STDs Expert Forum
Discordant test result
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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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Discordant test result

Hi Dr HHH,

I was on the receiving end of unprotected oral sex in May from a high risk partner.  My wife got pregnant in July.  Went for first OBgyn check up in Aug.  Her result came back in Sept. with HSV type I IGG 7.7, IGG type II at 1.7 and IGM 1.17 using HerpeSelect.  I went to get check at the end of Sept. and came back with type I IGG 6.6 and type II IGG 0.0 and IGM 0.04 also using Herpeselect Elisa.  I was confused since I must be the one who passed it to her yet I was negative for type II.  I also got a breakout sometime in June, did not know what it was then and it was gone within a day or two.  I took my wife to HarbourView STD clinic in Seattle in late Oct. for test again.  I wanted Western Blot Test but was convinced by the doctor to repeat Elisa since I was told that if positive for I or II they will use Western Blot to confirm.  ELisa result came out for my wife is positive for I and indeterminate for II while I am positive for I and negative for II (No Index value was given by them).  Western Blot for my wife confirm positive for type II.  They would not give me Western Blot for my type I and I did not insist.  Could my type II be false negative?  
My wife never experience an outbreak.  So far her pregnancy is going fine.  I don't know if she should be taking medicine?
I have no more OB myself.  Just stressed out and depressed everyday for causing all this.  Can you shed a light on our discordant?  Also she had gone through 5 years of Orthodontics
and always have canker sore in her mouth.  What's the likelihood of getting HSV from dental treatment?  Thanks. Sorry for the long post
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So you both are HSV-1 positive, as are most people in the population.  Most likely you both have had those infections (orally) since childhood; most people with HSV-1 antibody have not noticed symptomatic oral herpes, but that's nonetheless the usual site of infection.  In other words, your HSV-1 infection probably has nothing at all to do with your oral exposure last May.

And your wife has HSV-2, as proved by the Western blot test.  She could not have acquired it from you, since you clearly do not have an HSV-2 infection.  She had to have acquired it from someone else, most likely a long time ago, before you were married.  I agree with the Harborview providers you saw:  there was no need for you to have a western blot test.  There is some risk that someday you will acquire HSV-2 by sexual transmission from your wife.  However, since it hasn't happened yet, it may never happen.  I wouldn't worry about it; if it happens, effective treatment is available in case you have a symptomatic infection.

Canker sores are not due to HSV-1; that's not an issue.  There is no reason to suspect your or your wife's HSV-1 infection was acquired from dental treatment.  That never occurs, or is too rare to worry about.

A final minor comment:  The IgM test results are completely meaningless.  And there is no such thing as a HerpeSelect IgM test.  The lab that originally tested you and your wife did a HerpeSelect IgG and some other manufacturer's IgM.  But IgM testing is useless no matter what.

Bottom lines:  Neither you nor your wife has infected the other with HSV of either type.  You both have HSV-1, probably acquired before you ever met each other.  Your wife has asymptomatic gential (genital) herpes due to HSV-2; she did not catch it from you.  If you have further questions/concerns about all this, I suggest returning to your Harborview providers, who have provided accurate assessments to date and will continue to do so.  (After all, they had a superb boss and trainer for 25 years:  me.)

Good luck--  HHH, MD
6 Comments
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Is it possible to get genital HSV1 infection now even after having been exposed to oral HSV1 in childhood? Thanks.
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I read it's highly unlikely.  For example: if you touch an active cold sore and then immediately scratch yourself in genital region, even then the antibody developed from oral infection will most likely fight it off and will not let the virus to settle in lower part of your body.  Bottom line chances are so extremely low that it is not something to be paranoid about, but just be careful when you have a cold sore or don't let a person with active cold sores to perform oral sex on you (common sense).  To Dr. HHH: Per advice from my ID I got retested with WB 3 months later; the result is indeterminate again. NOTE: No change in antibody profile. And as I said before I know that I did not have any exposure in over 2 years.  ID said giving my history and results I am NOT infected.  As Dr. Morrow said I might test indeterminate for the rest of my life due to some other non-herpetic antibodies.  Also in June I had a few shots done; such as MMR, Varicella (Chicken pox) etc. May be that caused a
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Loranta is right; superinfection is believed to be rare.  Most people are at least highly resistant, and probably completely immune, to a new infection (at an body site) with the same virus type they already have.

HHH, MD
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Is it possible for me to be a carrier of type II without showing any antibody?
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No.

That's your last comment/question.

HHH, MD
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