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Different Results for HSV1
Dear Dr. Cook,
I am a female, 20 years old. Here is my dilemma: In June 2009, I had redness and was very sore in my genital area. I went to see my ob/gyn. She did an exam and wasn't sure what it was so she also did a culture test which came out positive for HSV1. She believed it was an initial outbreak and that it would have been transmitted within the last two weeks. No blood test was done. My partner of two months insisted he did not have HSV1, but would not get tested so I was never able to confirm where it came from. Can this virus be dormant in your system and not cause an initial breakout until months later? I was prescribed an antibiotic and an anti-viral med which I never took because I couldn't afford the prescriptions.
Since then I have not had any further outbreaks or symptoms. Last week, which is 10 months since the outbreak, I decided to get a blood test to follow up and make sure the diagnosis was correct because everything I've read indicates I would have had recurring outbreaks, especially since I didn't take any medicine to prevent it. The test used was "HSV Specific Type 1 & 2 IgG Combo (HerpeSelect)". The results show:
HSV 1 IGG TYPE SPECIFIC AB <0.90
HSV 2 IGG TYPE SPECIFIC AB <0.90
The interpretation is negative.
So I'm very confused. My understanding is that certainly after 10 months I would have built up enough antibodies to show a positive result in a blood test. How accurate is the HerpeSelect test and which test should I rely upon? I am also considering getting a third blood test if necessary to find out for sure.
Thank you for your help.
I am a female, 20 years old. Here is my dilemma: In June 2009, I had redness and was very sore in my genital area. I went to see my ob/gyn. She did an exam and wasn't sure what it was so she also did a culture test which came out positive for HSV1. She believed it was an initial outbreak and that it would have been transmitted within the last two weeks. No blood test was done. My partner of two months insisted he did not have HSV1, but would not get tested so I was never able to confirm where it came from. Can this virus be dormant in your system and not cause an initial breakout until months later? I was prescribed an antibiotic and an anti-viral med which I never took because I couldn't afford the prescriptions.
Since then I have not had any further outbreaks or symptoms. Last week, which is 10 months since the outbreak, I decided to get a blood test to follow up and make sure the diagnosis was correct because everything I've read indicates I would have had recurring outbreaks, especially since I didn't take any medicine to prevent it. The test used was "HSV Specific Type 1 & 2 IgG Combo (HerpeSelect)". The results show:
HSV 1 IGG TYPE SPECIFIC AB <0.90
HSV 2 IGG TYPE SPECIFIC AB <0.90
The interpretation is negative.
So I'm very confused. My understanding is that certainly after 10 months I would have built up enough antibodies to show a positive result in a blood test. How accurate is the HerpeSelect test and which test should I rely upon? I am also considering getting a third blood test if necessary to find out for sure.
Thank you for your help.
MEDICAL PROFESSIONAL
Welcome to the STD forum. Dr. Hook and I take questions interchangeably, without regard to specific requests. We have been close colleagues for 3 decades and our opinions and advice never differ significantly.
The HSV blood tests are not perfect, and the HSV-1 test is less perfect than the one for HSV-2. It can take up to 6 months, sometimes as long as a year, for positive results; and around 10-15% of people infected with HSV-1 never develop positive blood test results. By contrast, the culture and PCR tests -- i.e. the tests done directly on genital lesions -- are highly reliable if positive. So your negative blood test doesn't change anything: you definitely had genital herpes due to HSV-1.
That your partner has no history of HSV-1 doesn't mean much. About 50% of all adults in the US (higher or lower percentages in other countries) have HSV-1, mostly oral infections acquired in childhood -- and most of them have no knowledge of having had herpes and have no history of cold sores, etc. So despite his denial of infection and refusal to be tested, sure he is infected. It is most likely you were infected through oral sex; genital to genital HSV-1 transmission is uncommon -- although that certainly is possible as well.
As for recurring outbreaks, "everything I have read" is wrong. That's true for genital HSV-2 but not usually for HSV-1. In the first 2-3 years after a new genital HSV-1 infection, about 40% of people have no recurrent outbreaks at all; about half have 1 or 2 outbreaks, then no more; and only a few have episodic outbreaks that keep recurring. (By contrast, 90% of those with HSV-2 have repeat outbreaks, usually 3-8 times per year.) In addition, asymptomatic shedding of the virus is less common for genital HSV-1 than HSV-2, which is why most people with genital HSV-1 don't pass it by intercourse to new partners. It can happen but isn't a very high risk.
Going back to your blood test, you might want to consider another one after 6 months and/or at the one year mark. But even if the HSV-1 test remains negative, it really won't change anything -- so there's really no need. But it's available if you're curious about it.
Lots of accurate information about genital herpes is available at some excellent websites. Try the American Social Health Association (www.ashastd.org) and The Westover Heights Clinic of Portland, OR (www.westoverheights.com). Disclosure: Dr. Hook and I serve on ASHA's board of directors and Terri Warren, moderator of MedHelp's herpes forum, is the WHC owner/director. There also have been hundreds of discussions on this forum; try using the search link and enter "HSV-1 genital" or "HSV-1 symptoms" and see what you find.
I hope this helps. Best wishes-- HHH, MD
The HSV blood tests are not perfect, and the HSV-1 test is less perfect than the one for HSV-2. It can take up to 6 months, sometimes as long as a year, for positive results; and around 10-15% of people infected with HSV-1 never develop positive blood test results. By contrast, the culture and PCR tests -- i.e. the tests done directly on genital lesions -- are highly reliable if positive. So your negative blood test doesn't change anything: you definitely had genital herpes due to HSV-1.
That your partner has no history of HSV-1 doesn't mean much. About 50% of all adults in the US (higher or lower percentages in other countries) have HSV-1, mostly oral infections acquired in childhood -- and most of them have no knowledge of having had herpes and have no history of cold sores, etc. So despite his denial of infection and refusal to be tested, sure he is infected. It is most likely you were infected through oral sex; genital to genital HSV-1 transmission is uncommon -- although that certainly is possible as well.
As for recurring outbreaks, "everything I have read" is wrong. That's true for genital HSV-2 but not usually for HSV-1. In the first 2-3 years after a new genital HSV-1 infection, about 40% of people have no recurrent outbreaks at all; about half have 1 or 2 outbreaks, then no more; and only a few have episodic outbreaks that keep recurring. (By contrast, 90% of those with HSV-2 have repeat outbreaks, usually 3-8 times per year.) In addition, asymptomatic shedding of the virus is less common for genital HSV-1 than HSV-2, which is why most people with genital HSV-1 don't pass it by intercourse to new partners. It can happen but isn't a very high risk.
Going back to your blood test, you might want to consider another one after 6 months and/or at the one year mark. But even if the HSV-1 test remains negative, it really won't change anything -- so there's really no need. But it's available if you're curious about it.
Lots of accurate information about genital herpes is available at some excellent websites. Try the American Social Health Association (www.ashastd.org) and The Westover Heights Clinic of Portland, OR (www.westoverheights.com). Disclosure: Dr. Hook and I serve on ASHA's board of directors and Terri Warren, moderator of MedHelp's herpes forum, is the WHC owner/director. There also have been hundreds of discussions on this forum; try using the search link and enter "HSV-1 genital" or "HSV-1 symptoms" and see what you find.
I hope this helps. Best wishes-- HHH, MD
Oops... sorry... wrong doctor name...
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
