Significance of IGG titre levels

[supercleen]

I have never had an obvious Herpes outbreak [age 59].
My wife  of 15 years recently developed a Herpetic vulvar lesion.
So, I got my IGG results back today:

" HSV I     < 0.91

HSV II  =  2.56

Question :   Is there any significance to the level of HSV II titre ?
Might it indicate a more recent or remote exposure ?
Do you think I should begin treatment ?

Thanks!

[H. Hunter Handsfield, M.D.]

There are two main reasons to take continuing suppressive therapy.  Neither of them seems to apply in your case, either for you or your wife.

The first reason to control symptoms, if there are frequent outbreaks.  Apparently you have no symptoms, so this is irrelevant.  The second is to prevent transmission to uninfected sex partners.  Your wife -- presumably your only partner currently, although you haven't said so directly -- is already infected and cannot catch it again.

It sounds like your wife probably is chronically infected; your description ftis better with a recurrent oubreak, not her initial infeciton.  Her current treatment is appropriate.  (Despite what you have read, her dose is typical and should be effective.)  She should continue treatment until her outbreak has cleared, typcially 7-10 days.  Then she should stop treatment.  For now, I see no reason for either of you to take suppressive therapy.  People don't "ping pong" HSV back and forth; you both are immune to a new infection with the same virus type.  If either of you develops frequent recurrent oubtreaks, then treatment to prevent them will be a consideration.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum. I'll try to help.

It is highly likely you have HSV-2.  At an HSV-2 ELISA index of 2.56, plus a negative result for HSV-1 (under 0.91), probably there is a 90% chance the test result is accurate.  It's not quite certain, and perhaps you would like to consider a confirmatory test.  If so, ask your provider about doing an HSV Western blot test, the ultimate gold standard for HSV blood tests.

In addition, as the sex partner of someone with genital HSV-2, probably you have been repeatedly exposed to the virus over the years.  You might have been the source of your wife's infection, but not necessarily.  If you can provide a bit more detail about her diagnosis -- the severity of her symptoms, exactly what tests she had that showed HSV-2 -- we might be able to sort out whether her current problem is a brand new infection or a recurrent oubreak of something she has had for a long time.  But this really may not matter much.  Either way, this situation doesn't necessarily imply that either of you has had other sex partners during your marriage.  Apparently new genital herpes often pops up in permanently monogamous couples.

If you are infected, the height of the ELISA index makes no difference.  In other words, it says nothing about whether or not your infection is new or old, or how "active" the infection is at this point in time.

Here are two past threads on this forum that discuss HSV-2 blood test results and also issues of herpes in couples.  You can use the search link to find numerous other discussions.  Please take a look, then feel free to return with any remaining questions.

http://www.medhelp.org/posts/show/1129740
http://www.medhelp.org/posts/show/593272

Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

Of course, since HSV-2 is only sexually transmitted, the possibility that one of you had another partner has to be considered.  However, if you have no other suspicion your wife has had other partners, you should believe her.  In and of itself, the your herpes situation definitely is not "suspicious" for sexual infidelity.  This sort of situation happens all the time in long-term monogamous couples.  And it is not at all strange that genital HSV-2 remains latent for 18 years; it is very common.  20% of the US population has HSV-2, and more than half never have symptoms but all are at risk for later outbreaks.

Your wife can forget the toilet seat theory, however.  Nonsexual transmission never occurs.  Such explanations were invoked often over the years, when herpes first appeared in someone who was not recently sexually active or in monogamous couples.  But those face-saving excuses fell by the wayside a couple of decades ago, when research revealed the truth about asymptomatic infection and late outbreaks.  There was never any truth to them.

That should end this thread.  Find a provider who understands genital herpes and follow his or her advice.  Also consider getting involved in MedHelp's herpes community forum, where the moderators are excellent herpes nurse-counselors.  You'll find other forum participants with experiences similar to yours.

[supercleen]

Thank you so much.
Yes, I know I have been monogamous; my wife states she has been as well.
But, the whole scenario seems a bit suspicious, especially since we have been married for 15 years [together for 18], and neither of us recalls ANY prior genital issues.

At times, I have had some suspicious areas at the corner of my mouth, but I have a low HSV I titre.

It seems strange that this could have been latent for well over 18 years.
She wonders about non-sexual transmission [ eg., toilet seat, hotel bedspread, etc.]

[supercleen]

Thanks for your informative reply.
Wife has had no other constitutional symptoms, simply a single typical 1.5 x 1 cm lesion to the left of he outer labium which has been cultured [ no blood testing performed on her].
She has had  no prior obvious outbreaks.
So, What should MY treatment be now? I suspect the only medical regimen suitable for me now is a daily prophylactic dose of Valtrex.
[Wife has been on 500 mg BID for a total of 5 days, which seems quite low from what I have read].

Thanks!