Need Clarification

[blue1970]

Dr Hansfield/Hook,

My girlfriend and I would like to have sex without condoms so we both agreed to get tested (my first in 15 years).  My tests just came back (she has not done hers yet) and everything was negative for the 8-panel test with the exception of HSV-1.  I am fully aware that HSV-1 is common and that more than half the population at my age (42) has some form of HSV-1.  My results are as follows:

HSV 1 IgG - 2.0
HSV 2 IgG - <.91 Negative

It is important to note that I have never had a oral cold sore or lesions on my penis (at least that I can remember).  I have read that low positive's less than 3.5 can be also be a false positive.   Yesterday, I had more blood taken for the Western Blot test and should get the results in a week or two.  I have been a little depressed, so here are my questions:

1.  In the absence of symptoms, what are the chances that the Western Blot is also a positive for HSV-1?
2.  Could the Western Blot contradict the IgG and result in a HSV-2 positive (this would be bad)?
3.  If I do indeed have HSV-1 per the Western Blot, how at risk is my partner with un-protected sex in the absence of any oral or genital outbreaks?
4.  Is this risk of transmission higher for oral or genital or are they essentially the same?
5.  In theory, if it is oral she may have already gotten it already, correct?
6.  Am I making to big a deal of this?

Thanks

[Edward W Hook, MD]

Sorry, mis -ead the question.  the chance of contradicting your current HSV-2 result is vanishingly low.  EWH

[blue1970]

Thanks for the responses, I feel much better.   In regards to one question:

2.  Could the Western Blot contradict the IgG and result in a HSV-2 positive (this would be bad)?
If the WB is positive, it would not "contradict" the HerpeSelect, it would confirm the result you have at this time.

I was negative with the IgG test for HSV-2.  My question was, is it possible that the Western Blot contradicts this finding and states that I am positive?  If I had to choose, I would rather have a confirmation of HSV-1 than a brand new result for HSV-2.  Hope that makes sense.  

Thanks again.

[Edward W Hook, MD]

Welcome to the Forum.  My sense from reading your question is that you have read some of the other posts regarding HSV diagnosis using antibody tests and are aware that while these tests represent useful tools for sorting out the possibility of herpes infections they are not perfect, particularly when results are in the "low positive range".  Because we deal more with HSV-2 than HSV-1, we don't comment on the HSV-1 tests as much as the HSV-2 tests and to address your question we need to.  The specificity of the tests for HSV-1 is a bit lower than the specificity for the HSV-2 test, meaning that they (the HSV-1 IgG tests) are more likely to give false positive results.  Thus there is a pretty good chance that your low positive HSV-1 test result is falsely positive.  The Western blot will help you to sort this out.  If the results are negative or equivocal, then you most probably do not have HSV-1.  

In answer to your specific questions:
1.  In the absence of symptoms, what are the chances that the Western Blot is also a positive for HSV-1?
Most people with HSV-1 do not have symptoms, including cold sores.  That said, there is still a better than 50/50 chance that your WB will show that you do not have HSV-1.

2.  Could the Western Blot contradict the IgG and result in a HSV-2 positive (this would be bad)?
If the WB is positive, it would not "contradict" the HerpeSelect, it would confirm the result you have at this time.

3.  If I do indeed have HSV-1 per the Western Blot, how at risk is my partner with un-protected sex in the absence of any oral or genital outbreaks?
If you do have HSV-1, the risk of transmitting HSV-1 to her through direct contact with the infected site (most likely your mouth) is estimated to be less than 1 infection per 10,000 exposures

4.  Is this risk of transmission higher for oral or genital or are they essentially the same?
The risk of transmission is low either way and there are no comparative studies.  Our experience is that it is VERY rare for genital HSV-1 to be sexually transmitted to partners.


5.  In theory, if it is oral she may have already gotten it already, correct?
In theory, I suppose but it is unlikely that this is what happened.

6.  Am I making to big a deal of this?
Yes.  If you do have HSV-1, so what.  I suspect the has kissed others.  If so, the odds are greater than 50/50 that they had HSV-1, yet she did not get it.  Further, getting oral HSV-1 is just not that big a deal, even if it were to cause occasional cold sores.  you would be a member of a very big "club".  I'm not trying to be cavalier about this, HSV is just not all that transmissible and when persons get it, is just not that problematic.  that is a major part of the reason that we do not recommend routine antibody testing for our clients who have no indication of infection

I hope my comments are helpful.  EWH