New HSV Test Results and HSV-1

[bstp8]

Hi Terri,

In October, I started dating someone new. He informed me that he had been diagnosed with HSV-2 after two positive IgG tests. The first test was late January 2015 during a routine STI screening. The results were:

HSV IGG Type 1 <0.90
HSV IGG Type 2 1.12

The second test was 4 weeks later and he obtained the exact same results: HSV IGG Type 2 = 1.12. Still negative for HSV-1. He told me that he’d never had any breakouts or clear symptoms. He took Valacyclovir 500 mg for about 3 months after the second IGG test (March to June/early July), then stopped until early October when we started dating.

After doing lots of research online and finding this forum, I realized that his results were considered to be a very low positive. Since the HSV-2 results were very low and remained the same, I thought getting a Western Blot would help clarify things. He agreed and recently received his results from the University of Washington.

Results of the Western Blot yielded a negative for HSV-2. However, he did test positive for HSV-1. He stopped taking the Valacyclovir for 4 weeks before the test.

I know the Western Blot is considered the “gold standard” of HSV testing so I believe we can trust these results. However, we were both surprised when the HSV-1 came back positive after he was originally negative for HSV-1 on the previous 2 tests. Is it normal for this to occur? I believe I read that IgG tests miss 1 out of 4 HSV-1 infections?

I’m assuming his HSV-1 infection is oral and not genital but without having any outbreaks, we’ll never know. What is the prevalence of genital HSV-1?

I recently (mid-October) went through an STI panel and was negative for both HSV-1 & 2. I’m not concerned about getting oral HSV-1 because it’s already so common. However, I’d like to avoid getting it genitally. Besides the Valacyclovir he’s taking and using condoms, how else can I best protect myself should we engage in oral or genital sex?

[Terri Warren]

Two things:
I would definitely believe the western blot. The screening test for HSV 1 misses one out of every four infections, when compared to western blot, so it is also possible that the screening test missed an HSV 1 infection in you. You may wish to consider getting that test of you really want to know your HSV 1 status. And no, you cannot know where his infection is without some kind of outbreak. The prevalence of HSV 1 is 56% in people 14-49 in the US.
Condoms and daily antiviral therapy and symptom recognition are the things that you two can do to reduce the risk of transmitting HSV 1 (if indeed you do not have this already)

Terri

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