Questions about HSV2 infection

[maxluck]

Hi,

I am a 35 year old male with no history of herpes outbreaks. I recently got tested for HSV1/2 as a screen and I came back positive (igg > 5) on HSV2, and negative on HSV1. I was retested and HSV2 came back positive again (igg>4). HSV1 negative.

My girlfriend has been screened also and is HSV1 & 2 negative.

I have never had unprotected sex, including oral sex (the closest this has come was a girl licked my scrotum for literally a second while I had a condom on), except with my current girlfriend who is negative.  We have had unprotected sex for sometime and othertimes with protection to prevent pregnancy.

Question:

1) Since I've never had an outbreak, how can I tell which region i am infected with?
2) Is it possible that since I had chickenpox that the Herpeselect test is misreading the result?
3) Is it possible to be symptom free and never pass on the virus despite showing a positive IGG?
4) Could anything I have contracted in the past lead to a positive IGG (ie: passed on during delivery, antibodies from my mother, etc)
3) Could HSV2 be passed on during oral sex with a condom, or when the condom is taken off?

[Terri Warren, RN, Adult Nurse Practitioner]

'm quoting the statistics that were recently published in Archives of Internal  Medicine. 2009 Jul 13;169(13):1233-40, which suggest that regular condom use reduces transmission by 30%, though other studies we have published say 50%, so I wrote down a range.  You can look at the article on PubMed and see what you think.

For MaxLuck:  I would be interested in your confirmatory test results.  HSV 2 oral infection alone would be so unlikely to be transmitted because it is shed so infrequently from the mouth. If the HSV 2 antibody test is positive, one should assume it is genital.  If you were truly infected as an infant, you would have been sick, almost always, and your parents would know, and yes, your antibody test would be negative.

Let's see what your western blot says and go from there.

Terri

[jimcasy]

"Condoms only reduce transmission of herpes by 30-50%"  This is confusing.  It seems to run counter to what Dr. Hook and Dr. Handsfield say about condom use and Herpes (provided the condom is used correctly).  In fact, Dr. Handsfield clearly stated in a recent post that, "There is no risk of STD of any kind, including herpes.  That's what condoms are for and they work.  Congratulations for using a condom in this situation.  Keep that up and you can expect to have the same sort of sexual experiences and never catch any STD."  Sorry.  I'm not intending to hijack a thread but find this to very confusing at times.

[maxluck]

Hi Terri,

I will order a confirmation test. I would like to ask you a few follow up questions

1) Assuming i've only had unprotected vaginal sex with my current GF, what are the typical transmission risks of oral sex with a condom? ie: How easy is it for a woman with Oral HSV2 infection to transmit this to a male during oral sex with a condom?
2) I understand oral HSV2 is extremely rare. How does one ever find out the location of the infection?
3) Would neonatal herpes infection as an infant provide antibodies that would show up in testting?

This all comes back to the fact I never had intercourse with anyone but my GF and she has received two tests confirming she is negative.

[Terri Warren, RN, Adult Nurse Practitioner]

A repeatedly positive IgG HSV 2 test at those levels is accurate.  Condoms only reduce transmission of herpes by 30-50%.  You should assume that your infection is genital.  Chickenpox would not cross react with this test.  It is possible to be symptom free and transmit virus, yes.  Nothing you contracted from your mother at birth would cause this unless you had neonatal herpes, which I am guessing you would know already.  HSV 2 is almost never transmitted through oral sex, though it is not impossible.  I don't think that's your source.

I believe that uou are both infected and infectious.  However, if you have doubt about this, and sometimes people do when they have no symptoms, you might consider getting a confirmatory test  The one that I would recommend is the herpes western blot.  It is available through Quest labs, not LabCorp that i know about, and the code is 34534.  You can get this testing done through any provider who uses Quest labs.  That will give you confirmation of infection, and you might feel clearer if you had that behind you, yes?

I would recommend that you read my herpes hand book at westoverheights.com for more information as a starting place.

I would also strongly recommend that you go on daily suppressive antiviral therapy to reduce the risk of infecting your partner.  You can transmit when no symptoms are present, and this and condoms will reduce that risk considerably.  

Please do your reading, get further testing if desired, and write me back with further questions.

Terri