Mixed Results

[seekinganswers2015]

Terri, I first want to thank you for this forum, it is much appreciated by the people in limbo with herpes diagnosis. I have lived with active oral HSV1 since I was a kid, with pretty regular outbreaks. I first was tested for HSV2 by Quest Labs Jan. 2010 (3 months after last sexual encounter), with a negative result IGG .52. I was already entering a new relationship, this person was my only partner for the next three years. We ended our relationship in 2013. I had unprotected sex once with a new partner. Four days later I went to see my OBGYN because I was nervous about this encounter, my blood was drawn for baseline testing. To my surprise HSV2 came back positive at IGG 1.10. This test was conducted by Labcorp. I know this is a low positive, the nurses/doctor could not give me a straight answer as to if this was an old infection or if i was already forming antibodies from the sexual encounter 4 days prior. The person i had the sexual encounter with was not willing to test and of course denied having herpes. So i went to my ex partner. He agreed to testing, at this point a month had passed, his results were negative for both HSV1 and HSV2. I was also tested again at this time, this lab used quest, the result was negative for HSV2 IGG .55. I then entered a brand new relationship, I disclosed as if I had herpes. I began taking suppressive therapy a couple weeks before we first had sex. Three months after the baseline testing I went back to my OBGYN for “conclusive” testing, my result was positive again at IGG 1.17. I was already in my new relationship, my partner was fine with the possibility of me having herpes so i dropped it. I am still with this partner, and still on suppressive therapy. A few months ago, I got a new doctor and we tested for HSV2 again, this time it was equivocal. She said she doesn’t think i have herpes because i haven’t had clear symptoms. I sometimes get extreme itching outside of my outer labia, especially on the bikini line. I sometimes have some fleshy bumps which could very well be ingrown hairs, but I always wonder. I also have felt weird nerve pains in my pelvic area and legs, very strange feeling. I’m unsure if its me just being overly aware and looking for something to be wrong.

So now my questions are:
Is it possible that I began forming antibodies after 4 days of an exposure?

Or is it possible that the original negative test back in 2010 was a false negative and I’ve had type2 for a while now and just didn’t know it and these low positives are due to strong HSV1 antibodies keeping the hsv2 dormant?

Is it possible to get a definitive answer from the Western Blot at this point, considering I’ve been on daily antivirals for over a year now? If so how should I go about this?

Sorry for the lengthy post! and again thank you!

[Terri Warren]

If I had to guess, I don’t think you have HSV 2 infection.
The only problem here is your use of suppression for one year after having sex with the new partner. Let me see if I have the facts correct:

1) You were negative in 2010
2) You had sex one time with a new partner then had a very low positive and started on suppression one month after that contact?
3) You have been on suppression for a year and you again have a low positive HSV 2 test.

First, I think the chances of you getting HSV 2 at one encounter is very low, all by itself. And no, I don’t think the very low positive would be a result of an infection four days prior. Given that the first time you were tested and you had a rather high negative, I am not surprised that tested slightly higher on the LabCorp test. In my experience both in the the clinic and reading lab results from people on this board, I feel like I see a few more low positive on the LabCorp test than on the Quest antibody test. I would need a study to determine how many false positives there are in that group.

Since you took a year of antiviral therapy, it is going to be slightly more challenging to sort this out. But we must keep in mind that your risk from a single encounter was also very low, statistically. The other factor here is that we don’t know the HSV 2 status of your current partner. Is he willing to test? He cold have HSV 2 and not know it and then that puts you at risk, of course, if you were not infected.

I guess the best thing to do would be to do the western blot now, and if negative, get your partner tested, and he is negative, come off suppression. If you are negative and he is positive, then he should be on suppression.

I’m sure I”ve forgotten something here – please ask me follow up questions.

terri

[seekinganswers2015]

What do the high negatives mean? Is it possible for strong HSV1 antibodies (being I’ve had HSV1 for many years) to keep an HSV2 infection dormant and therefore produce low positive scores or high negatives? I would be open to taking the Western Blot at this point even with its high cost. But I’m confused, wont the antivirals screw up the results? Or should i come off suppression prior to getting the Western Blot? If so how long should I wait before testing? I will definitely have to talk to my partner about getting tested, because it would be nice to know where we both stand.

[Terri Warren]

What usually happens in this situation is that the test isn’t able to completely separate HSV 1 from HSV 2, even though the test is type specific – sometimes it just dribbles over a bit, that’s the only way I know how to describe it.
If you happen to have gotten infected at the one encounter that you had, then yes, the antivirals could interfere with the results, but that is so very unlikely. If you are concerned about that, then you will need to wait about 3 more months. How long was the time from your one time sexual encounter to the time you began taking suppression?

Terri

[seekinganswers2015]

I don’t know if I’m stating my question correctly, but I am very curious.

I understand the possibility of the spill over effect with HSV1 antibodies, but is it ever possible that its the other way around. That an HSV2 infection could be kept dormant by the body, and could produce low positives with strong HSV1 antibodies present, but the person is truly HSV2 positive?

Is there a difference in terms of what is a true negative with high vs. low negatives?

I began suppression about 15 weeks after the one time sexual encounter. I guess its up to me, whether I want to spend the money for a Western Blot at this point while I’m on suppression or waiting till I feel comfortable with getting off of antivirals (I don’t want to put my partner in higher risk of possibly getting HSV2 if he already doesn’t have it).

Thank you again Terri. I really appreciate your help.

[Terri Warren]

No, I have never seen the reverse.
I don’t know what you mean by what is the difference between true negative vs. high and low negatives.
OH! If it was 15 weeks from the time of the sexual encounter to the time you started suppression, that was ample time for you to make antibody before you started suppression. I think you can definitely test now with the western blot.

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Terri

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