Results

[Questions25]

I am a 49 year old woman who was recently tested for HSV-1 and HSV-2 (this month). Both results were positive. I have been getting cold sores since I was 17, so I was not surprised by the HSV-1 result. I was surprised by the HSV-2 result, as I have not had any symptoms. I have not had any sexual relations in over 4 years, and in the 20 years prior to that I was in two long term relationships. I am wondering if I am one of those people that have symptoms that are so mild that I mistook them for other things, such as razor stubble, etc. I do remember my ex husband saying that he thought he had been exposed to HSV-2, but I do not recall seeing any lesions on him, etc. Neither of us were ever tested at the time.

My doctor was very casual about my recent results, and stated that if I am not having active lesions, I do not need to worry about transmitting it to others. I am considering getting into a new relationship and am very worried about this. How much would someone with my history have to worry about transmission through viral shedding? Would suppressive therapy be a good idea to help with that? Is it worth getting a Western Blot test to confirm the results? I have listed my results below:

HSV 1/2 IgM AND TYPE-SPECIFIC IgG (HerpeSelect), ELISA

HSV 1 IgG INDEX >=6.00 H
HSV-1 IgG ANTIBODY DETECTED (A)

HSV 2 IgG INDEX 4.18 H
HSV-2 IgG ANTIBODY DETECTED (A)

HSV 1/2 IgM INDEX 2.18 H
HSV 1/2 IgM CONFIRMATORY IFA NEGATIVE
HSV 1/2 IgM ANTIBODY NOT DETECTED

[Terri Warren]

Are you saying that you’ve had two or three sex partners in your lifetime? Although that technically doesn’t put you at high risk of having herpes, if one of them was infected, it certainly could be correct. You are over the number (3.5) that we generally consider the upper limit for likely false positive, but I have had two people with an index value over 4.0 in the past year that did not confirm by western blot.

My impression is that you would likely confirm by western blot but possibly not. If you want to get one to be absolutely certain, I don’t think it’s a bad idea.

The risk of infecting someone else assuming no sex during outbreaks, assuming you’ve disclosed the information to a partner,assuming sex about twice per week, assuming daily therapy on your part and no regular condom use by your partner, the risk of infecting someone else is about 2% per year.

Do you know if either of your previous partners has been tested for HSV 2?
Terri

[Questions25]

Thanks for your reply. I meant to say that I had just two sexual partners in the last 25 years, but I had 4 prior to that. So, the possibility that I contracted HSV 2 many years ago is certainly not out of the question. I do not know if any of my previous partners have been tested and do not communicate with any of them on a regular basis.

I will probably have the western blot just to be absolutely certain, but I have pretty much accepted that I am positive. I was just shocked because I do not ever recall having an initial outbreak, or anything that resembled what I thought herpes would look like.

I do have one spot on my outer labia that seems to get slightly irritated once in a while, and I had always assumed it was just from shaving, or the way I sit, etc (I sit for many hours a day in a chair for work). So now I am wondering if this is the area where I have been getting a very small outbreak (a couple of small red bumps with no real pain or itching). If that is the case, is there anything that can be done externally to reduce shedding or minimize the risk of transmission to a partner? For example, applying lemon balm ointment to this area, etc? I realize that there are likely not any studies about this, but the idea seemed to make sense to me 🙂

Thanks!

[Terri Warren]

Yes, you could have contracted this more than 25 years ago and the area on your labia that gets tender could most certainly be herpes.
Daily therapy with acyclovir or valacyclovir can reduce transmission rates to a partner by about half. I would be cautious about other topical medicines. we know, for examples, that nonoxynol 9, a antiviral agent found in some condoms and vaginal, can actually make the situation with transmitting herpes worse. So be cautious. I would stick to stuff that is known to work, like these oral antiviral agents.

Terri

[Questions25]

Hi Terri,

One other question: What does this part of my results mean:

HSV 1/2 IgM INDEX 2.18 H

Does that mean that the HSV virus was active at the time of the blood test? I thought that the longer you had the virus, that this value would be negative.

[Terri Warren]

The IgM test is NEVER recommended to assist in the diagnosis of genital herpes infections in adults. There are many false positives on this test. I think that many clinicians are not aware of the limitations of this particular test. It is the IgG type specific antibody test is the one we pay attention to.

Have you given any more thought to confirming your diagnosis with the western blot?

Unfortunately, your three posts are complete and your subscription is fulfilled. If you have more questions, you can certainly renew.

Terri

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