HSV Results

I received blood test results from my doctor this week, and am trying to remain level headed about this, but it's not easy.  My doctor said I have HSV, and that it shouldn't matter whether I have Type 1 or 2.  I am not in a monogamous relationship. I have had unprotected vaginal sex twice in the last year with the same man. I have given and received oral sex with two different men in the last year. I feel stupid, angry, and like I'm being punished for my promiscuity.

The test results were as follows:

HSV Ab Screen IgM Detected
HSV Ab Titer IgM 10 H

HSV1 Ab IgG 4.2 H Positive
HSV2 Ab IgG  0.00 Negative

My doctor focused on IgM result and told me I probably contracted HSV within the last 12 months. She said HSV1 can be transferred to the genital area. I have had a minor irritation/sore in the genital area off and on for the past 6 months.  I kept trying to understand the results and asked her questions about which type I have, as it looks like I have type 1, which I've always had, and had not been concerning to me previously. She gave me an Rx for Acyclovir 800 mg 3xday for a week then 400 mg maintenance, which I began yesterday. I've always tested positive for HSV1 and get cold sores about 1-2 times per year. I've never had any symptoms in my genital area until about 6 months ago.

Questions for you:

1.  Was my doctor correct in her interpretation of the results?
2.  Do I need to be concerned with an HSV1 positive result and/or the IgM result?
3.  Was my doctor's treatment correct?  If not, what would you recommend?
4.  Should I get a different, more specific test?  If so, what would be the value and are they covered by insurance?
5.  What is the difference in Type 1 vs Type 2 in regards to spreading it.

I so appreciate your advice!!
  

[Terri Warren, RN, Adult Nurse Practitioner]

1.  Was my doctor correct in her interpretation of the results?

So this is the downside of clinicians doing blood antibody tests for herpes, when they have no idea how to interpret the results.  No, she was not correct in her interpretation, most likely..
2.  Do I need to be concerned with an HSV1 positive result and/or the IgM result?

Because you have cold sores in your past and you are infected orally, you will be positive for HSV 1.  The IgM likely has no meaning whatsoever.  But the IgM test is not wrong every single time, just most of the time.  How long has it been since you've had unprotected sex, and is the man willing to be tested?  If its been 4 months or longer, you are fine, no worries.  If four months or less, then you might ask him to be tested.  If he is HSV 2 negative, you are fine.  If he is not willing to be tested, and it has been less than four months since you last had sex with him, you could retest when four months have passed for HSV 2, just be to very clear.

3.  Was my doctor's treatment correct?  If not, what would you recommend?

I would recommend no treatment unless your cold sores bother you and you would like to have them less often, then you might consider suppression.

4.  Should I get a different, more specific test?  If so, what would be the value and are they covered by insurance?
No, and the answer to further testing is above.  The IgM test is NEVER recommended to diagnose HSV in the adult.  

5.  What is the difference in Type 1 vs Type 2 in regards to spreading it.

You have HSV 1 orally, it is very unlikely that you would get it genitally as well since you have an immune response to that virus.  You could shed HSV 1 from the mouth and give it to someone else through oral sex, that is a possibility.

I so appreciate your advice!!

You're welcome.  I"m so sorry you had to go through this worry.

Terri