infection with HSV1

[simina]

Dear Doc's

I am a woman, 28yo.
I was tested for herpes recently, although I have never noticed any oral or genital outbreaks. The lab performed both IgM and IgG tests, but they gave no further info about the specific methods used. Also, they stated the results as positive or negative, without giving any numbers.
So, the IgM hsv 1, 2 test and also the IgG hsv2 test were negative but the IgG Hsv1 was positive.
My ex boyfriend has had oral herpes, but for the time we were together (1.5 years), he never had an outbreak. I have not been having any sexual contacts with him him for about 1 year now.

My questions are:

1. What are the chances that the IgG test was false positive (or false negative)?
2. The negative IgM results mean that the infection has been acquired a long time ago?
3. Since I have never noticed any symptoms, does this mean that hsv1 is probably in the genital area?
4. If the virus is oral, is it possible that I will never notice any symptoms?
5. Could it be both in the oral and the genital area?
6. I am considering to start taking acyclovir pills daily in order to prevent an outbreak and the transmission to my partner. Do you think this is a good idea? Are there any risks from taking these pills for a long time?
7. If I do get an outbreak


Thank you for the help!

[Edward W Hook, MD]

It sounds as though the tests you had were older, non-specific tests for HSV and not the better, type-specific tests such as the HerpeSelect in which the test results are reported as numerical values.  The older tests claim to be type specific but in fact are not.  In addition, there are NO IgM tests that give ANY meaningful information.  They are a waste of time and money and the results should be ignored.  You may have HSV-1 but that would put you in the company of over 60% of Americans who have HSV-1 infection, most of whom do not know they have it.  In these situations nearly all such infections are oral, not genital in location.  As for your specific questions:

1.  Hard to tell.  As I said, you were probably tested with an older, less reliable test.  Even if you have it, to be honest, it really is not all that big a deal.  
2.  See my comment above about the IgM test.  The result you have makes it a bit more likely that your IgG test was falsely positive but I sure wouldn't make any definitive statements based on an IgM result.
3.  No, statistically it is far, far more likely your infection is oral.
4.  Absolutely.  It is also possible/probable that you are at little risk for transmitting infection to others although in science we never say never.
5.  No, infection is much more likely to be present to only be in one location.  When HSV infections are present they almost never get spread from one part of a person's body to another.
6.  Chronic suppressive therapy is not recommended for persons with HSV-1 because the infection really is not transmitted often at all.  In addition, you don't know if you even have HSV.  having opened this "can of worms" at this time the right way to pursue things is for both you and your partner to have good, reliable type-specific blood testing with a test such as the HerpeSelect.  In the interim, I would not change anything you do in your sex life other than tell your partner so you can agree to go and get things sorted out together.  Be prepared however, there is no way to predict what his results will show.  He could be infected with one or both viruses and not know it as well
7.  No, see above.

The topic of herpes is a complex one.  The disease is common with HSV-1 being present in over 60% of adults and HSV-2 (the virus which causes most genital herpes) being present in about 1 in 5 Americans.  For both infections, the majority of people who have the infections are not aware that they are infected, either because they either acquired it without knowing in the past or because they misidentified their herpes as something else.  I have done my best to answer your questions but in general, many of these questions and information about herpes can be obtained by accessing excellent informational web sites such as the one run by the American Social Health Association (disclosure, Dr. Handsfield and I are both on the Board of Directors of ASHA).   I hope this helps.  EWH

[simina]

I am sorry, by mistake I deleted part of my last questions. Here it is again:
7. If I do get an outbreak on the lips, how possible is it to transfer the infection to my eye or other areas of my body?

thank you again!