Possible HSV-2 false positive/next steps?

[stressedandconfused]

Hi Terri,

To provide some background on my situation, I (male) am considering entering into a relationship with a woman who has cold sores 1x a year (assuming this is oral HSV-1). We had unprotected oral and vaginal sex often before she got an outbreak/I learned that she got cold sores. I have not had sexual contact with her since 12/11 (so 6-7 weeks) and have not had sex with anyone else since.

Even though I have never had an outbreak or any symptoms, this made me scared that I may have contracted genital HSV-1 from her, since she could potentially transmit oral HSV-1 to me from unprotected oral sex. Even though we never did anything when she had an outbreak, I read up about asymptomatic shedding/transmission that may happen. This prompted me to get a Herpes I/II IgG antibody blood test.

I just received my results back and I am shocked. For HSV-1 antibodies, I tested negative (<0.9) which I was relieved about. However, for HSV-2, I tested positive with an index of 1.56. Again, I have never had any symptoms/outbreaks so I was shocked by this result, given that if anything, I was expecting a potential positive HSV-1 result (due to cold sores being HSV-1). I have been reading that almost 50% of positive HSV-2 results are false positives, but I’m not sure how accurate that is.

So my questions in summary are:

1) Do you have any more concrete information regarding the asymptomatic shedding transmission rates of oral HSV-1 to genital HSV-1? How much do antivirals lower the asymptomatic shedding transmission rates?

2) From my antibody test results above, do you think it is likely that my 1.56 positive HSV-2 index may be a false positive? Again, I have NEVER had an outbreak/symptoms so I have a feeling this might be a false positive.

3) I’ve read online that for unexpected positive HSV-2 results, follow up testing is recommended. What would you recommend for next steps (Western Blot, or HSV-2 IgG Inhibition test from Quest, etc?)

Thanks in advance for your help.

[Terri Warren]

First of all, it is totally inaccurate that 505 of HSV 2 tests are false positives. It IS true that 50% of people who test with an index value of 1.1 to 3.5 are false positives, but these account for only about 6% of total HSV results. Big big difference.

1) Do you have any more concrete information regarding the asymptomatic shedding transmission rates of oral HSV-1 to genital HSV-1? How much do antivirals lower the asymptomatic shedding transmission rates?
We don’t have good data on HSV 1 transmission rates. We do know that people who have oral HSV 1 with frequently (6 times per year) recurring disease, shed virus on about 25% of days. And about half the population has HSV 1 and the IgG test misses 30% of HSV 1 infections compared to the gold standard western blot

2) From my antibody test results above, do you think it is likely that my 1.56 positive HSV-2 index may be a false positive? Again, I have NEVER had an outbreak/symptoms so I have a feeling this might be a false positive.
At an index value of 1.1 to 1.5, the false positive rate is 85%.

3) I’ve read online that for unexpected positive HSV-2 results, follow up testing is recommended. What would you recommend for next steps (Western Blot, or HSV-2 IgG Inhibition test from Quest, etc?)

The western blot is by far the best antibody test for HSV 1 and 2. It is run only by the University of Washington but anyone can send samples there though you must work with a provider who will order this test. I also can do it for you via telehealth.

Terri

[stressedandconfused]

Hi Terri,

Thanks for your responses and your clarifications on the % of false positive tests. I had a few follow up questions:

1) By how much do antivirals (i.e. Valtrex/valacyclovir) reduce asymptomatic shedding and transmission rates (for oral HSV-1)? I have only read about those with daily Valtrex prescriptions, but my partner who has oral HSV-1 was prescribed Valtrex non-daily, as in “take it only whenever she feels a flare up coming”. She only gets one outbreak a year. Her doctor said that even though this is not a daily dose, it will still virtually eliminate all asymptomatic shedding between outbreaks (“basically zero”, according to the doctor). Do you have any more information on this/can you confirm this?

2) Do those who have had HSV-1/cold sores since they were a baby tend to asymptomatically shed less than those who just had their primary outbreak recently? In other words, does asymptomatic viral shedding decrease over time post initial infection?

Thanks in advance

[Terri Warren]

1) By how much do antivirals (i.e. Valtrex/valacyclovir) reduce asymptomatic shedding and transmission rates (for oral HSV-1)? I have only read about those with daily Valtrex prescriptions, but my partner who has oral HSV-1 was prescribed Valtrex non-daily, as in “take it only whenever she feels a flare up coming”. She only gets one outbreak a year. Her doctor said that even though this is not a daily dose, it will still virtually eliminate all asymptomatic shedding between outbreaks (“basically zero”, according to the doctor). Do you have any more information on this/can you confirm this?

We don’t have data on how much antivirals reduce transmission of oral HSV 1 but I most certainly disagree with her doctor that she’s not shedding between outbreaks. That is totally inaccurate.

2) Do those who have had HSV-1/cold sores since they were a baby tend to asymptomatically shed less than those who just had their primary outbreak recently? In other words, does asymptomatic viral shedding decrease over time post initial infection?

While we have data that people with HSV 2 shed less virus the longer they have the infection, we do not have the same data for oral HSV 1. Sorry, I wish I could give you a clearer answer.

Terri

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