Do I Have HSV2 or Not - Very Confused?

[wineman62]

Hi Dr. Hook,

First of all, I would like to thank you and the rest of the Dr's and contributors to this site. The information here is invaluable.

Let me start off by referencing a link below detailing my situation pretty well:

http://www.medhelp.org/posts/Herpes/Positive-and-Negative-HSV2-Results/show/738912

I tested both pos & neg for HSV2 at the 12 wk mark (HerpeSelect), after a protected encounter with a female (unknown HSV2 status) in Oct-08. The pos results have usually been in the 1.1 to 1.4 range. My doctor prescribed 500mg-Valtrex, which I've been taking daily since Jan-09, mostly because I didn't want to deal with outbreaks. I have never had an outbreak of any kind, no inflamed lymph nodes, no fever, no pain in the back, etc....

I decided to take the Western Blot at about the 23 wk mark, and it was indeterminate. I was taking 500mg daily when I took the WB test. Fast forward to Sept-2009, and as part of a physical, I asked my doctor to test one more time for HSV2. He agreed. The test results from last week were still slightly positive at 1.4. The test was HerpeSelect. I have never tested pos for HSV1 or anything else, but have had chicken pox and mono much earlier in life.

I have several questions:

1) What is the possibility that I REALLY have HSV2? My antibodies have not changed appreciably in almost 12 months via the HerpeSelect test.

2) If I do not have HSV2, what can be causing my body to show antibodies to HSV2?

3) I have read several posts from you and Dr. Hunter that early anti-viral meds can suppress the body's development of antibodies. Would this still be the case after almost 12 months?

4) How reliable is the Indeterminate WB test I took at 23 weeks? Should I stop taking Valtrex and retake the WB? If so, how long should I stop taking Valtrex before retaking the WB? What if I get another indeterminate WB test?

5) How likely is it that someone could be positive for HSV2 and never have an outbreak after almost a year, even with Valtrex?

[wineman62]

A related discussion, Do I Have HSV2 or Not - Very Confused? was started.

[Edward W Hook, MD]

No, the other vaccines would not effect your HSV antibody tests.  EWH

[wineman62]

Hi Dr. Hook,

Thank you very much for answering my questions. I should add one more item. I used to travel to Asia for business almost two years ago, and my doctor recommended getting vaccinated for Hep-A and Hep-B, measles, and one or two other potential viruses before my travels (I have to look at the med forms to remember them all). I completed the three rounds of vaccinations for Hep-A and Hep-B about 6 months before testing for HSV2. Is it possible the anti-bodies to Hep A/B (or other vaccinations) could be what is cross reacting with the HSV2 tests? If this is possible, why would my HSV1 test results be consistently negative and not cross-react?

Is it possible to have HSV2 on another part of your body (other than the genitals), where evidently HSV2 does not have OBs as frequently or as noticeably? To my knowledge, I can't recall anything on any other part of my body that would resemble a primary HSV2 OB.

With respect to my first question, it seems very unlikely to me that I would be positive for HSV2 and have my antibody response not changed in almost 12 months, the Valtrex not withstanding. This does not seem logical.

I am going to stop the Valtrex for now and re-take the WB in a month or so. I will post the results when I get them.

[Edward W Hook, MD]

I've reviewed some of the 22 posts you've had regarding this issue and rather than summarize them I will answer your questions directly.  To cut to the chase before I do however, I will tell you that I do not think you have HSV2.  You have antibodies which cross react with HSV in several of the HSV tests but, in the absence of outbreaks and without an evolution of your antibody tests, there really is little evidence that you have HSV-2.  On to your questions:

1.Low.  As Dr. Handsfield has told you, your HerpeSelect values are in the range where most are false positive.  That the Western blot you had was also indeterminate makes this even more likely.  

2.  Unknown.  Sometimes these are due to cross reacting antibodies to other viruses.

3.  Rarely, antiviral therapy can delay development of antibodies.  

4.  It is good.  If you want one more test, I would stop antiviral therapy for at least a month.  If your Western blot is then still indeterminate, you do not have HSV-2.

5.  It happens.  For persons who have had prior outbreaks, about 1/3 still have outbreaks on valacyclovir, but they are fewer, shorter when they occur and less severe.

I hope this helps.  As I said before, I would suggest you stop taking the valacyclovir. Should you get a genital lesion have it tested, preferably with PCT ASAP after it appears.  Culture is an alternative to PCR.  Since I suspect you will not have an outbreak and this will continue to trouble you, if you do not have an outbreak, at least 1 month after stopping valacyclovir, I would suggest you consider another Western blot.  EWH