HSV-1 questions

[Anon0192]

Terri,

This service really helps to clear up a lot of the incomplete and incorrect information circulating about HSV. Thank you for doing this.

I undergo comprehensive STI screening 2-3 times a year, including for HSV. My most recent test came back positive for HSV-1 (IgG index 1.43). I was very surprised to see this, as my number of sexual partners in the past 12 months was relatively low and all my prior testing was negative (although I understand IgG can miss up to 30% of HSV-1 cases). I have also been asymptomatic throughout the previous year. A few questions:

1. What are the odds this is a false positive given the relatively low index value?

2. Depending on the probability for #1, do you recommend confirmatory testing? If so, when? Should I repeat IgG or move straight to Western Blot?

3. Because I am asymptomatic, I don’t know if this is oHSV-1 or gHSV-1. Are the odds low that I could eventually develop the infection in both places?

4. If the test is accurate, I would like to start daily antivirals for suppression right away. Is there any data available on how much the medication reduces asymptomatic shedding? I would like to inform prospective partners about this in the future when I disclose.

Thank you!

[Terri Warren]

I don’t have an exact number for the chances that this is a false positive but I would GUESS there is about a 25% chance. I see false positives for HSV 2 far more often than HSV 1.

I don’t know that doing another IgG is going to give you the clarity that you seek but the blot likely would. Even if the blot was positive for HSV 1, it would not tell you the location of your infection.

We have far less data on the success of HSV 1 suppressing viral shedding, but I think we can reasonably extrapolate from HSV 2 data that it is around 70%.

Terri

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