Negative at Four Weeks. Now What?

[Elli]

I recently dated a man who disclosed that three years ago he tested positive for HSV-2. He said he has never had an outbreak and does not take antivirals.

Over the course of a month, we spent seven nights together, and each night involved unprotected vaginal intercourse three or more times. There was alot of skin-to-skin contact and very aggressive sex.

I have not had any lesions, blisters, sores, or flu-like symptoms. Beginning two weeks after our last night together, I experienced recurring (mild) anogenital itching but don’t know if its related.

My IgG results –

Initial Test (six months ago)
HSV-1: 0.14
HSV-2: 0.21

1 Day after Final Exposure
HSV-1: 0.04
HSV-2: 0.11

4 Weeks after Final Exposure
HSV-1: 0.16
HSV-2: 0.23

Although it has been only four weeks since the final exposure, it has been nearly two months since the first. It surprises me that I am still showing a low negative.

In your experience, what outcomes have you seen in situations similar to mine? I haven’t been able to relate to most of the stories I’ve seen. It seems like they’re mostly from people that caught it the first time they had sex with the infected person, they had outbreaks, they rapidly seroconverted, and they knew right away. These things are quite the opposite of my experience.

Could it take longer for me to seroconvert because I’m asymptomatic? If I end up still testing negative in 16 weeks, is it likely that the guy I was with might have had a false positive?

[Terri Warren]

Not everyone who has herpes transmits it. You have really consistently tested negative with no real change in the index values. By three weeks from infection, 50% of people will be positive by antibody test. If a person is negative for HSV 1, they will make antibody slightly more quickly than if they are positive for HSV 1. So basically, you still have a 50-50 chance of seroconverting, but I think it is slightly better than that because you are HSV 1 seronegative.

Are you still having sex with him? Are you still talking with him? If you are still talking with him, I think it might be interesting to know more about his test results to be certain he had the correct test done and that is not within the range needing confirmation. If he had the wrong test done or he had a low positive that did not confirm with another test, this would be good news for him, certainly but also for you so you wouldn’t have to worry about it anymore

Whether you are asymptomatic or not likely has little or no bearing on serconversion times though we don’t know that for certain.

Do you have other questions for me about this?

Terri

[Elli]

Sorry for taking so long to followup. My boyfriend didn’t have his old test results so he had another one done and we got the results last week. It was an IgG antibody blood test and his results were indeed positive for HSV-2 (4.2).

I’ve known this man for years, and he’s “the one.” Our romantic relationship has rapidly progressed and we just moved in together. We still don’t use condoms, and he doesn’t take antivirals. These are points we’ve discussed at length and have mutually agreed upon. I believe this relationship will last at least a few years and I’ve accepted that I will likely become infected.

This might be a ridiculous question, but what if I don’t? What if I never become infected? As you mentioned, not everyone who has herpes transmits it, but how does a person know if they’re in this group? For HSV-2 discordant couples that have sex (with no condom, no antivirals), when is it safe to think that transmission probably won’t happen? Never? Is it always a possibility? I heard of discordant couples being together for years without becoming mutually infected and without taking special precautions (aside from avoiding sex before/during/after outbreaks, but my boyfriend has never had an outbreak). Are there statistics on this? I would think its very rare.

I have easy access to blood tests and retest often, mostly because I’m curious about when/if I become infected. I stay around 0.2 (+/- 0.05), and I continue to have no symptoms. If I received a result of something liek 0.8, while that’s still negative, would it be an indication that I’m seroconverting?

[Terri Warren]

Unfortunately, there is no time when you can know that transmission if not going to happen. I’ve seen people transmit after 20 years together and I’ve seen many more people transmit in the first three months of a relationship. I think you are going to have to deal with just not knowing. It sounds like you have resigned yourself to the possibility of contracting herpes which is a good emotional place to be in, I think.

The likelihood that your boyfriend actually has herpes is very high, but in the past year, I have seen three people who tested over 4.0 on ELIsA and negative on the western blot. I don’t know why. Two of three were born in India, so I’m wondering if there is something going on there. We could certainly order a western blot for confirmation if he wanted to do that.

I would say if you are testing at 0.8, you may be in the process of serconverting but it could certainly be a true negative. We don’t often see values that high on the negatives. I think it could concerning.

If you want to talk more about this, I’m hear for you.

Terri

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