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Positive HSV 2 IgG Antibodies
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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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Positive HSV 2 IgG Antibodies

I am in a relationship with someone that has disclosed that he has had HSV-2 outbreaks (1-3) in last 10 years.  I have to add that he has never had serum testing, however his ex-wife was positive for HSV2 and he always "assumed" that this is what his "lesions" were.  

I have never had an outbreak of any type of lesion at all, but i was curious and had serum testing done.  My HSV2 IgG antibodies were positive = 5.5.  My results mention "All positives will reflex to a confirmation test. Report is not final until confirmation is performed", however i have not received any confirmation results and neither has my GYN (first results 3/13/2009).  

Could an outbreak have been so mild that i did not notice any lesions??  What is the likelihood of having an outbreak now?  

My partner and i are planning marriage and other than "unforeseen" complications will be monogamous for life!  Should either of us be treated with antivirals or wait for an outbreak?

Also what "confirmation" test would the lab be referring to?  The testing was performed by ? Specialty Laboratories.  

Thanks in advance for any recommendations!
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Welcome to the STD forum.  I'll try to help.

You are infected with HSV-2.  Despite the lab's apparent confirmation policy, it probably isn't necessary; type-specific HSV-2 antibody tests with ELISA ratios over 3.5 almost always are truly positive.  At 5.5 there is little doubt in your case.  I'm not sure what confirmation test they are referring to -- perhaps what is called an inhibition assay.  But I think it's moot in your case.

About 20% of adults in the US have HSV-2 and most never had (or do not recall) symptoms that suggest herpes.  However, many such persons come to recognize symptoms once they know about the blood test results.  If you stay alert you may find you are having mild but typical outbreaks.  If so, they likely to show up as one or more mild, small sores that would appear every time in more or less the same spot (give or take an inch) and reappear no more often than every 1-2 months.  Or maybe never.

As the partner of a man with known genital herpes, he is a logical source -- but it could be you both are infected but not necessarily from each other.  In any case, couples do not "ping pong" HSV-2 back and forth.  You and your partner both are immune to catching a new HSV-2 infection from each other (or from anyone else).  There need be no limits or restrictions on sex between you, unless required for comfort -- i.e. if there is a painful outbreak, avoiding sex would make sense.  Otherwise, no worries.

But a last bit of caution:  It sounds very likely that your partner indeed has HSV-2.  However, since his infection has never been confirmed, you and he might consider it, i.e. he could have a blood test just to be certain.

I hope this helps.  Best wishes--  HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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