We are both HSV2+ but...

Hi. I'm dating a great guy who was forthright & disclosed his recent HSV2+ status (score 5, asymptomatic). My recent blood work showed, to my surprise, that I'm also HSV2+ (score of 2.3, also never had symptoms). (Years ago I was also diagnosed with Epstein Barr Virus and Chronic Fatigue Immune Deficiency Syndrome). I''ll probably get retested for a possible false + on the HSV2, but I'm wondering, if our relationship should progress, if I can get 're-infected' and possibly develop symptoms if we decide to have unprotected sex. Since I'm already HSV2+ but scored a 'low positive', could having sex with him put me at any greater risk or make things worse, or doesn't it matter since I'm already exposed? (I should add that he firmly believes he is contagious since his former lover contracted it from him via shedding). Thanks!

[Edward W Hook, MD]

I cannot help with whether or not you should continue the relationship, you have to decide that but I can give you some facts.  Before I do, let me comment that you are lucky.  Most people would not disclose as he did, the chances are that if you have a new partner the odds are 1 in 5 that that person will have herpes but not know it, and you may have the infection yourself.  That should weigh on your decisions.  Now on to the facts and your questions:

1.  Your low positive.  I presume this test was a type specific test such as the HerpeSelect and if so. there is a chance that this is a false positive.  The Focus people do have a confirmatory test which may be helpful in sorting things out.
2.  As for him, transmission can occur but can also be minimised by taking chronic suppressive antiviral therapy (reduces the risk of transmission by 50%), using condoms ((reduces transmission by 50-75%) and not having sex if he is having in outbreak.  this combination of measures will reduce your risk of getting infection a great deal and many partners of people who have herpes avid getting infected by following these measures.
3.  Finally, if you indeed do have herpes, your risk of infection in minimal because you would be protected by the antibodies you already have.  It certainly won't make your herpes worse if you already have it.

I hope this helps.   EWH

[maxine716]

Best $15 I've spent lately!  Thanks.

[Edward W Hook, MD]

Thank you and good luck.  EWH

[maxine716]

Hello again Dr.

I've just received my Focus/Quest HerpeSelect test results to confirm as you suggested and scored 3.6 (last time was 2.3) so I'm definitely HSV2+. Still not sure if there's any correlation betw this and EBV or if having sex with my 'higher score' HSV2+ partner can put my in any further danger. My EBV is currently dormant, but I don't want to bring in back of course.

Would appreciate your further opinion. Many thanks.

[sara725]

Hi, I recently took 2 herpeselect tests 1 week apart.
Test 1: HSV-1 4.18    HSV-2   2.58
Test 2: HSV-1 3.87    HSV-2   3.46
I do get oral sold sores and I have never had any genital herpes symptoms.
My UWashington Western Blot came back + for HSV-1 and negative for HSV-2.
Are you confident in your test results?
Perhaps you would benefit from confirming the herpeselect results.
It is a good test, although imperfect.

[maxine716]

Thank you for your comment. I thought I was confident but now am not! The fact that this type of crazy & contradictory test results is not only confusing but disheartening, particularly just when I'm searching for answers and thought the HerpesSelect test was more accurate than the first one. ugh!
I have read online that Western blot test may be rather expensive and not be covered by most health ins...I wonder if you could comment on that? I guess we cannot put a price tag on the peace of mind, however, if possible.

[Edward W Hook, MD]

All test results must be taken in context and interpreted that way.  You have a partner who has HSV-2 and you have rising antibody titers.  While not super high, your titers have increased substantially since your initial test.  In this setting it is more likely than not that indeed you do have HSV-2.  The UW Western blot is the "gold standard" for these tests but, as you point out, is often not pad for by insurance.  As I mentioned above, the Focus peole do offer an "inhibition test" which may be helpful and cheaper for resolving your question.

Sara725's experience is not a common one as the numerical value of the HerpeSelect result get up around 3.5 and above.  The HerpeSelect is not a perfect test but it is a good one.  Neither of us recommend routinely confirming positive HerpeSelect results with Western Blot.  

Sorry for the lack of satisfactory clarity.  I hope this helps.  EWH