Future testing recommendations

[angelyn1]

I have had 8-10 timely (within 24-48 hrs) cultures for genital HSV over the last 18 years. All negative except one when I was pregnant (18 years ago)--3 days before I gave birth. I was in the hospital in labor, but it stopped. That's why they cultured me, not because I had a lesion--there was nothing there. I did however, feel a cold sore coming on that day and have had them since childhood. A week later they called as said the culture was positive, but after many years I eventually stopped worrying about it because so many other cultures with symptoms were negative. I do not recall an "initial episode" and my symptoms are always very mild. And multiple (4-5) significant others over the last 17 years have never shown symptoms, although they could be asymptomatic.

I'm well read now on the percent of population affected for HSV1&2, asymptomatic shedding, risk of transmission, etc. I'm in a new relationship and had a mild OB over Labor Day weekend and could not get a culture because of the long weekend. I decided to get the blood test for the first time on Sept. 2. Doc scripted for the IgM test so I went back and had her scrip for HSV Type 2 spec, as well.

Results from LabCorp:

HSV, IgM I/II Combination <0.91 Ratio
HSV 2 IgG, Type Spec 2.56H  Index (I do not know if this was HerpeSelect or the test they are switching to)

Unfortunately, we did not do a type specific test for HSV 1 even though I am sure I have it orally.

Partner was tested on 9/11 and sent brief email on 9/17 saying his results were "fine" (I don't have the specific test types or numbers yet). We've had unprotected sex twice. Once 3 weeks before his testing and once 5 weeks before his testing. I realize the risk of transmission to him from those two times is extremely low; I had no lesion either time, but that he might want to retest in a couple of months to be sure.

My core questions are regarding the posts here about how being positive for HSV 1 can sometimes elevate the risk for a false positive HSV 2 if that result is under 3.5. I believe I'm in the 50/50 category as far as chances for a false positive?

1. Should we both get the HSV 1 IgG Type Spec? (He says he's never had a cold sore, I get a couple a year)
2. Why would my IgM, as unreliable as it it, be definitively negative, esp. when I know I have oral herpes AND the HSV 2 test was positive?
3. Should I get the WB or BioKitUSA test for HSV 1 & 2 for a definitive answer?
4. I am seeing an ID specialist next week, and he knows my results and will do additional blood work--I'm assuming either the BioKit or WB.
5. In addition to the WB or BioKit test, should I have future oral and genital outbreaks cultured for type specific HSV 1 & 2?

My partner is relaxed and understanding, thank goodness, but I would like to know for certain if either of us has HSV 1 and/or 2 so we can better plan our sex life and understand his risk, as well as informing potential future partners accurately.

I sincerely appreciate your response.

[gracefromHHP]

Actually there's probably little reason for a different blood test at this point unless you just need the convincing. You've had recurrent symptoms that are suggestive of genital herpes I assume since you've had so many multiple cultures over the years.  You also had a + lesion culture at one point.  Even though you are a low positive for hsv2, it's highly likely that indeed you do have it.

The igm should've never been drawn on you. You only needed the igg done. completely disregard it's results.

grace

[angelyn1]

Yes, I suppose I do need the convincing. My symptoms are so mild, one very small area, usually with redness and soreness, sometimes a small blister, never any ulceration phase like my oral herpes and it is almost always at a "pressure point" where my underwear seam or my jeans are pressing on my labia. Often looks more like a small rug burn.

And it I have no idea if the one + culture so long ago even distinguished between HSV1 & 2 or if it could be a lab error because I had NO lesion and the doctor said it took a very long time to "grow". In other words, that one testing situation was very unusual. Every other time I've had "something" my doctor(s) have all said it doesn't look like herpes and the cultures are neg and I've been tested right away.

Is it possible for me to have oral AND genital HSV-1? In any event, I appreciate your time in responding. I'm already prepared to accept it, and have already had the difficult conversation with my partner. I wish I had found this website earlier. I could have cited the very low risk of transmission to him (past and future) and been much less emotional when I gave him the news. I feel 100% better and more confident going forward after perusing the site.

Thank you.

[gracefromHHP]

You can have hsv1 both orally and genitally.  It happens but not all that often from what we know in studies.

Hopefully you have a good experience with the specialist next week. To be honest, sometimes they don't know much more about genital herpes and testing than your regular doctor does :(  See if you can get them to order you the WB and go from there.  

grace

[angelyn1]

Hi, a couple of further questions. BTW, I haven't had luck with the ID specialist in getting the Western Blot yet.

I've read about recurring genital herpes occurring on one side of the midline or the other. Does that mean, you wouldn't have a recurrent OB on both sides at once, or does it mean you will always get the OB only on one side?

Also, is it possible to spread genital HSV-1 to a partner genitally?

Thanks.

[gracefromHHP]

in general they tend to only reoccur on one side at a time when they are recurrences.  As with everything else, there are exceptions to every rule.

You can spread hsv1 from genitals to genitals but the risk is low.

grace