[clarification123]

Hi Terri,

I just paid for more questions.

Thanks!

[clarification123]

Hi Terri,

The saga continues…

Just to recap the situation:

-boyfriend was visually diagnosed with genital HSV in 2011. Symptoms were micro-ulcerations and redness at the tip of the penis only.
-In 2013 he did the Herpes Simplex IgG/EIA test. Results:

Type 1 = 0.44, non-reactive
Type 2= 0.25, non-reactive

Both tests were done using the Platelia kit. The nurse told him that he was still infected with HSV. However, according to the reference values that I found, the results of this test would indicate that he did not have either type of HSV.

-in summer of 2015, did another IgG test to determine type as he was under the impression he was infected. Results:

Type 1=0.8, negative ( values lower than 0.9 were considered negative)
Type 2=0.3, negative

-doctor advised him that he did hot have hsv due to 2 negative tests and that it was most likely balanitis and refused to send him for a western blot.

-finally got the western blot test referral via another reluctant doctor who also thought he was was negative for both hsv 1 and 2…

-result of the WB is positive for hsv 1.

1) What to do next with 2 negative IgG tests and 1 positive WB for type 1? Does he have gential hsv 1 or not? Could he have been exposed to oral hsv ealier in life and be asymptomatic and in fact have balanitis and not genital hsv?

2) Should I get a WB too? My previous IgG test showed that I was negative for both types but since it missed 1/4 hvs 1 antibodies I could potentially have hsv 1 and not know it. If so, i would be protected correct? our goal is to prevent transmission to me genitally to reduce complications during childbirth down the line…

3) if he does in fact have hsv1 genitally, can I give myself the virus orally (from someone who has had cold sores since they were a child) and this way i protect myself against getting it genitally?

Thanks for you time

[clarification123]

Hi Terri,

thanks for your clinical opinion on the matter. I guess the thing to do here is to order a WB to see if HSV-1 is present or not as the previous results showed negative, yet high, IgG values of 0.4 and 0.8 for HSV-1…we will be in touch with your clinic to get that arranged.

Also, would it please be possible to clarify some of the questions from above that weren’t addressed?

1) You mentioned that incubation could affect the WB results and make them show up a false negative, but that shouldn’t be an issue here as he was ‘diagnosed’ 5 years ago right?

2) If all these 3 test come back negative (2 IgG tests and the WB), should we still assume that he has type 1 as there was a history of herpes-like symptoms before OR should we assume that he is truly negative?

thanks so much for your help
I will keep you posted.

[clarification123]

Hi again,

just to add to my previous post, here are the exact numbers from the second IgG test done in August 2015:

Type 1 = 0.8, negative
Type 2= 0.3, negative

Interpretation:
lower than 0.9 = Negative
between 0.9 and 1.1 = Equivocal
above 1.1 = Positive

The IgG values fluctuated from the IgG test in 2013…is this possible? Both tests still remain negative though…

Has your clinical impression now changed based on this increased IgG level for type 1?

thanks!!!

[clarification123]

Hi Terri,

It was in fact bio-rad. No cut off values were given, but it did say non-reactive so I am assuming that means negative. From what I researched, anything below 0.8 for this specific test is considered negative. So, it was in fact negative.

1) So do you suggest still doing the WB to get a final answer?

2) Incubation shouldn’t be an issue here as he was ‘diagnosed’ 5 years ago right?

3) If all these 3 test come back negative (2 IgG tests and the WB), should we still assume that he has type 1 as there was a history of herpes-like symptoms before OR should we assume that he is truly negative?

4) In your opinion, if you rule out hsv due to a negative WB result, what else do you think it could have been?

5) What are the chances that all 3 tests come back negative and that he does in fact have HSV.

6) Finally, what is your expert and professional opinion on this case? Do you think he is infected or not?

thanks so much for your help

[clarification123]

Hi Terri,

(I bought additional follow-up questions). So, we got a hold of my boyfriend’s old patient file and read them over. There was never any mention of swab test results in 2010 (when he initially contracted HSV, or so they thought). There is only a note saying that he has genital herpes and that we was giving a course of valtrex for the infection. We are starting to think that he was only visually diagnosed, or that paperwork indicating a positive swab test was lost…

In 2013 he did a blood test to find out the type of HSV. He had never been on suppressive therapy at this point. The test that he did (as per the document found in the patient profile) was the Herpes Simplex IgG/EIA test. Results:

Type 1 = 0.44, non-reactive
Type 2= 0.25, non-reactive

Both tests were done using the Platelia kit. The nurse told him that he was still infected with HSV. However, according to the reference values that I found, the results of this test would indicate that he did not have either type of HSV.

He passed another type specific IgG test 3 weeks ago, and the results were negative for both HSV-1 and HSV-2, as confirmed by the doctor. (I did not ask for the levels, sorry). He was on suppressive therapy at this time.

1 ) Was the test in 2013 in fact negative for both types of HSV?

2) Would you agree that the possibility of him having HSV-2 in non-existent, and that if infected, it is HSV-1?

3) Given this new information, should we still proceed with WB testing? Or after 2 negative IgG specific blood test is he clearly negative for both HSV-1 and HSV-2?

4) If we do decide to do the WB, is there still a chance that it shows up negative?

5) Could you please explain what you mean by ‘incubating the virus’ (from your previous reply)

Your thoughts on how to proceed are greatly appreciated.

Again, thank you so much!

[clarification123]

Hi again,

We would like to do the WB test rather than repeating thr type-specific test. How do we go about getting a WB test if we are not in the states? I assume valtrex won’t affect the results…

Thanks

[clarification123]

Just to add, in another post you advised another client to stop taking valtrex before getting retested as it could affect the results:

(You are in a bit of a pickle here, for sure. Yes, the daily Valtrex can impact the antibody test. I would say that optimally, you would be off of it for 4 months before retesting.)

But in my response you said that valtrex would not affect the test results. Is this because it was a different test?

Thanks so much!!!

[clarification123]

Hi Terri,

Thanks for your response. It is greatly appreciated. I wanted to add that my boyfriend has had what he thought to be ‘outbreaks’…maybe 3-4 in the past 5 or 6 years. However, perhaps they weren’t truly outbreaks afterall given the situation. Maybe it was an irritation of some sort, but thinking that he had herpes, he just assumed it was an outbreak. This mild pattern is not typical of hsv-2 from what I understand, as such, if he does have herpes, it makes sense that it is most likely type 1 (as you mentioned).

When he was given the diagnosis, no values or information were given to him. As such, we don’t know if they came to this diagnosis via the results of the swab or the results of the blood test (which was maybe IgM tests). Therefore, the fact that a swab test may be of no importance in this situation. However, given this clarification, do you still think that the IgG test could be a true negative?

All we know for sure is at this point is that the recent IgG test showed that apparently he does not have herpes. I have had the IgG testing and I am negative for both types.

The reason why it is important for us to know if he has herpes or not (as well as the type) is because I would rather get oral herpes than genital herpes in order to prevent any complications during pregnancy. As such, our plan was for me to ‘purposely’ get the virus on my lip thus preventing me from getting it genitally and avoiding complications down the line.

Given the additional information on the situation, would you suggest retesting to see if the test will show a positive result for hsv-1 and if so, should he stop valtrex before retesting just in case?

Also, please let me know if I have used up my questions…I think I had 2 left from my previous subscription.

Thanks!

[clarification123]

Just to clarify: My inquiry relates to the risk of transmission of hsv 2 to the genitals of a non-infected person when the infected male touches himself and then touches the non-infected partner’s genitals (rather than the risk of transmission to the non-infected person’s hands after touching the infected partner’s genitals). Hope that makes sense even if it sounds a little confusing!

Thanks

[clarification123]

Hi Terri,

I believe that I still had one follow-up question left with my renewed membership? (If not, please let me know and I will renew again) With regards to mutual masturbation where both partners touch eachother and when the infected partner does not have any active lesions, the risk of transmission is qualified as extremely low from what I gather. Is this because in theory there could be transmission of the virus or have you seen instances throughout your career where a person actually comtracted hsv2 because of mutual masturbation where no direct genital contact took place?

Thanks!

[clarification123]

And were those female partners successful in acquiring oral hsv 2? What is you professional opinion on doing this?

[clarification123]

Hello Terri (i have purchased follow-up questions)

Based on the information above,

1) Hypothetically speaking then, if I purposely came into oral contact with an active hsv 2 infection I could contract oral hsv 2 and thereby vaccinate myself against getting genital hsv 2? This would then eliminate the chance of transmission to my child during vaginal delivery as there would be no concern with a genital outbreak and would also eliminate the chance of me giving hsv 2 to a future partner during genital sex?

2) is oral hsv 2 more easily transmitted to the genitals than oral hsv 1 as oral hsv 2 prefers the genital area?

Thank you

[clarification123]

Hello Terri,

wonderful advice. I think that you really hit the nail on the head by saying that the true question is would I rather be with him and risk getting herpes or not be with him. Good guys are hard to come by and so I will definitely continue to explore where this relationship goes. Also, thank you for sharing your personal experience.

Just one clarification (perhaps I worded in wrong in my previous post) can herpes be transmitted via bodily fluids like blood and semen?

Finally, what is my risk of contracting hsv 2 orally from engaging oral sex without use of a condom?

Thanks again, this forum is an excellent way to get quick and reliable answers. The work that you do is great!

[clarification123]

Hello again,

Thank you for the quick response.

No, he does not take currently take daily antiviral therapy, but it would be something that we would like to look into if we decide to go further. All in all, if he did take daily antiviral medication and condoms were used, it seems like the risk of transmission would be quite low? Also, is the virus spread only through viral shedding and liquid from the blisters or can it also be transmitted via bodily fluids like blood and sperm?

Finally, I really care for this person and do not want to end things with them solely based on an hsv 2 diagnosis. This virus does not define him and in no way takes away from all of the amazing qualities that he has. However, I do find myself sometimes struggling to fully commit to the relationship from fear of contracting the virus myself. Do you have any words of wisdom or advice for me in that regard?

thank you kindly.

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