False negative HSV 2

[rjshule]

My ex-husband had genital herpes.  I had a few outbreaks that started 2 years into our marriage but only lasted about 1 year.  Even though I did not have any other outbreaks, we assumed I had contracted the virus. We did not take any precautions.  After divorced I started taking Valtrex just in case.  Before I got into another relationship I had a blood test done.  It came back negative.  I stopped the Valtrex.  Now 2 1/2 years later I am starting another relationship so I had an STD workup done it is now positive - the result is HSV 2 Ab IgG index 11.64.  (I do not have the other results readily available)  I have told my current partner about this and he is doing his own research and trying to decide if he wants to continue a relationship with me.  We had unprotected sex twice before I got the results - unfortunately I assumed I was safe.

1.  I am assuming the first test was wrong and the second one is right - correct?  If not, is there another test that is more reliable?

3.  Do the numbers reflect the strength of the virus in the system?  My numbers seem high so I wondered if that means anything.

2.  Since I have not had any outbreaks for 8 years and my past partner did not contract the virus from me am I less likely to pass it on?

3.  I have a congenital kidney defect that made my kidneys smaller than normal (about 25% smaller) that causes my GFR to run around 50.  Could the Valtrex be harmful for me to take because of this?

4.  Can genital herpes be transmitted to the mouth during oral sex?

5.  Can genital herpes be passed from the hands to the mouth or genitals or is it only mucous membranes to mucous membranes?

Thank you in advance for your help!

[rjshule]

Thank you!

[H. Hunter Handsfield, M.D.]

Valacyclovir has no renal toxicity to speak of, but do confirm with your nephrologist.  Hand-genital contact rarely if ever transmits any STD.  With herpes, nobody can say it never happens, but I have never seen or heard of a case.

[rjshule]

I want to clarify two of my questions - I asked about infection spreading from the hand to other parts thinking of my partner - as an example - can he spread it from his hands to his mouth or his penis?

Also about the kidneys - I wanted to know if the Valtrex would affect my kidney function not whether or not the level renal function affected the level of Valtrex.  I will of course consult with my nephrologist on this one

Thanks again

[rjshule]

Thank you very much for your information - including pointing out my lack of logical skills (believe it or not I'm a computer consultant - I won't tell anyone I can't count!)  :-)

I will share this information with my partner.

This is a nice - easy to afford service, I will definitely use it again.

[H. Hunter Handsfield, M.D.]

I forgot to add that your partner can be tested to see if he is susceptible to HSV-2 or perhaps already infected.  Since 25% of the adult population has positive blood tests for HSV-2, there's a fair chance he already has it.  If so, you need take no precautions to avoid transmission.

[H. Hunter Handsfield, M.D.]

Interesting and confusing diagnostic test results.  Most likely your first blood test was falsely negative, but it is also possible that you were not actually infected during your marriage but acquired HSV-2 sometime after the negative blood test result.  But given your symptoms during your marriage, the false negative test result seems the best bet.  (You might recheck with the provider who did that first test and make sure you were given the correct result.)

To your direct questions, in order, but using your typographical numbers  ;-)

1) I agree; seee above.  Given the discrepancy, you could request a confirmatory test, such as the HSV Wesern blot test (which is available primarily at the University of Washington clinical labs).  But strongly positive index results like 11.4 rarely are wrong.

3) No, the ELISA index says nothing whatever about the "amount" of virus or about the likelihood of asymptomatic viral shedding, symtpomatic outbreaks, or the likelihood of transmission to a partner.

2) The frequency of symptomatic outbreaks definitely declines with time.  The same probably is true of asymptomatic viral shedding and the risk of transmission in the absence of symptoms, but that aspect has not been well studied and transmission risk probably never falls to zero.

3) That level of renal dysfunction should have no effect on valacyclovir blood levels or toxicity, but you definitely should not rely on online advice for that sort of question.  Also check with the provider who prescribed it.

4) Yes, a partner could get an oral HSV-2 infection if s/he performed cunnilingus on you.  It's pretty uncommon, though.

5) Autoinoculation of HSV--self infection from one body site to another--can occur, but almost all cases are limited to the very first infection, before immunity develops.  It is rare in people with longstanding infection like yours.  The greatest risk is for your eyes, but even that is rare.  Just use common-sense, everyday hygiene, especially handwashing after toilet, but don't otherwise worry about it.

All in all, my bet is that you are not highly infectious at this time, and that if you take suppressive therapy with valacyclovir (or acyclovir) and avoid sex with your new partner if/when you have an outbreak, there will be very low risk of transmission. If you add condoms as well, that will probably drop the risk to near zero.  Perhaps that is a strateg that would allow the partnership to continue while your partner considers the options.  I hope he will come to understand that herpes should never interfere with development and blossoming of a potentially long term, rewarding sexual relationship.  It's just not that big a deal.

Excellent innformation on herpes is available from the American Social Health Association (www.ashastd.org) and Portland, Oregon's Westover Heights Clinic (www.westoverheights.com).

Good luck--  HHH, MD