Herpes Test Results- How accurate for asymptomatic people?

[NeedPeace35]

Dear Dr. Handsfield,
I am a 35yr old female that started getting recurrent yeast affections for the last 2 yrs; OTC medicines weren’t working until after a couple of times. For the past 2 months it seemed that the itching wasn’t going away (never really get colored discharge, just itching). I go for my annual at a Planned Parenthood. I asked for STD testing and the herpes test- as usual. The PA wanted to dismiss the herpes test, but evidently, she went ahead and I get a call a week later saying I tested positive for Herpes type 2.To my knowledge, I have never had any symptoms, let alone an outbreak (living a high stressful, lack of sleep lifestyle, coffee drinking workaholic, with no symptoms!). In denial, I called an online STD testing that directed me to LabCorp and took another blood test. Waiting for the result, I went to another clinic, in fear that the itching near my vaginal opening had something to do with a ‘symptom’, but the PA there said I looked healthy and normal. She believed that I may still have yeast and gave me an RX for Fluconazole and told me to put cortisone in the tiny area that itched.  She said if it went away in a couple of days it couldn’t be a herpes outbreak. This worked in one day and the itch went away.
I then get my lab test from LabCorp: HSV 1 and 2 –Specific Ab, IgG
HSV 1, IgG- Type spec  result: 2.95   flag: high (Negative 1.09)
HSV 2, IgG- Type spec  result: 3.68   flag: high (Negative 1.09)
I'm getting better with being positive; which for me, I should be grateful that I haven’t had a symptom (someone's cold is a flu for me, so being asymptomatic is strange), but is there ANY slim chance that my type of test result is not accurate and I should go and find someone to do a HerpeSelect or Western Blot test?
I appreciate your help and expertise

[Edward W Hook, MD]

Thanks. Glad we can help.  As far as the two questions I see here:

Duration of suppressive therapy.  The FDA has approved suppressive therapy for up to a year however the reason for this duration is because that is how long it was studied (the FDA can only approve what is studied).  There are many people who have taken suppressive therapy for more than five years without consequences.  The data are better for acyclovir than for valacyclovir simply becasue acyclovir has been around longer.  In general, drugs such as acyclovir and valacyclovir are among the best tolerated medications in routine use.

You do not need to worry about spreading your infection from one location to another through an errant scratch of your fingers.  For all practical purosess this does not happen.  The immune response that your body has prodiced (and which is in part detected by the blood test) is protective against this.   EWH

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.  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).  

You asked several good questions and may have been given some mis-information by some of the health care providers you have seen.  Let's start with the lab tests.  The lab test results you have appear to be from a HerpeSelect assay.  Both of the levels reported are in the range where they are likely to be true positive and  reflect infection that you may have gotten at some time in the point (hard to say when).  There is still a small chance that one of them is falsely positive and a Western blot is the test that would best sort this out.  My recommendation however is to assume that you indeed do have both HSV-1 and HSV-2, like so very many other people.  

Location.  As you probably know, HSV-1 most often causes cold sores but can occasionally cause genital herpes as well.   When it does recurrences or sexual transmission is uncommon. HSV-2 is typically a genital infection.  Importantly, persons with this infection can be asymptomatically shedding the virus, and therefore be at risk for transmission to sex partners, about 10% of the time, even without lesions or symptoms.  This asymptomatic shedding accounts for most transmission of herpes to others.  Risk of transmission can be reduced by regular and proper condom use and chronic suppressive therapy with an antiviral medication such as acyclovir or valacyclovir.  The choice of chronic suppressive therapy is yours but, as explained below, I think it may be worth your while considering it, at least for a while.  Further information on both asymptomatic shedding and suppressive therapy are available on the web-site mentioned above.

BTW, that you have herpes and so much asymptomatic shedding occurs does not mean that every partner you have will acquire infection.  It turns out that most exposures do not lead to infection however this is a numbers game and with so much herpes around, transmission is not at all uncommon.

No, this  issue of symptoms.  There is a possibility that the "recurrent yeast infections" and itching you have experienced are not yeast but herpes.  Most people expect the symptoms of herpes to be really distinctive but it turns out they can be highly variable and can mimic other processes like yeast infections.  Because the recurrences can come and go, treatment can seem to be associated with improvement when the fact is that the treatment and improvement were unrelated coincidences.  As I mentioned above, given your history of recurrent symptoms, it may be that you would not have further recurrent symptoms with antiviral suppressive therapy.  If so, this would be suggestive that you were not having recurrent yeast infections but recurrent herpes episodes.  

Similarly the tiny itchy area that you treated with hydrocortisone cream could have been an HSV outbreak as well.

To summarize.  Bottom line is that you are likely to have HSV 1&2.  Some of your recent symptoms may have been due to the HSV but not identified as such.  One way to sort this out would be a trial of several months of chronic suppressive therapy.  Hope this helps.  Check out the web-site.  EWH

[NeedPeace35]

Thank you Dr. Hook,

Although I'm frustrated of the unknown and mildly uncomfortable, I'm relieved with your advice that this is not an outbreak and I will concentrate on finding a Doctor who could work with me to find the solution.

I also forgot to mention, the itch 'coincidently' started after I had sex with someone last year; possibly the one I may have gotten HSV2 with, but could he have had a
yeast infection as well?

I will ask no more questions....

Be well :)

[Edward W Hook, MD]

I understand your frustration.  Now that you are aware that you are likely to have HSV, you are vigilant in looking for outbreaks.  That said, not every genital symptoms that you ahve will be due to herpes. Indeed, most will not.  As pointed out, the duration of the symptoms and the lack of lesions all inidicate that this is not herpes.  I agree with the numerous health care providers you have seen.

So what is it?  I do not know.  I would suggest the you work with one health care provider whom you feel good about to sort this out.

Take care.  EWH

[NeedPeace35]

Hello Doctors,

I'm extremely confused about the vulva itch that I have in a certain area that I discussed with 3 PA's where I live and on this forum with Dr. Hook that it could possibly be my type of genital herpes outbreak.
The thing is, I have been on episodic therapy 2 weeks ago
(Acyclovir-200mg, 2tabs 3xdaily for 5 days)
and then went straight to suppressive therapy (400mg 2 tabs daily)
and I still have the itch (it's slightly red in the area; no pain/bumps/blisters), but now along with a little bit of cloudy discharge that seems to be the cause of the itch(?).
I've been taking yeast infection medicine for close to a year now-all kinds, and that just suppresses the symptoms for a bit.
I've just moved to another state and I've been to 3 PA's in Orlando, FL that tell me it's probably yeast and it couldn't be an OB because this has been a constant for so long. If you're unsure what this possibly could be, what can be done to get a straight answer? I was tested for all other STD's and came out clean.I forgot to mention I've succcessfully handled yeast infections for 20yrs and this doesn't feel like one.
Since I've never had a physical OB- not even a bump, just tested positive for type 1&2, could I be outbreaking on my cervix that is causing the discharge and itch?
Thrush?or some other bacteria infection they're not testing me for?

I apologize for another question, but I'm frustrated
Thank you  

[NeedPeace35]

Thank you so much Dr. Hook for your extensive answer. I was upset that Planned Parenthood never told me I had Type 1-which I kinda new because I've had an occasional cold sore inside my cheek (I haven't had one in over a decade), but I had to find that out with the second test.

How long can someone be on suppressive therapy? I've read that it could be up to a year, but since this a lifetime infection, can taking suppressive therapy be harmful to the body over time?

I know outbreak durations vary as well, but itching in the past seemed to be longer than what I've read about how long outbreaks last; but I definitely understand what you are saying. I will go find an OBGYN to start me on suppressive therapy. I also felt tingling for about a week (since I found out) but that's gone away and I've read that could just psychological.

I forgot to ask that during the time I would checked myself for any visible signs I had an itch in the corner of my eye and used my finger nail to scratch it. I wasn't thinking and I got a little hysterical thinking I could of spread the infection to my eye. I don't have any eye symptoms, but being asymptomatic (until I figure out the truth about the itching), can you spread Type 2 to your eye and get no symptoms?

I wanted you to know that what you and Dr. Handsfield are doing with answering questions for the concerned is such a wonderful thing to do. Thank you for caring.