need help with HSV-1

[lookingforhelp24]

Ms. Warren,

Thank you for this forum and everything you do.  I have read many of your postings, including the Herpes Handbook on your website and have found it all to be very helpful.  So again thank you.  In addition to reading your posts I have also read a lot of the postings by Dr. HHH and Dr. Hook.  I was hoping you could give my some insight into my boyfriends and I situation.  We are both 24 and met in college,  5 months ago it appears I gave him GH (type1), I have never had any symptoms of  HSV1 orally or genital.  He came home one day and said that he was having possible symptoms (sore lymph nodes and red bumps that formed a scab), his doctor said it looked like folliculticus but swabbed anyway (HSV-1).  In addition to that we have never engaged in oral sex in the almost 2 years we have been together, either him on me or me on him.  This is what has me very confused, HOW?  - he has had only one other partner (I have had a few more), and had multiple blood tests done before he met me all negitive, I have not had any tests done, I figured that when I get my pap they test.  After hearing his results I was tested and sure enough HSV-1 pos.  

I have read on many Dr. HHH’s threads that GH due to HSV-1 is a “trivial matter.” Also that it is “not a big deal,” and something people should not worry about.  That 60% in the US have it and am I just part of that majority. And when positive with no symptoms, concidered normal.   I would like to hear your opinion on GH due to HSV1, do you share the same opinion?

I recently went in to have my annual pap, I told my gyno that I have GH (I went to a different place for the test).  She immediately asked which type and she had the same reaction that its not a big deal, as HSV2 can be a problem.  She said that it was very RARE that transmission happened (HSV1, never any symptoms, and the location). I dont question her expertise, but I know you’re a nationally respected expert and I’d like your opinion.  

Thank you!

[Terri Warren, RN, Adult Nurse Practitioner]

you're welcome, good luck with that!
Terri

[lookingforhelp24]

I definitely will let you know how everything goes, Its going to take a while.   But we'll get this test somehow.

Thanks again!!!!!!

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, all of his test are negative, but again, the western blot is more sensitive for HSV 1 and I'm glad he is pursuing it.  Will you let me know how that all goes?

Terri

[lookingforhelp24]

Thanks so much, again.  This has been helpful to both of us.

As far as the results, I have not seen the actuall results (i think you may mean the numbers).  What I did see was:
HSV TYPE 1 AB, IGG NEGATIVE
Reference range: NEGATIVE  
HSV TYPE 2 AB, IGG NEGATIVE
Reference range: NEGATIVE

Thats all it said for both of our blood tests. He is going to pursue the WB, hopfully that will make this a little bit clearer whats actually going on.

[Terri Warren, RN, Adult Nurse Practitioner]

I think the western blot would be the way to go for him because of its greater sensitivity for HSV 1.  I've not seen a case like yours where you have HSV 1 and pass it without symptoms, but I know it has happened, so don't be too reassured.  

He needs to work on this fear.  If he decides this is all too much for him, the chances that he will find a woman without HSV 1 or 2 is pretty small, and really narrows the population from which to choose.  

Have you or him actually seen the test results for herpes?

Terri

[lookingforhelp24]

in the third paragraph I ment to say......"he was tested again in Jan 09, after he met me, to ensure that he didnt have any of it."

[lookingforhelp24]

First, thank you so much for your response.  This is so nice to be able to communicate with some of the nations leading specialists in this field.  Your response makes perfect sense to me, and actually he had been planning on being retested.  He said that he will go back in, in May to allow ample time for his body to adjust to the virus, if indeed he did receive it from me.  Also he was looking at getting the WB, just to be absolutely sure.

Also yes, I did have a blood test that was positive.....But I have never had any symptoms either genitally or oral.  Does genital HSV1 cause asymptomatic infections?  Also from what i have read that asymptomatic genital infection is rarely transmitted  by genital contact, have you seen a case like mine i.e. never have any symptoms and pass genital HSV1?

lastly I did have him review his results with me.  He did have one other partner that he did receive oral from.  He never had any symptoms since then (summer of 2007).  He actually had a STD class in college which lead him to being tested.  He tested negative twice in spring of 2008 and then after he met me he. Then of course a 4th time in DEC with the whole thing started.  As you can see he has always been "scared" of this virus, I really wish I knew of all of this so that I would have been tested.  And your right for us this has been far from "trivial."  I really wish we could go back to being a happy couple of 24 year olds.  This have been very, very depressing.

[Terri Warren, RN, Adult Nurse Practitioner]

My personal experience is that, for HSV 1, if the ELISA test misses it, it continues to miss it.  But we normally wouldn't do it more than two times before running a western blot which is more sensitive for HSV 1 than the ELISA.

Terri

[fm123]

Terri, I've read through some of your responses and had a question from this particular one, which is a question I've had. This woman's boyfriend tested negative by blood test for hsv1 by multiple blood tests. I've gathered from Grace's responses that "the positive predictive value goes up significantly that they are accurate when you've had this many negative tests." Meaning the test should pick it up with multiple samples, not keep missing it.

Do you agree? Do you see patients who've had the test pick it up, then miss it, or the other way around?

Thank you, your work here is wonderful.

[Terri Warren, RN, Adult Nurse Practitioner]

Well, first of all, you don't actually KNOW that you have genital HSV 1 infection, I don't believe.  What you know is that your partner has HSV 1 infection and that you didn't give him oral sex, but you also know that he has had one other partner.  The only way you would know that YOU gave him HSV 1 infection is for him to have tested antibody negative at the beginning of this situation, and subsequently tested positive by antibody test for HSV 1 (indicating seroconversion related specifically to this incident).  Does that make sense to you? The problem with the HSV 1 antibody test is that is misses one out of 10 infections, so even if he did test negative for HSV 1 prior to sexual contact with you, it might have been because the test missed it.  Also, most places don't include screening for HSV 1 in their STD screens - he might want to check on that.  Do you know if his other partner gave him oral sex?  

Also, as I understand your post, you test HSV 1 antibody positive, but you haven't had a genital outbreak, is that correct?  about 70% of those infected with HSV 1 orally don't have symptoms, do I'm not clear that you really know the location of your infection for certain.  

So lets say that you do have HSV 1 infection in the genital area.  I don't know that I would say it is a trivial infection, rather, I would say that it recurs infrequently and shed infrequently, reducing the risk of infecting a partner.  I hesitate to use the word trivial as that implies that it isn't important, and it sounds important to you.  I would rather say that it is a minor medical problem.  However, if you DO have HSV 1 genitally, when and if you become pregnant, you need to let your provider know that as HSV 1 genital infection can be transferred to neonates, though not commonly.  You may not have any symptoms orally or genitally and it may be tough to figure this out, but if you do have any symptoms in either locations, get them swabbed. When my patients have this problem (antibody positive for HSV 1 and no symptoms anywhere), I send them home with PCR swabs so they can gather samples at home at the very first sign of symptoms and bring them back into the clinic and we send them to the lab.  

I hope this helps, and I want you to feel free to ask more questions on this topic as I'm sure its quite common and others will be helped as well.

Terri