STDs Expert Forum
Nonseroconverter
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Nonseroconverter

I've carried a very heavy burden after the end of my relationship with my ex girlfriend who had confirmed HSV2 genital.  We engaged in 6 months of mutual oral sex both ways and a few isolated cases of condom protected intercourse. We believe she did not have an outbreak during any sex act and outside of one questionable occasion we believe she never had any visible outbreaks at all.   Seven months after the end of the relationship I had a western blot and Focus Elisa done.  I was negative for HSV2 and positive for a childhood known infection of oral HSV1.  I remained concerned that I would be an assymptomatic non-seroconverter outlier.   I had another ELISA done after a year with the same results, so the blood test option has been exhausted.  I also worked with my Doctor to do a series of PCR swabs at home for a few months to see if any shedding was detected from my genitals, and none was. (this did not test my oral cavity however).

I did more research to see if there is anything further I could do to confirm my position.  I realize since most of my contact was oral and I did not do any shedding PCR analysis orally, it is possible I could be an outlier and pass HSV2 through kissing or giving oral sex.  This is a fear with my family as well.  

I stumbled across a ten year old study referenced several times regarding how many individuals have a Tcell response to HSV in discordant couples but don't have detectable shedding, don't seroconvert... but may still be infected or perhaps vaccinated, this could not be confirmed or denied.  I imagine I would fall into that category.  This is still unsettling.  I was hoping you could offer thoughts on the study.

http://www.ncbi.nlm.nih.gov/pubmed/12682275

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Welcome to our Forum. I will try to help but I am not confident that I can. For you to continue to worry about some occult HSV-2 infection a decade after the end of a relationship with a partner who had HSV-2, despite no clinical evidence of infection and multiple negative tests is, to be honest, a bit paranoid.  You are grasping at a single older study by investigators who are friends and colleagues of both of us on this Forum and who have not published further on what they described as a TRANSIENT T-cell reactivity.

The fact is I have numerous patients who have long term partners with HSV-2 who do not become infected, even when the relationships go on for years.  Your pre-existing HSV-1 is likely to reduce your vulnerability to infection with HSV-2, you took precautions against infection, oral infections are quite rare, and you have multiple negative blood tests.  The evidence is compelling that you did not get HSV. For you to continue to worry suggests that you are wrestling with some element of guilt or are unusually prone to anxiety and would benefit from talking this through with a counselor.  


As for your specific questions:
1.  Ten years later, are we still non sure whether folks with T cell responses are infectious or not?
See above. this transient observation has not been borne out by further study. it was a curiosity.

2.  I read there is a much more sensitive test called the ECL Western Blot.  I contacted Quest, and it IS offered.  Perhaps this test would confirm or deny my status?  However it did not appear to do so with the subjects in the study.
To the best of my knowledge the University of Washington remains the "gold standard" which defines detection of antibodies to HSV.  The test you refer to may have performance advantages over the Focus assay and other commercial tests but as one who is engaged in HSV research, I know of no data to suggest that this test is more sensitive than the Western Blot you already had.

3.  What is you assessment of my potential shedding in the oral cavity?  I realize all things considered kissing my family or french kissing a date would likely be low risk, but would doing so be moral considering there is no guarantee I'm not infected
There is no credible reason for you to think you have HSV, much less to worry that you might transmit HSV-2 to someone you kissed.

Please, talk to a counselor about your concerns.  They should not be worrying you this way.  EWH

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Sorry Doctors, I did have a few specific questions:

1.  Ten years later, are we still non sure whether folks with T cell responses are infectious or not?
2.  I read there is a much more sensitive test called the ECL Western Blot.  I contacted Quest, and it IS offered.  Perhaps this test would confirm or deny my status?  However it did not appear to do so with the subjects in the study.
3.  What is you assessment of my potential shedding in the oral cavity?  I realize all things considered kissing my family or french kissing a date would likely be low risk, but would doing so be moral considering there is no guarantee I'm not infected

Thank you for your response in advance.  I am sure this an unusual and likely demanding question.
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I am also male, if that matters
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I do have one follow up Dr. Hook.  I appreciate the encouragement.  Perhaps I have been overreacting.  

To be clear, the relationship was back in 2008, I apologize for the confusion, it was not a decade ago.  

Also, I did once have a blistery rash very early on in our relationship, but it was clustered on my forearm and nowhere else.  It may have been a result of a plant allergy as it was during the summer and I was outside a bit.  I never had anything else show up there, and outside of some fingering, my ex-partner and I did not have any sexual contact yet.  I realize you can't offer much info with a long gone rash from a distance, but would you think that this would possibly be herpes or change your assessment?
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Also, to be clear, the rash has never returned.  I have thought doing some PCR testing on that area of my arm, but I imagine I probably wouldn't be shedding there nearly often enough to detect due to the thick skin...?
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The rash that you describe does not sound like herpes. Its time for you to stop worrying about the past and move forward.  EWH
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