HSV-2: Two Atypical Western Blots

[Confused5665]

Hi Terri-

When getting a routine STD test a few years ago I was offered a Herpes test as part of a scientific trial.  I tested positive for both HSV-1 & HSV-2 (trial did not provide IGG scores). HSV-1 was not a surprise since I had many cold sores as a child. HSV-2, however, was a shock since I have never had an outbreak or symptom.

I had follow up HSV-1 & HSV-2 blood tests done & the IGG scores were HSV-1 (3.83) & HSV-2 (2.81). My doctor suggested a WB due to the low positive HSV-2 IGG.  The result was positive for HSV-1 and for HSV-2 it was "Atypical reactivity was noted in both specimens against herpes simplex type 2. These results are not consistent with recent infection with HSV-2."

During this time I was in a committed relationship with an incredibly understanding partner. We had regular unprotected oral, vaginal and anal sex.  She was tested a couple of times for HSV-2 and both times the results were negative. It's worth noting that she has HSV-1 & takes Valtrex daily to suppress oral cold sore outbreaks.

Seven months later I had another WB (convalescent serum) and received the same "atypical" result. I was only with the same girl during this period. My doctor followed up with the UW virology lab & the tech told her that it's "highly unlikely" that I am infected with HSV-2. However, since the WB cannot fully rule it out, no one can say with certainty that I do not have it.

I am now single & struggling with how to address this with future partners. It appears that I must explain my situation since they may be a chance I could transmit HSV-2. However, the awkward conversation is one that I would prefer to avoid given the uncertainty. Is it possible to get a more definitive diagnosis of HSV-2?  Since it is unclear whether I have HSV-2, are the odds of transmission impacted (vs knowing I have it)? Are there "safer" activities that so not require disclosure (oral sex, etc)?

Thanks in advance for your help!

[Terri Warren, RN, Adult Nurse Practitioner]

If you are with someone who is negative for the type of HSV that you have, you could consider taking daily therapy to reduce the risk of transmission.

Terri

[Confused5665]

So in terms of being cautious and mitigating risk, is it safe to say that I should be equally careful with kissing as with oral sex?  Beyond not kissing or performing oral sex when a sore is present (or known), what precautions do I take when kissing and/or performing oral sex outside of an outbreak if I assume that the risk of asymptomatic transmission via both methods is equal?

Thanks.

[Terri Warren, RN, Adult Nurse Practitioner]

I don't believe we have any data about the differences between transmission rates during kissing and giving oral sex, and I like to base answers to questions based on science.  

Suffice to say, we see patients who are infected both by people who have a cold sore and people who don't that have given them oral sex or kissed them.  

Wish I had more information to give you on this topic.

Terri

[Confused5665]

Thanks Terri.

Is there a difference between infection rates during shedding between oral to oral contact (kissing) and oral to genital contact? I understand that having HSV-1 presents a risk of transmission. I know my original question was about oral to genital HSV-1 transmission, after reading your response I am now wondering if oral to oral contact somehow poses less risk.  

In researching this issue, I came across a response from Dr. Handsfield on this forum.  It's from 2007 and in it he says the following in response to a man's concern about the possibility of contracting HSV-1 from his HSV-1 positive girlfriend:
"Yes, there is a possibility you could get oral herpes by kissing her; the odds are very low if she isn't having an outbreak, but they aren't zero.  Same if she performs oral sex on you."

Here is a link to the entire thread.
http://www.medhelp.org/posts/STDs/HSV1---Asymptomatic-Shedding-Risks---oral-and-genital/show/249237

Thanks again for your help.  This is such a confusing topic and your knowledge and insights are incredibly helpful.

[Terri Warren, RN, Adult Nurse Practitioner]

You should definitely avoid giving oral sex when you have a cold sore, that is the one time you can be very clear that you are shedding virus.  However, you can shed virus when you have no symptoms, and the problem is that you cannot know when that is happening.  We have seen patients who have been infected both by someone who had a cold sore and for those who were given oral sex by someone who did not have a cold sore.  I wish there was some magic way to know when shedding is happening.

Terri

[Confused5665]

Question about HSV-1 transmission during oral sex.  Is oral HSV-1 asymptomatic, or is the major risk of oral transmission when one has a developing and/or active HSV-1 oral outbreak?  My question is so I can better understand the precautions I should be taking to mitigate the HSV-1 risk you mentioned above.

Historically, I have not performed oral sex during a HSV-1 outbreak. For what it's worth I infrequently get oral outbreaks.  

Thanks.

[Terri Warren, RN, Adult Nurse Practitioner]

None of those things influence the test.

Can you send some serum to my clinic?  That's what I need.

Terri

[Confused5665]

Thanks Terri.  I am interested in the Illinois test as that may offer a different perspective.  As further background, I had chicken pox as a child, have had molluscum and also have tinea versicolor (fungal condition).  I have no idea whether those things may trip ELISA or WB, but they are there.

How do I best pursue the Illinois option?

Thanks again.

[Terri Warren, RN, Adult Nurse Practitioner]

You are in a difficult situation.  
You could do the western blot again and see if it is different (I doubt that it will be).  Since you are positive for HSV 1, you giving oral sex without risk is not possible.  However, it is our experience that people who test repeatedly atypical for HSV 2 are unlikely to be infected.  We agree with UW.  And no one can say with certainty that you are not infected.  This has to do with the state of testing, not so much you or your situation.  I have actually seen this happen many times with low positives such as yourself.  Something is present in the antibody that trips both the ELISA  and partially, the western blot.  If you could arrange to have some of your serum sent to our clinic, we are working with someone who might be able to give another opinion based on a new test out of Illinois.  It is not an FDA approved test (neither is the western blot), but he looks at this in a slightly different way.  

So you have two options:
To decide that you might really be infected, and take daily therapy to reduce transmission risk or to decide that you aren't infected and forget about it.  I don't think you have any other options.  However, you could retest and send serum to us for us to send to Illinois as potential helpful measures.

Terri