HSV2 Positive: Questions in absence of symptoms

[emtwalker]

Hello:

I recently tested positive during a routine STD screening (general doctors appointment, no signs or symptoms) for HSV2 through a herpes select ELISA type specific IGG, the numerical value was 1.9.  I then received confirmatory testing through the Western Blot at University of Washington, and it came back as positive as HSV2 confirmatory. To my knowledge, I have never exhibited a sign or a symptom as it relates to an HSV2 infection and have gone back through my last 4 sexual partners (females over the past 3.5 years) to notify them and ask them to be tested and all of them have tested negative.  (I am a 36 year old, single, heterosexual male.)

My physicians have essentially said that even though I test and retest positive, that I am in fact negative and that I should not take suppressive therapy or treat it in any way.  Additionally they have indicated that I do not have disclose that I am positive to any potential partner.  My primary care physician, stated - "if you didn't have this test result and I asked you if you had HSV2, you would say no, so the answer is no."  

Both of my physicians have stated subclinical shedding isn't possible in the absence of signs and symptoms, but I have read information that states the exact opposite, including clinical trials related to antiviral therapy, one conducted at UW by Dr. Christine Johnson (http://www.medscape.org/viewarticle/756557)  

I am of course going to inform any partner going forward that I test positive and allow them to make the decision.  However, I am trying to clear up the questions that surround the information I am getting from my own physicians and if you think that I should seek an additional opinion from another physician or any thoughts you may have on this situation.

Do I need to inform partners?
Am I truly at risk of infecting a partner in the absence of any signs/symptoms?
Does the WB test for active infection or just antibodies with higher accuracy rate than the ELISA?

Thank you!

[Terri Warren, RN, Adult Nurse Practitioner]

Whoa!  That was not nice.  This board is set up so others can post, and often, their opinions are very helpful.  In fact, doublestandard is exactly correct on this.  Exactly correct.  

With all due respect to your physician at Northwestern, they are incorrect. ( and I have to say that surprises me about Northwestern, they are an excellent teaching institutions.    An HSV 2 positive western blot means you are both infected with herpes and infectious to others.  I suggest you do some reading of the scientific literature on this one.  It is well documented.  

I know it is hard to accept this when you don't have symptoms and your partners aren't infected, it is difficult.  But if the western blot is positive, then you are infected.

Now if you want the UW to look at your blot again, that would be fine.  You could ask whoever ordered it to call the lab and ask that that be done.  If you have any concerns that your blood could have been mixed up with someone's elses, you could order it again.  Those are two possibilities that I have pursued with patients before, but rarely (though once or twice) as it made a difference.

Terri

[emtwalker]

It amazes me that you continue to post behind me on a paid board for professional opinion, when I think nothing about your opinion.  Please stop following my posts and go back to the trailer park.

[Doublestandard]

I think you still sound in denial or resistant to the fact that you have been infected w the virus. And was hoping the fact that you do not have symptom will reduce the chance of transmission. The fact has been repeated many times that w hsv2 asymptomatic shedding is present and using protection alone w already reduce the chance of transmission and being on suppressive therapy will again reduce that chance (of transmission as well as reducing OB). It's up to you whether to choose to take the drug or specially when sexually involved w someone.

Last words quit your docs as the info they had provided you sounded alarmingly ignorant.

[emtwalker]

Hi Terri,
Thanks for your response, I hope you don't mind if I add a little more information and a few additional questions.  The doctors I have consulted with are Chief of Internal Medicine and the Head of In-Patient Dermatology at Northwestern Memorial Hospital, the latter is specializes in cutaneous infectious disorders and blistering diseases.  

I am very conscious of my body areas and am fairly well read now in this subject.  I do understand my risk of transmission and take it very seriously.  I have a clinical medical background and I mention this because I believe I would be aware of any of the associated symptoms and/or signs or at the very least would have noticed "something" as being on usual, as I have always been highly sensitive to my body and any changes.  I will look for the Lancet Article and read it.

Wouldn't it be slightly unusual for my last 4-5 partners to have not contracted HSV2 or tested positive in the course of the last 4 years, given the fact that there was repeated unprotected sexual encounters?  

What do you believe the best course of treatment is?  Prophylactic anti-viral medication even in lieu of symptoms?  Both docs have recommended against taking Valtrex at this point.

I am just at a loss as to why I am testing positive with no symptoms (which I understand is a blessing) or positive partners in the last 4 years - I am accepting of the positive test and will treat it as such from now on.

My doctors have recommended I go to see an infectious disease specialist to continue to sort through this situation.  Do you not think that this is warranted?  

Thank you for any additional commentary you might be able to provide!

[Terri Warren, RN, Adult Nurse Practitioner]

I don't think you need any further testing as the western blot is very definitive nor do you need a further opinion.  I completely disagree with your physicians.  Since herpes is quite an unusual specialty, it isn't totally surprising that your physicians are not adequately informed about all the current research.  Please forgive them.  

Yes, I believe that you need to inform partners that you are HSV 2 positive.  You are truly at risk of infecting other people even if you have no symptoms.  Yes, the western blot if more accurate than the ELISA.  Neither test for active infection, though we know that people who test positive for HSV 2 by western blot are infectious to others.  

I hate to be the bearer of bad news, but I think it is important that you have the most accurate facts possible.  I encourage you to be aware of any symptoms between waist and mid-thigh, including anus, penis, thighs, abdomen, even into the foot.  

I would encourage you to read the Lancet article by me, Anna Wald, etc.  It is a good summary article.  

Terri