Blood tests without outbreaks

[moxie999]

My boyfriend recently got an all around STD test because he came down with molluscum contagiosum.  It was an EIA, and though everything else was negative he tested positive for HSV-2 they said it was over five.  He has never had an outbreak and neither have I.  
I have HVS-1 and we are both going for biokits this week.  
I am curious if the Molluscum or the fact that he has Mono as a teen have affected his HSV-2 number in the EIA.  
I am also curious if my HSV-1 will affect the results of the biokit.  
This is all a huge surprise and the test was merely a precaution.  I guess we are just trying to get a sense of how accurate the test results we are getting are because as I said, neither of us have ever had an outbreak.  

[moxie999]

That the number 2% goes down to 1% with the addition of condom use?  

He has already gotten valtrex and is planning on starting immediately.  

Also, that number is lower than the percentages I have been reading, do you have a link to that clinical trial?  

thank you doctor for all your great info.  

[Edward W Hook, MD]

Your antibodies to HSV-1 may provide partial protection but it is not complete.  In the best clinical trial of this subject, among discordant couples like you the aquisition rate of HSV-2 was  less than 4% per year among those who did not take antiviral therapy..  If he take suppressive antiviral therapy, his likelihood of transmission declines 50%, to about 2% per year.  It is a good idea.  EWH

[Edward W Hook, MD]

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 (over 45 million) 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.  Many 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).  Now, for your questions:

Blood test results must be taken in context.  By that I mean that all blood tests have both false positive and false negative results from time to time (the goal is to minimize this and know when it is likely, that is a large part of my job).  The results depend on the type of test performed.  The HerpeSelect and Biokit are among the best, type specific tests.  My other brands can confuse HSV-1 and HSV-2.  Your BF's reading of >5, if the test was a HerpeSelect is a reliable indication that he has HSV-2.  Numbers below 3.0 start to be questionable and raise the possibility of confusing HSV-1 and HSV-2.

Molluscum should not affect his test results.  Mono turns on the immune system and is cause by viruses related to HSV. Nonetheless, it would be rather unusual for it to affect a HerpeSelect assay.  It could if the test type was some other test.

Your HSV-1 should have little impact on the Biokit.

Hope this is helpful.  Please let us know what you learn.  EWH

[Edward W Hook, MD]

You've got it.  That trial was performed by Dr. Larry Corey but I do not have the link with me at this time.  It was int he New England Journal of Medicine.  EWH

[moxie999]

The results of the biokit confirmed that he is infact positive for HVS-2.  
And after about two and a half years together without protection I am still negative.

I have heard that the antibodies in my HVS-1 might have protected me from getting HVS-2-- is there any merit to that?

He doesn't have outbreaks or never has since I have known him if he is on the Valtrex what are my odds of staying negative without condom use?

We have been together a long time and are planning on getting married and starting a family next year.  Condoms would be a real drag at this point, yet I want to maximize my chances of staying HSV-2 free if possible.