Aa
What to make of borderline test result based on specific scenarios
Thank you in advance for your time.
I am a 37 year old male.
On the 19/09/08 I had a negative HSV2 antibody test and had not been intimate with anyone in anyway for at least 3 months prior - so at this point I was definitely negative for HSV2.
On the 18/10/08 I had unprotected oral sex with a woman who has been HSV2 positive for 13 years, did not have any visible lesions and who wasn’t on suppression therapy. Two days later I started 800mg of Acyclovir 5 times a day for 10 days.
I had safe sex (no oral sex) with the same individual about 5 times over the next 2 weeks.
On the 20/12/08 I had unprotected penetrative sex with the same woman who had started suppression therapy (Valtrex) and 4 days later I started 800mg of Acyclovir 5 times a day for 10 days.
On the 03/01/09 I had a borderline HSV2 test result (HSV2 IgG 0.962 (>1.0 = positive)) and upon recommendation of my doctor I will be retesting on 24/01/09 in order to see if there is a rise in the number of antibodies to determine whether I am truly positive or whether the test on the 03/01/09 was a false positive.
My questions for this forum are
a) Based on the above data / exposure(s), how LIKELY is it that the HSV2 antibody test on 24/01/09 will be positive?
b) If the test on the 24/01/09 is positive, is it LIKELY that the infection occurred from the unprotected oral sex or the unprotected penetrative sex?
I accept there are no absolutes in any of these scenarios, however any opportunity to potentially narrow down the site of infection is important to me. The reason being, in the future if I am positive, when I disclose my status to future discordant partners, it is one thing to disclose based on a genital infection that can be managed through condoms and suppression therapy and it is quite another to suggest you are infectious with type 2 orally.
I am a 37 year old male.
On the 19/09/08 I had a negative HSV2 antibody test and had not been intimate with anyone in anyway for at least 3 months prior - so at this point I was definitely negative for HSV2.
On the 18/10/08 I had unprotected oral sex with a woman who has been HSV2 positive for 13 years, did not have any visible lesions and who wasn’t on suppression therapy. Two days later I started 800mg of Acyclovir 5 times a day for 10 days.
I had safe sex (no oral sex) with the same individual about 5 times over the next 2 weeks.
On the 20/12/08 I had unprotected penetrative sex with the same woman who had started suppression therapy (Valtrex) and 4 days later I started 800mg of Acyclovir 5 times a day for 10 days.
On the 03/01/09 I had a borderline HSV2 test result (HSV2 IgG 0.962 (>1.0 = positive)) and upon recommendation of my doctor I will be retesting on 24/01/09 in order to see if there is a rise in the number of antibodies to determine whether I am truly positive or whether the test on the 03/01/09 was a false positive.
My questions for this forum are
a) Based on the above data / exposure(s), how LIKELY is it that the HSV2 antibody test on 24/01/09 will be positive?
b) If the test on the 24/01/09 is positive, is it LIKELY that the infection occurred from the unprotected oral sex or the unprotected penetrative sex?
I accept there are no absolutes in any of these scenarios, however any opportunity to potentially narrow down the site of infection is important to me. The reason being, in the future if I am positive, when I disclose my status to future discordant partners, it is one thing to disclose based on a genital infection that can be managed through condoms and suppression therapy and it is quite another to suggest you are infectious with type 2 orally.
I took an HSV2 antibody test this weekend and the result was negative.
Many thanks for your help.
Many thanks for your help.
MEDICAL PROFESSIONAL
Hmm. I understand taking a drug to prevent infection, if it would work. I don't understand taking a drug to control symptoms of an infection that hasn't yet been acquired. From teh standpoint of symptoms, genital herpes is usually a trivial problem -- there are exceptions, but that's what they are -- exceptions. The only effects of taking acyclovir before getting infected would would be to delay symptoms and make diagnosis more difficult. I suggest you don't do that any more, regardless of your upcoming test result.
Nobody wants to get genital herpes, but you seem over the top in your concern about it. In my opinion, you don't need additional herpes testing; for practical purposes, your most recent test is negative, despite the borderline official report. But if you go head with another one, I suggest waiting until 3-4 months after your last exposure to the infected partner.
Nobody wants to get genital herpes, but you seem over the top in your concern about it. In my opinion, you don't need additional herpes testing; for practical purposes, your most recent test is negative, despite the borderline official report. But if you go head with another one, I suggest waiting until 3-4 months after your last exposure to the infected partner.
Many thanks for your response - especially with respect to answer b).
Just to clarify, the Acyclovir was taken in order to reduce the severity and intermittence of outbreaks (primary or otherwise) should there have been a transmission - as opposed to trying prevent infection at all.
I will post my re-test result once I receive it.
Your point about testing without symptoms and the reliability / variability of tests has been noted.
Many thanks again.
Just to clarify, the Acyclovir was taken in order to reduce the severity and intermittence of outbreaks (primary or otherwise) should there have been a transmission - as opposed to trying prevent infection at all.
I will post my re-test result once I receive it.
Your point about testing without symptoms and the reliability / variability of tests has been noted.
Many thanks again.
MEDICAL PROFESSIONAL
I very much doubt you have HSV-2. The risk of transmission of genital herpes for any single episode of unprotected vaginal sex with an HSV-2 infected partner probably is less than 1 in a thousand, and likely is even lower when the infected partner has been infected for more than 10 years and was taking Valtrex. Oral sex uncommonly transmits HSV-2. Your risk really wasn't high enough to warrant testing in the absence of symptoms that suggested you might have been infected. And as you found, the available tests have reliability issues, with exactly the sort of variability on repeat testing that you found.
With regard to your self-treatment with acyclovir: Research shows that it does not protect against catching HSV unless it is taken before exposure. In experiments with laboratory animals, if the drug is given any more than an hour after exposure, it has no effect in prevention.
OK, lecture over. How to interperet the tests? In the roughly 10 years since the type-specific HSV antibody tests have been commercially available, I have never seen a case with such a low ELISA ratio who actually had HSV-2. So the direct answers to your questions are:
a) I will be very surprised if your repeat test shows a clearly positive result.
b) Oral HSV-2 is rare. In the very surprising event the repeat test is positive, in the absence of symptoms to tell you the anatomic site of infection, you would have to assume your infection is genital.
I hope this helps. Best wishes-- HHH, MD
With regard to your self-treatment with acyclovir: Research shows that it does not protect against catching HSV unless it is taken before exposure. In experiments with laboratory animals, if the drug is given any more than an hour after exposure, it has no effect in prevention.
OK, lecture over. How to interperet the tests? In the roughly 10 years since the type-specific HSV antibody tests have been commercially available, I have never seen a case with such a low ELISA ratio who actually had HSV-2. So the direct answers to your questions are:
a) I will be very surprised if your repeat test shows a clearly positive result.
b) Oral HSV-2 is rare. In the very surprising event the repeat test is positive, in the absence of symptoms to tell you the anatomic site of infection, you would have to assume your infection is genital.
I hope this helps. Best wishes-- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
