Help! Do i have Herpes TYpe 2

[Sunflower1804]

Hi Doctor-

I am almost sick with worry- got the test results for Herpes Virus Test, and the test said it is an "Antibody Test" which is "Type Specific Glycoprotein-G1 for HSV1 or Glycoprotein-G2 for HSV2". The results I got for Herpes Virus Type 2 Antibody IgG was 3.1 which is much higher than the acceptable units of 1.1.

However, i have no signs of lesions, blisters or sores. However, there is a "cyst" like thing- which is about 0.5cm in diameter, very deep in the skin- like a very deep pimple which does not "erupt" and has been there for more than 2 months. It is painless and feels like a small seed deep in the skin when i touch it. This is right at the bottom outer left lip of my vagina, near the anus.  

I have been in this relationship (monogamous) for the past 15 months, and my partner has confirmed that his recent STD tests (june 2008) were all negative and has been monogamous. I have occasional thrush- like an itch on the external vagina but it it manageble after i started on regularly taking "probiotics".

A bit of my medical history, last year 2007 i had several occurences (7 times) of UTI but it has all stopped now. Mainly due to the reason that the doctor did not give me a "strong" enough dose of antibiotics- 3 days only. THis year, after seeking a second opinion, the doctor covered me for 7 days of medication and it all cleared up. Since 2008, i only had 1 occurence of UTI.

I am not sure if this is a "HerpesSelect" or "Pockit" test- it is a test from a local medical laboratory. Just states it is a "Type Specific" Test. The results are devasting, and i am very stressed on whether i should confront my partner or not.

Questions:
1. Do I have Herpes Type 2?
2. What should i do now? I have been reading, and it says the "Gold Standard" for herpes virus is to wait for an outbreak for it to be "confirmed".
3. The doctor who saw me also gave me a course of anti-virual drug (Acyclovir). Should i take it?

Thanks,
Devasted

[Edward W Hook, MD]

No.  Herpes is not transmitted with every exposure.  If he did not have it when your relationship started he still may not. If he has not been tested using the same blood test he should be.  Until you sor thtis out, please use condoms.  EWH

[Sunflower1804]

Hi Dr Hook,

THanks for your comment.
my bf and i have been having unprotected sex since we got together- and it is a decision that we both made. to be monogamous.

Does that mean he probably already has contracted it?

[Edward W Hook, MD]

The topic of herpes is a complex one.  The disease is common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans.  For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else.  I will do my best to answer your questions but in general, many of these questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).

The blood test you have had sounds like it is a HerpeSelect.  Your results are positive for HSV-2, suggesting that you may have HSV-2.  There has been much discussion about the issue of false positive results, both on this forum and elsewhere.  In general, the closer the result is to the cut off, the more likely it is to be a false positive result.  Most experts will tell you however that once a result gets up to the range of 3.0-3.5 or above, the likelihood of false positives starts to get quite low.  Thus, on the basis of the numbers alone, it is more likely than not that you have acquired HSV-2 at some time in the past without know that this is the case unless your own personal history contradicts this probability.  The statistics show that 1 in 12 Americans with only 1 sex partner in their lifetime has HSV-2 and that overall the figure is about 1 in 5;  of these, 80-90% of persons do not know that they have herpes.  

While I am not saying that this is the case, it is not unusual for recurrences of genital herpes to be mis-identified as recurrent yeast infections, recurrent bacterial vaginosis or recurrent urinary tract infections by persons who do not suspect that they could have herpes.  

The cyst that you describe is not herpes.  If it were, it would not have been present for 2 months or longer.  ON to your questions:

1.  Can't say for sure but based on your test results it is more likely than not.
2.  Over half of people who have positive blood tests as you have then go on to notice a mild outbreak in the next 4-6 months.  My advice would be to not use antiviral therapy at this time, to discuss with your doctor and to arrange to have a herpes culture or PCR test performed ASAP after the appearance of any new genital lesion or discomfort.  Your may have a false alarm or two but if you have herpes this will help you to recognize how it manifests for you and to find out more definitively whether you have infection or not.  In the interim, I would suggest you and your BF go on and use condoms when you have sex.  Most exposures to partners with HSV do not lead to transmission and condoms work to prevent transmission.
3.  See above.  If indeed you have HSV-2, it will be in your interest to take therapy and chronic suppressive therapy (taking a pill to prevent outbreaks and asymptomatic shedding of the virus) reduces outbreaks, asymptomatic shedding and transmission of infection to others.

Hope this helps.  Take a look at the web site or search this forum for more information.  EWH