HSV 1 Confused and Maybe Overconcerned

[Mike_T]

Hi Terri,

I’m 43 years old and dated a 43 year old woman for about a year and a half. We had protected sex and unprotected oral sex many times (I didn’t realize there was a risk for HSV1). Before our relationship I tested negative for both hsv1 and hsv2 on the Herpes Select IgG type specific test. I found out right after our relationship ended that she tested positive for hsv1 but negative for hsv2. She told me she would get a sore on the side of her nose like ever 4-5 years since she was a child. I never noticed a sore on her while we were dating or during oral sex. I feel like I’m pretty in tune with my body and never noticed or felt any symptoms. I’ve been looking pretty closely lately since our relationship ended 16 weeks ago. At 14 weeks and 3 days past last exposure (i.e. almost 2 weeks ago), I tested negative again for both hsv1 and hsv2 on a Quest Herpes Select type-specific test.

1. What’s the likelihood that I would’ve been infected, not shown symptoms already (I have no detectable antibodies to fight infection), and test negative for hsv1? Are there many false negative for hsv1 14.5 weeks after exposure?

I talked to Dr. Anna Wald from the UW and she seemed to have no confidence in the Herpes Select tests which to put it mildly, really freaked me out! To the point I’m having a very difficult time sleeping at night trying to figure out the odds I’ve been infected.

2. I ordered a Western Blot HSV test kit with the idea I would look to confirm the negative test results. Do you think I should get the WB test done? Or am I way too concerned about this past relationship?

[Terri Warren]

Sorry I didn’t get to this sooner, I’ve been traveling back from Istanbul where I gave a herpes lecture at a medical meeting. The ELISA test misses about 1 out of 10 cases of HSV 1. Having said that, yes, the western blot is better at HSV 1 detection but not as good as it is for detection of HSV 2. We should have some exact numbers for that later this year. So this means that the ELISA test could have missed your HSV 1 infection both time. In my experience, if it misses it once, it will likely miss is every time. So yes, you can get the western blot drawn, but if it is positive, it cannot tell you whether you have new infection or old infection. The point also is that you have no symptoms. So either way seems to be might be about the same answer. You’ve been having sex without worrying about HSV 1 for years, right? So if the WB is positive, you may have exposed other partners to HSV 1 (not this one) and didn’t know it. Not your fault, fault of the test. At this point, it is good to know that 56% of people in the US from age 14-149 have HSV 1 infection and most don’t know it. If you do plan to not have sex with women you are HSV 1 positive, you are ruling out half the population as potential partners. And for what? A sore that may recur once every other year or so genitally or 3-4 times a year orally, that can usually be stopped at the very beginning with high doses of antiviral medicine. And what will you have missed in return? Perhaps a lovely person, who, like the majority of Americans, has a recurring virus somewhere on her body (many people who test positive for HSV 1 never know where their infection is). Now what will be interesting is what you’ll do with your information from the western blot results. What do you think you will do with the results, positive or negative?

Terri

[Mike_T]

Hi Terri,

Thank you for your response. Hope your travels are going well. I’m not going to restrict myself from dating hsv-1 positive women, but I would like to have an some idea about the potential for being infected in my genital area from this recent relationship and then infecting another completely innocent person. I would feel horrible!

I’ve read blogposts by Dr. Handsfield and Dr. Hook that strongly suggesting that in the absence of overt lesions, blisters, etc within 2 weeks of oral to genital exposure of hsv1, one can safely assume they were not infected with the hsv1 virus. I’ve also read that if someone didn’t have antibodies to hsv1 or hsv2 and were infected (ie true primary) with hsv1 genitally, they would show obvious symptoms that could not be ignored within 2 weeks of the exposure.

In addition, you wrote in a Medscape column the following:

“Most patients with genital herpes do not have truly asymptomatic infection; they have symptoms but aren’t tying them to genital herpes.”

1. When you say “most” do you mean like 70%, 80% or 90%? I feel with your many decades of experience you would have a really good feel for this.

2. Would you’ve expected someone like me if I’m truly negative for hsv1 and hsv2 antibodies to have shown symptoms by now from my recent relationship that ended over 16 weeks ago?

3. I’ve seen the odds of acquiring hsv1 through oral sex being quoted as 1/1,000 and even lower when no lesions are present by Dr. Handsfield and Dr. Hook. Do you think this is credible?

[Terri Warren]

I honestly don’t know, and I don’t think that anyone does, because I don’t think there is a study about this, what percent of people with new HSV 1 infection actually have symptoms within the initial period of new infection. I also don’t think we have a study (I could ask Hunter for a reference if he has one) about what the risk is of getting hSV 1 from oral sex is over time. I would think for a truly accurate answer to that, we would, again, need a study looking at discordant couples where one has HSV 1 and the other does not. The problem with such a study is that the diagnoses would need to have been made by western blot, given the lack of sensitivity of the ELISA for screening and then we would need to keep very close track of the oral sex encounters. This was what we did with the genital HSV 2 transmission trial. Then we would need to know where the HSV 1 infection is – that is, that they only have it orally (for example, someone who has had cold sores since they were a child and had no possibility of having HSV 1 genitally. Do you see how complicated this is? The genital transmission trial took several years and 70 million dollars to complete. I seriously doubt that there will be a similar trial for HSV 1 transmission.

So I guess what I’m saying is that I can’t comment on the 1 in 1,000 change of getting HSV 1 from oral sex because I give advice based on studies and generally gathered information from my practice of 32 years.

I think if you’ve been watching your genitals very carefully which I think you have, and you have no symptoms, that your antibody status is likely not different from the beginning of the relationship until now. Whether your first test was accurate, we do not yet know. But you will find out from your western blot. I think waiting 14+ weeks is enough. If your western blot is negative, then I would believe that you are uninfected. If your concern is infecting someone else right now, then I would recommend waiting for your western blot results before having sex with anyone else.

If I had to take a guess, I would say you are not infected, not before and not now. But I don’t think you are looking for guesses. Waiting for the test results will give you all you need to know, I believe, about your true situation.

Terri

[Mike_T]

Terri,

I’m not sure if you miss this based on your previous reply, but I just did take a Quest Herpes Select Type Specific IgG test at 14.5 weeks after last exposure to this relationship which came up negative to both HSV1 and HSV2. I’m not sure if this reinforces your guess that I’m not infected.

I wanted to know your opinion on whether or not I should now take the Western Blot at 16 weeks post last exposure.

• This reply was modified 8 years, 4 months ago by Mike_T.

[Terri Warren]

I did see that you had testing at 14.5 weeks, that’s why I felt that that was enough time for an accurate test result. Yes, take the western blot at 16 weeks post last exposure. The fact that you tested negative at 14.5 weeks is one of the reasons that I would guess you are not infected. My opinion about the lack of sensitivity of the ELISA for HSV 1 vs. the western blot remains.

Terri

[Mike_T]

Thank you Terri,

I appreciate your time and the great work you are doing. I have to say that I was stunned to learn that HSV1 could be transmitted to the genitals. All these years I felt that using condoms was safe sex, at least safer than not using them. This whole experience has been an eye opener for me.

I feel like the sex education I received growing up was lacking to say the least. I feel like the adults have really let kids down. It doesn’t seem like I’m the only one is this situation. I’m very well educated with a bachelors degree in Biology and graduate degree in finance, so I would have understood this risk had I been taught about it. I was ignorant and naive.

Recently I’ve told others in my age group that thye have at least a 50% chance for testing positive for hsv1 and that it can be transmitted to the genitals through oral sex. Many of them don’t believe me. Keep in mind these are college educated, some with PhDs and some are medical doctors.

[Terri Warren]

I would agree that the public is not well educated about these issues for sure.

Mike, if you want to post more questions or comments, you can do that by registering for follow up questions at:
http://www.westoverheights.com/herpes/questions/subscriber-account/options/.

I hope this board has been helpful for you.

Terri

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