test both partners for HSV 1 and 2 if HSV is so common?

Again, I apologize for the length. Thank you for your input and invaluable information!!

[Terri Warren]

#1. Is it more likely that this first recognized oral outbreak, given how mild and with the absence of flu like symptoms, was a reoccurrence rather than a primary outbreak? Could it possibly have had something to do with a weakening of the immune system? Do most children that get infected have primary outbreaks? Or do they usually present symptoms later in life? Is there anyway to know?

There is no way to know from an outbreak whether it is a primary outbreak or not unless that person has a positive swab test and a negative antibody test when first symptoms present. Many children with primary infections have no symptoms at all

#2. If someone was to get infected with HSV1 through direct contact with an active lesion, are they more likely to have a primary outbreak than someone who was infected via viral shedding during an asymptomatic episode? Does contact with a lesion ensure infection?

No, similar amounts of virus or should during symptomatic and asymptomatic episodes. Contact the lesion does not result in 100% transmission.

#3. And so anyone that has a known case of oral HSV1, unless they have not received oral sex, and even then, may also have a concurrent genital HSV1 as well?

If a person has not received oral sex than they are extremely unlikely to have genital type

#4. And if the false negatives for HSV2 are due to the fallibility of the test itself, and not the biology and immune response of the individual, why wouldn’t retesting with a new IGG provide a greater chance at picking up the antibody?

It is possible of the different brand of test might pick up an infection when the previous brand has not picked it up though I have seen people who have their HSV-2 infection missed by two different laboratories but positive by the Western blot

#5. Additionally, in your experience, does retesting with the IGG ELISA at a later date, perhaps giving the antibodies more time to develop, result in a decreased chance of false negative?

This would be true only was suspected new infection

#6. I guess I am just wondering why the test would consistently miss an infection in a specific person if it has nothing to do with the biological disposition of the specific individual. Are people with a positive HSV1 more likely to have a false negative for HSV2 even after more than 6 months post potential exposure?

We do not have that data

#7. How common is neonatal herpes? Why don’t doctors test both partners for HSV 1 and 2 if HSV is so common?

Neonatal herpes is not a reportable infection in the United States. It is difficult to know the prevalence but it is estimated between 1500 and 2500 cases per year

Terri

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