STDs Expert Forum
Carrier?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Carrier?

I was recently given a blood test for Herpes and tested positive for anti-bodies.  However, I cannot recollect an episode of having herpes in my entire life.  Does this mean I have herpes?
Does this mean I am a carrier of the virus?
Does this mean I can and/or could have passed the virus to someone I did not have protected sex with?
Thanks.

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I'll try to help.  The first thing is to be sure you had the right test.  Several blood tests are offered by various laboratories, and many health care providers don't know the differences between them.  The accurate ones are the HerpeSelect test, produced by Focus Technologies; biokit-HSV-2, produced by Biokit USA; and the Western blot HSV test, which is used by research labs and isn't very often commercially available.  Be sure that one of these was used; if not, then your result might be falsely positive.  NO OTHER BLOOD TEST RELIABLY DISTINGUISHES ANTIBODY TO HERPES SIMPLEX VIRUS TYPES 1 AND 2.

The rest of these responses assume you indeed are positive for HSV-2, the usual cause of genital herpes, with a proper test.  I'll answer briefly; for more information, click on the link to STD summaries/articles at the top of this form, or go to other sources, such as the excellent website offered by the American Social Health Association (www.ashastd.org).

Yes, a positive test means you are infected with HSV-2, most likely in the genital or anal area.  Yes you have herpes, but most cases are asymptomatic.  Yes, you are a carriers; even people with asymptomatic infections are able to pass the virus to their sex partners.  However, I have no way of knowing you have done so.  Asymptomatic shedding of the virus occurs intermittently, and even when the virus is present, it isn't always transmitted.

Most people with apparently asymptomatic herpes in fact have mild symptoms that they can recognize once they know what to look for.  Pay attention to minor sores, itchiness, irritation, or scabs; they may be very tiny, even a millimeter or less.  They can appear anywhere on the genitals; in men they are most common on the penis, and in women anywhere near the vagina or between the vagina and rectum.  Sometimes lesions occur around the anus, even in men and women who haven't had anal sex, and sometimes quite distant from the genitals, such as the buttocks or thighs.  Repeat outbreaks typically occur in more or less the same spot.  So be on the lookout for minor symptoms like those, and if you have them, look closely, with a mirror if necessary.  (You don't say your gender; recognizing lesions can be more difficult for women than men, for obvious reasons.)

Don't panic.  Most cases can be controlled and with care partners can be protected.

Good luck--  HHH, MD
5 Comments
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As a follow up, the test I was given was the Herpeselect Type 2 Test.
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2nd follow up,

Now that I know I am a carrier and I am infected with the virus, should I ask my physician to put me on medicine to prevent out breaks and transmission of the disease?

Or is that not necessary since I think I am asymptomatic or I might be asymptomatic?


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Even if you're totally asymptomatic, you still sometimes shed the virus subclinically. Suppressive therapy doesn't prevent transmission of herpes, but it does cut the risk in half. So, if your partner(s) get tested and are negative, that's something to consider for their benefit. The risk in general depends on whether you're male or female - if I remember correctly, assuming you avoid sex during outbreaks/prodrome, it's around 4%/year (2% with treatment) for female to male, and around 8%/year (4% with treatment) for male to female. Otherwise, if you're not having bothersome outbreaks, there's no reason to be on suppressive therapy.

And as Dr. Handsfield noted, it's possible people aren't so much asymptomatic, as they just don't recognize the outbreak. Herpes is just so weird - it's not always the classic blisters. I have both HSV1 and 2, and aside from a painful "yeast infection" a couple of years ago (which is why I asked my doctor to test me), I've never had anything resembling a classic outbreak. Now, though, I pay closer attention to my body, and I have a feeling I have more symptoms than I was aware of. Chances are if you think about it, you might be having symptoms, too.

I'd suggest spending some time learning everything you can about herpes, so you can educate your partners as well. Dr. Handsfield's site (linked at the top of the page) is a great resource, as are his truly excellent responses on this board. Also, a terrific source for herpes info is Terri Warren's site, www.westoverheights.com; check out the online herpes handbook. And of course, don't forget www.ashastd.com and www.cdc.gov/std.
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Monkeyflower has it right.  However, the efficacy of valacyclovir in preventing transmission may be better than 50%; there were aspects of the research study design that probably minimized the drug's protective effect.  In any case, look at antiviral therapy as one of 3 main tools to help you protect partners, the others being condoms and avoidance of sex during outbreaks (hence the importance of you recognizing outbreaks if possible.  None of these is perfect, but for some people they work very well over long periods of time.

Monkeyflower's additional information sources also are excellent.

Good luck--  HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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Edward W Hook, MDBlank
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