Recent Positive HSV without ever having symptoms

[anonymous33]

Between 2008 and 2014 (6 years) I was in a monogamous relationship which ended in October 2014. Both of us had STI tests most recently in 2012 with no observed STI’s – though not directly tested for HSV1 or HSV2. Neither of us had any symptoms or sores observed in those 6 years.

I began a new relationship with someone in November 2014 who told me at the time they were HSV2 positive via a culture swab in July 2014 with negative IGg blood test at the time. Her nurse practitioner gave her a Valtrex prescription based on the positive culture test. Over the past 2.5 months (November until January 11th) we had unprotected sex 4 times. In early January 2015 I began having a feeling of sensitivity on the left side of the head of my penis with what I thought were a few red bumps (not raised but smooth) that I noticed the day following sex but that had disappeared a few days later.

We stopped having sex and I went to get tested for HSV1 and HSV2 on January 26th (about 2 weeks after the last time we had sex). My IGg HSV1 was 2.56 and IGg HSV2 was 1.27. They said this could be indicative of an early or recent infection.

So the girl I was sleeping with went to her doctor and got retested IGg HSV1 and HSV2 on February 9th. Her results for both came back negative – despite the positive swab back in July 2014. So her doctor told her to stop taking the Valtrex because it makes no sense with her negative antibody test. This would also seem to indicate that I couldn’t have gotten a recent infection from her correct?

So how can I explain my HSV1 and HSV2 test results considering the 2 sexual partners in the past 6 years? I’m not sure if the increased sensitivity I had for about 1 week could be attributed to HSV if her test results came back negative for both HSV1 and HSV2?

I suppose I have a lot of questions buried in here, e.g., can her recent negative test be trusted considering a positive swab result in July 2014? If that is the case, does that indicate anything about both of my positive results for HSV1 and HSV2 considering I’ve never had any oral or genital symptoms other that that 1 instance of a few unraised red bumps and increased sensitivity that lasted for a few days or a week?

Thanks for you time and advice.

[Terri Warren]

Interesting case but I think I can help you understand it. False positive cultures or PCR tests from a lesions are rare. I would likely believe the swab test in this situation, especially since it was also typed AND if it came from a lesion. You could talk to her about those circumstances. When a person takes antiviral medicine (Valtrex) daily when they are first infected, they can delay antibody development for weeks or even months Normally, if they are taking medicine daily, this is not an issue because the medicine is in essence taking the place of the immune response and helping to keep outbreaks under control. However, because the immune system is not seeing the virus because the medicine is stopping or reducing viral replication, antibody is not produced quickly and sometimes not at all. This could be why she has no antibody yet.

As for you – It’s possible that your low positive for HSV 2 is a false positive. It is in the range where there is about an 85% chance that this is a false positive. Yes, it could also represent a new infection and the number could certainly go higher. It is also possible that you have been infected all along and just maintain a low positive HSV 2 antibody index value, since you mentioned at the start of your post that you have not been tested for herpes. Is that correct? Unfortunately it is likely too early to retest using a western blot.

Terri

[anonymous33]

Thanks Terri – great info.

A few things to follow up – I’ll add if needed. You are correct, I can not say that I have been definitively tested for HSV previously. How long should I wait until trying to seek a Western blot and is it worthwhile in the meantime to see where my HSV2 IGg level is currently?

And do you have any thoughts on my test level indicating both HSV1 and HSV2 positive without any mouth or genital sores?

And just to clarify something you mentioned, when she presented to the clinic with a lesion, this could still have happened prior to her body producing antibodies?

Thanks

[Terri Warren]

You can seek the western blot any time, but if you are looking for new infection only, it is best to wait 4 months from a risky encounter. In your case, if you keep having sex, it is a moving target all the time.

If I had to guess about you, I would guess, and it is a total guess, that you have HSV 1 but not HSV 2.

Yes, the lesion that she presented with at the clinic could have happened prior to her making antibody, in fact, likely did.

Terri

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