Confused by test results

I am really confused!  I am a medical doctor and I can't explain these results! Let me put this into context for you. I have recently tested positive for both HSV-2 (AB IgG @ 1.31 EIA units), HSV-1/2 (AB IgM positive titer 1:40)& HSV-1 IgG was 0.05 EIA units (negative) on 8/5/05.  Previously on 2/7/05, HSV-1 AB IgG was 0.20 EIA; HSV-2 AB IgG EIA 0.87 (technically negative) & HSV-1/2 IgM 1:160 (positive).  When I was tested in Nov. 2002, both HSV IgM and IgG were listed as negative.  I had an exposure to HSV-2 in early 1999.  I never developed any symptoms and to this day I still have not.  In early 2002, my then current fiancee (after being with her and only her since 2000)came down with genital HSV infxn (She denied being with anybody else).  Still, I had no noticeable symptoms.  So I got tested.  As you can see from above everything was negative.  Now this would not seem unusual except for the fact that since that engagement fell apart because of this, I am now getting married to someone else and we have been monogomous since 2002.  No interim relationships between the two engagements.  I have not been with anyone else and neither has she since 2002 (we have lived together since then).  My question is multi-part.  1) How am I now just testing positive for HSV in 2005 when my first and only exposure was in early 1999? - I have not heard of IgG levels falling to a "technically negative" value over time.  2)How do I know if I am contagious when I have absolutely no sign or clue that I have an active HSV infxn?  I do not want to give this to my future wife. 3) Are the earlier test results false negatives (even on two separate occasions, 3 years apart and from different states)?  4) Mentally, this is killing me.  How do I explain this to her when I can't explain it myself;  And, how am I supposed to be intimate (without condoms) with her without the constant fear of transmitting this to her (because I do not get any symptoms whatsoever)?  5) How do we go on and have a quality relationship with this looming out there?  
I don't know what to do.  I have currently made a unilateral decision to not have intimate contact with her and I know she needs and misses it; and it is killing me.  It is not healthy, but I don't want to give her this disease and I don't know what else to do.

Please help me.

Confused!?

[H. Hunter Handsfield, M.D.]

First, IgM HSV antibody results results are meaningless and should be entirely ignored.  See several other threads; in particular, look at what I posted in a thread started a week or so ago by "Papterdahl".

Next, be sure you have had (or arrange to get) proper HSV serology testing.  Although the range of numbers you give for IgG results suggest you had the HerpeSelect test, the fact that IgM testing suggests another test actually was used; HerpeSelect is not avaiolable as an IgM assay.  You might have had truly type-specific tests but I can't tell.  If you are in the US or certain other countries, HerpeSelect ought to be available.

Finally, if a proper serology continues in the gray zone range for HSV-2 (EIA ratio 1.0 to 3.0), have a specimen sent to a referance lab, such as the University of WAshington clinical lab in Seattle, for a Western blot assay.  That remains the ultimate gold standard.

To your specific questions:

1) Can't interpret whether your IgG antibody really went away or not, until it is sure you had truly type specific testing.

2) Unfortunately, if you have genital HSV, there is no ironclad way to know when you are and are not infectious.

3) See above.

4) Too complex for me to answer on line.  There are lots of strategies.  Lots of couples decide not to worry about it.  The silver lining around the dilemma of asymptomatic infection and shedding is that most people who acquire genital HSV don't even know it (like you, maybe); and in a permanent, monogamous relationship, protection of future partners isn't an issue; and if a person does get infected, effective treatment is available.  But as I said, you need more discussion than I can provide online. A great source is the American Social Health Association (www.ashastd.org).

5) Properly managed, genital herpes need not interfere seriously with a relationship or healthy, rewarding sex.  See no. 4.

Good luck--  HHH, MD

[Christie2004]

While you're waiting for Dr. HHH, click on Archives, then Herpes, then Herpes Test Results.  

HHH explained many times that tests using IgM results are misleading and not accurate.  There are a couple he mentions in the Archives, the most frequent test name that comes up is HerpeSelect by Focus Technologies.  You probably should be tested again, specifically asking for that test.  

He will give you more specific advice I'm sure, but he has said frequently in the past that IgM results are inaccurate and misleading.