Implications of a HSV-2 IgG test result of 'Detected'

I am a 33 yr old male.  Recently I began a new relationship and out of courtesy to my partner, I got a blood test conducted to check for any STD's.

What suprised me was the IgG test for HSV 2 came back as "Detected".  HSV 1 also came back as "Detected", which is what I expected having experienced an occasional cold sore.  The HSV 1/2 IgM test was "Negative".  No numerical values were attached to either IgG test result.

My doctor has told me that the "Detected" result for HSV 2 means I have been "exposed" to HSV 2 in the past... what does this mean?  Does this mean I have contracted HSV 2?  As far as I can recollect I never experienced an initial outbreak, nor shown any symptoms.

If I have HSV 2, and if so and I am asymptomatic, how do I know if its dormant or recurrent?  Can I also be asymptomatically virus shedding?  If so, how can I prevent transmission?

My doctor tells me not to worry, but I am extremely worried that I have HSV 2 and could have transmitted it to others without realising.

[H. Hunter Handsfield, M.D.]

You provide insufficient information to interpret your HSV test results. If the test was a type-specific one, like HerpeSelect, it would be helpful to know the OD ratio (also called ELISA ratio).  But in the meantime, you should assume you are infected with HSV-2.  Your doc is wrong in one important aspect:  there is no such thing as being "exposed" without being infected.  Everybody with a positive test for HSV-2 carries the virus and has the potential for herpes outbreaks and for sexual transmisison to partners.  Most infections never become "dormant"; at least some potential for reactivation and transmission persists at least for many years.

Your questions about symptoms, transmission, and protecting partners are the most basic and most frequent of all questions about genital herpes, and it would take 5 pages to answer them completely.  Do some research.  Start with the genital herpes article in the link at the top of this forum, STD Quick Facts and Articles; and look at the information provided by CDC (www.cdc.gov/std) and the American Social Health Association (www.ashastd.org).  After that, I might be able to answer a couple more brief questions.  

Good luck--  HHH, MD

[herpeboy]

Thanks for your response, your explanation makes a lot more sense than my doctors.  I am unfortunately very much assuming that I am infected with HSV-2.  I have no more information to provide with regards to my test results, only that it was a serological test which contained a disclaimer that assays for HSV-1 can sometimes cause a cross-reactive false positive result for HSV-2.  It is in this slim hope that I have ordered a western blot test, which I presume will definitively establish the whether or not HSV-2 is present.

Regarding my question about transmission and protecting partners, this was actually was borne out of the research I have done so far.  From what I've read, due to asymptomatic viral shedding oral sex isnt safe and even using condoms isnt 100% safe.  If this is true, how is it possible to have a normal sex life once you've been infected with HSV-2?

[herpeboy]

I'm sorry Doctor, please ignore the second part of my reply regarding having a normal sex life.  After reading more on this wonderfully informative site, I realise now that this is very much possible with the use of condoms and suppressants.  I guess when your grappling with potentially having asymptomatic HSV-2 its hard not to react ignorantly.

In retrospect my concern would be how to minimise the risk of my partner contracting HSV-2 orally by peforming oral sex on me, or how I should treat the prospect of peforming oral sex on my partner considering I'm not sure whether I contracted HSV-2 orally or genitally due to being asymptomatic.

[JDog7]

Oral HSV-2 is relatively rare compared the genital HSV-2.  The viral site of preference for HSV-2 is genital, and so until proven differently, I would assume your infection is genital. As such, you performing oral sex is relatively safe; someone performing oral sex on you also is safer, since oral infections are relatively rare (and again site of preference). Just be on suppression therapy to stongly reduce your shedding rate.

[Loranta]

Whould you please, post the results of your Western Blot test here later?  I was in simular situation and still looking for answers...  here is my post www.medhelp.org/forums/STD/messages/3233.html
BTW after being on 1mg daily Valtrex for 3 months I still got a cold sore, that kinda ruined my trust in Vlatrex...

[girl522]

I'm not sure but I think I read that valtex is good for helping prevent a symptomatic outbreak of genital herpes, but I don't think it works as well for oral herpes.  I may be wrong though.

[Loranta]

Yes, you are probably right.  Dr. HHH did say that it takes larger doses of Vlatrex to treat HSV-1 then HSV-2.  Vlatrex is probably more effective against HSV-2.  But of course it still should help to speed up healing and reduce severity of coldsores. That's bringing me conclusion that there is no point to be on the suppressive therapy for cold sores, but as suggested just take 2mg at first sign of cold sore and repeat same dose in 12 hours, that's all. Thanks

[H. Hunter Handsfield, M.D.]

JDog7 is correct; you should assume your HSV-2 infection is genital.  Most likely, it will become clear with time.  Once diagnosed with a positive blood test, 60-70% of people with HSV-2 who considered themselves entirely asymptomatic come to recognize mild genital outbreaks that they previously ignored, forgot, or didn't consider important.

The comment in the lab report about cross reactivity with HSV-1 is true, but it depends on the OD ratio.  If your value was 3.5 or higher, the HSV-2 result is solid.  If positive at a lower level (1.0-3.5), there is a good chance that your HSV-2 result is false.  If your provider doesn't have that information, surely it is available from the laboratory that did the test (assuming the HerpeSelect test was done).  If your result is in that middle range, you would be wise to request repeat testing and/or a confirmatory test, such as Western blot.

I'm not sure why Loranta is so keen on knowing your WB result, though.  The outcome in any particular case has no bearing on anyone else's own test result.

Just to clarify, there are no definitive data on the effectiveness of valacyclovir (Valtrex) for genital HSV-1 vs HSV-2.  But in general HSV-1 is somewhat less susceptible to the antiviral compounds, and studies have found that treatment or prevention of oral HSV-1 requires larger doses than genital HSV-2.  Loranta "loss of faith" in valacyclovir because of an oral herpes outbreak doesn't make much sense.  Even with genital HSV-2, about 60% of infected persons have complete supression of outbreaks, but 40% continue to have occasional breakthroughs.  Undoubtedly it's even more common for oral herpes, in someone being treated with genital doses (1 g daily).  It doesn't mean the drug isn't providing substantial benefit.

HHH, MD

[Loranta]

Dr. I understand and agree with everything you say or I would not follow up with this forum.  Don't be hard on me.  I am just trying to learn about HSV-2 and how it can behave (including testing) in hopes to come to some conclusions in my case.  That's how I learned about false-positives on the first place, after thinking that I was infected for sure. As for as testing goes: it's been over a year and I still can't figure out my HSV-2 status, just paranoia about every little thing.  Not a good feeling I

[herpeboy]

I understand Loranta.  Despite the logic of what the Doc says with regards to people who think they are asymptomatic when they really arent, I am still having trouble accepting I have contracted HSV-2.

I have had the blood sample drawn for the western blot test today, I will post the result once its known.

[eluder]

testing

[herpeboy]

Finally received the Western Blot test results.  HSV-1 Positive, HSV-2 Negative.

[scaredstraight25]

I just got a HSV I/II combination test for IGG and IGM. My IGM results were 1.7 and my IGG results were 2.7, does that mean I have both viruses. But I have never had an outbreak before besides maybe a cold sore after a cold. If I have never had an outbreak does not mean that the results are wrong and should I take the test again.

[clarify]

I just got blood work done for Herpes..Thisbis what it read..HSV 2 IGG HerpesELECT AB...4.25..My doctor said that I was exposed to it..I don't have it..It's very confusing...I've never had any cold sores or outbreaks..She said if I didn't chances are I won't..Please tell me do I have it?..Am I contagooius?..I wasn't given any medication..she said I was ok..I'm not sure if or how to explain this to my partner...

[Hmmm wondering]

Im so glad you brought this discussion back up.  I am in a similar situation, I had Herpeselect (R) drawn.  All HSV1 was negative 0.0 but my HSV2 was positive Igg 4.76.  My doc said the same thing, you have been exposed (which means YES you have the virus, I dont know why they just dont say that)

Ive NEVER had a sign or symptom of any OB.  Everyday I wait and wait.  Its been a month since I have found out.  I am actually thinking if I do not see or feel anything I will retest in a year.  This has destroyed me and left me nuts.  In a selfish way I wish I never requested the test, and therefore never know.  :( :( :(

My suggestion to you, is that you will want to call your doctor and set up a meeting.  You NEED those questions answered (I did, and this is what mine said...   Yes, if you have been exposed you have contracted the virus.  You are potentially contagious, if you arent experiencing symptoms there isnt a need for Valtrex, UNLESS you want to help protect an unifected partner).   I know this isnt what you want to hear, I am NOT a DR.  but that was my experience with a similar situation.  

One thing is for sure, I COMPLETELY understand what you are going through.  :)  BTW, What made you decide to get a bloodtest?  

[monkeyflower]

Wondering is right; exposed means you have herpes, and since it's positive for HSV2 it's a pretty sure bet it's genital. And yes, you are potentially contagious. But honestly, it's NOT a big deal. I have both HSV1 and 2, and it hasn't impacted my life in the least. I think the worst part for most people is the stigma of having a STD; but think about it--if you don't even have any symptoms, how bad can it *really* be? Still, you definitely do need to tell your partner. You can use condoms to help protect partners, and you can also go on suppressive therapy (take Valtrex every day) to further reduce any possible risk. But first, you should suggest your partner get tested as well. Since about 25% of the population has genital herpes, it's quite possible that s/he has it too. Who knows, s/he may have even given it to you--but I'll warn you, don't get into worrying about who gave whom what. It's a complete waste of time and totally counterproductive. If s/he has it, you don't have to take any special precautions sexually, and you can move on to more interesting subjects of discussion :-)

Go to www.westoverheights.com and check out the herpes handbook. That will tell you everything you ever wanted to know about herpes, and then some. I believe there's even a section on talking to your partner.

[guyunlucky]

Dear Doctor, I just last week exposed with HSV 2, kindly advise me can i remove HSV virus from my body by Stem Cells Treatment/ Gene Therapy? If do you know any hospital please tell me, I am very depressed pls help me, soon I am going to get married, very confused what should I do...

[ouchj]

So I've been dating a girl with HSV2 for about a year and have been sexually active with her between June and late August. I went in for a blood test in July and resulted in a 0.27 and just went back for another this past week and it was a 0.35 and my doctor said I was fine. Did I give it sufficient time or would you recommend another test in several months? I also had crazy bacterial outbreaks like a patch of pimples the first time and the last time(1.5mo ago) I noticed a sore almost like one that you would get inside your mouth occasionally after the pimples disappeared. A lot like what is described online for genital herpes.. yet my test results are normal? How is this possible?

[scared2102]

A related discussion, Herpes 2 was started.