Transmission question

[Worry3214]

Hi,

I received a positive hsv2 blood test back when I was in college. Not sure if it was IGG or IGM. I received a supplemental test (IGG) and it came back negative. I may have been on Valtrex at the time though. My obgyn says I shouldn’t test anymore and just accept that I’m positive. Do you recommend retesting? I don’t know if I’ve had an outbreak or if it’s just been irritation from shaving, etc.

Also, my boyfriend gave me oral on two separate occasions. I was on Valtrex at the time. He didn’t get a cold sore but did experience some irritation around the mouth or a rash. It stayed for about another half a month. Does oral HSV2 present like this? Or do you feel that was something else? The oral was mid august and beginning of Sept. and he got the rash end of September. We haven’t done that since. In December, he did start to get a swollen lymph node in the back of his ear/neck but it eventually went away. He often gets respiratory and sinus issues so I think that was correlated to that. Do you agree?

Finally, he did get a little cold sore in the corner of his lip in December as well. He hadn’t performed oral since early September. It was super small and resolved itself in less than a week (couple days). Do you think that was a delayed outbreak? Or is it likely not correlated? How rare is ghsv2 —> ohsv2 F to M?

Thank you for your help.

He also had developed a blood blister on his finger that’s been there for about a week but hasn’t gotten worse. Does herpes present in that way? If it was herpes, would it have progressed by now?

[Terri Warren]

We’ve been keeping track of people who get positive IgG with negative supplemental results. So far, all have been negative for HSV 2 by Western blot.
What was your HSV 1 result? And has he been tested for HSV 1 and 2?
Oral HSV 2 is rare indeed.
Herpes does not present as a blood blister.
I think that you need a herpes western blot for confirmation of your herpes status.
You need to have been off Valtrex for at least three months from the time you were initially diagnosed.

Terri

[Worry3214]

Thank you. What is your opinion on the oral transmission? Do you believe his facial rash on and chin and around the mouth is correlated? What about the swollen lymph node and cold sore that arrived in December if the oral occurred in August/September?

[Worry3214]

Also, I was diagnosed over 13 years ago in college. It came with a swab from what I remember and then confirmed with a blood test. But my supplemental test 3-4 years ago said negative. I don’t know my levels but can get them. Is it likely my results would come back negative on western blot?

Thanks.

[Terri Warren]

I think it is like, if what your boyfriend described as a cold sore was actually a cold sore, that either you have HSV one and kissed him and he got a cold sore or he had it already. Your swab could’ve been positive for HSV one. It’s difficult to know exactly what’s going on here but I would encourage you to obtain a western blot for clarity. So far, everyone that had a positive IgG for HSV 2 but negative supplemental test from LabCorp, has been negative on the western blot. I believe we have almost 40 patients now who had that situation with us.

Terri

[Worry3214]

So to clarify, you are saying that if what he had was a cold sore, it is more likely he either had it before or I have HSV1 on my face and kissed him? I thought my hsv1 had come back negative but sometimes I do have little cracks in my lips where it is dry. I may have gotten that from him though. Is it more likely that it is oral HSV1 vs oral hsv2 since that is rare? Do you think I have to worry about having transferred something genitally to his face?

Is it possible that something that looks like a cold sore isn’t actually a cold sore?

I will get the western blot for clarity. Thanks.

[Terri Warren]

If your HSV 1 came back negative, and is accurate, which we don’t know for sure, then he had this before. Not everything that he might call a cold IS a cold sore. I don’t think you need to worry about having transferred something from your genitals to his face, no

Terri

[Worry3214]

Thank you!

Is there a reason when I Google online if HSV2 can be communicable to the face it says it can be? I mean I know there’s a risk to everything but I just feel like whenever I Google certain things I see worst case scenario. Do you feel others just don’t know the statistics related to the transmissionability? I do think he was STD tested and it came back negative, but I don’t think he was comprehensively tested since they don’t tests for HSV unless you ask (not part of the general std panel).

[Terri Warren]

It is true that HSV 2 can be transmitted to the face, I have seen oral HSV 2 perhaps 10 times in my entire career. And these people all had genital infection as well. So they gave oral sex to and had intercourse with the same person and got it in both locations.

We can go round and round about this but it would be best if both of you had confirmatory testing done, the best is western blot, to know what you both may or may not have.

You had a positive swab test for something herpes but we don’t know the type. he has something that may or may not be a cold sore. Don’t you think instead of wondering or guessing, it would best just to know for sure?

Terri

[Worry3214]

For sure. And I am planning on that. But just want to learn as much as I can in the meantime to grasp this. I appreciate your patience and for answering my questions in advance.

Have you ever seen a situation where a swab came back positive and then the western blot came back negative? Or are you saying because a swab came back positive it’s got to be either 1 or 2 since swabs are more reliable?

In those situations where you did see ohsv2, did it ever display itself like a rash similar to periorial dermatitis around the nose or mouth?

Thanks!

[Terri Warren]

Yes, I have had 10 patients who had a positive swab and negative western blot. They were likely either on suppression or tested too soon, but it is possible the blot just missed the infection.
A positive swab from a lesion is almost always accurate.

When I’ve seen oral HSV 2, people have what looks like cold sores on the lip or in the nose.

Terri

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