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HSV Infection Assessment Question
I have had 2 episodes of protected vaginal sex (approx. 10 discrete acts) in early Feb and late Apr 2008 with an HSV+ F (+ for > 18 yrs; history of minor outbreaks 1-2x/yr). She had no apparent outbreak symptoms in the run-up to or during each episode. I have had no classical symptoms (e.g., no lesions or discharge). Approximately 2 weeks post first exposure I developed a fever and lung congestion that was treated with an antibiotic (this cleared up in 14 yr.
On 28-May (16 wks post first episode; 5 wks post second episode) I got both IgM and IgG testing (from LabCorp via HeathCheck), with the following results:
HSV, IgM I/II Combination <0.91
HSV 2 IgG, Type Spec 1.2
HSV 1 IgG, Type Spec 3. It is also apparent from prior posts and other research that the lag between the early February episode and the test date (4 months) ought to provide a reasonable result, whereas the duration between the late April episode and the test date (5 weeks) is probably too short to provide a reliable assessment of HSV status.
I would appreciate your comments about this situation, and any opinion regarding likelihood of having been infected and thoughts on how to proceed forward. I plan further testing at the 4 month mark for the second episode (mid August). Thank you.
On 28-May (16 wks post first episode; 5 wks post second episode) I got both IgM and IgG testing (from LabCorp via HeathCheck), with the following results:
HSV, IgM I/II Combination <0.91
HSV 2 IgG, Type Spec 1.2
HSV 1 IgG, Type Spec 3. It is also apparent from prior posts and other research that the lag between the early February episode and the test date (4 months) ought to provide a reasonable result, whereas the duration between the late April episode and the test date (5 weeks) is probably too short to provide a reliable assessment of HSV status.
I would appreciate your comments about this situation, and any opinion regarding likelihood of having been infected and thoughts on how to proceed forward. I plan further testing at the 4 month mark for the second episode (mid August). Thank you.
MEDICAL PROFESSIONAL
You don't say what type of herpes your partner has and whether it is oral or genital. Most likely you mean genital, in which case she probably is infected with HSV-2. If so, let's assume she wasn't having an outbreak with symptoms at the times you had sex with her. Let's also assume a 1% chance the virus was present when you had sex with her. (It would be higher if she had been infected recently, but with an infection 18+ years in duration, the chance of asymptomatic viral shedding probably is quite low.) Now assume maybe a 10% chance of transmission if the virus was present and you DIDN'T use a condom. With use of condoms, those odds are reduced by around 90%, making your actual risk around 1%. Now let's also figure that if you were infected, you probably would have noticed symptoms within the next 2-3 weeks, i.e. penile blisters, sores, etc
All this translates into an extremely low chance you caught the infection. In other words, a whole list of probabilities would all have to break the wrong way. The chance you were infected translates to well under 1 in a million. Had you been my patient, I would have recommended against testing at all. The odds of a false positive result were much more likely than the chance you actually were infected. And that appears to be what happened.
As for the test results: First, you have HSV-1, as does half the population. That probably goes back to childhood, whether or not you ever had (or remember) cold sores or fever blisters.
Your HSV-2 result is weakly positive. Most people in this circumstance are not infected, i.e. have false positive results. The more these tests are used, the more we understand that the ELISA ratio has to be above 3.5 to be considreed reliably positive. Factoring in the evidence that you weren't infected, discussed above, plus this test result, you can be very confident -- but not quite 100% certain -- you didn't catch HSV-2 during the sexual encounters that you describe.
There's not much difference between seroconversion rates between 3 and 4 months. So If you decide to get retested, as you suggest, wait until 6 months after the last sexual exposure. In the meantime, it is very unlikely you have HSV-2, but it cannot be ruled out with 100% confidence. (If you have it, most likely it has nothing to do with the recent exposure, but instead goes back to some other exposure in the distant past.)
Bottom line: Relax; almost certainly you don't have it. But follow through with repeat testing if you remain concerned.
I hope this helps. Best wishes-- HHH, MD
All this translates into an extremely low chance you caught the infection. In other words, a whole list of probabilities would all have to break the wrong way. The chance you were infected translates to well under 1 in a million. Had you been my patient, I would have recommended against testing at all. The odds of a false positive result were much more likely than the chance you actually were infected. And that appears to be what happened.
As for the test results: First, you have HSV-1, as does half the population. That probably goes back to childhood, whether or not you ever had (or remember) cold sores or fever blisters.
Your HSV-2 result is weakly positive. Most people in this circumstance are not infected, i.e. have false positive results. The more these tests are used, the more we understand that the ELISA ratio has to be above 3.5 to be considreed reliably positive. Factoring in the evidence that you weren't infected, discussed above, plus this test result, you can be very confident -- but not quite 100% certain -- you didn't catch HSV-2 during the sexual encounters that you describe.
There's not much difference between seroconversion rates between 3 and 4 months. So If you decide to get retested, as you suggest, wait until 6 months after the last sexual exposure. In the meantime, it is very unlikely you have HSV-2, but it cannot be ruled out with 100% confidence. (If you have it, most likely it has nothing to do with the recent exposure, but instead goes back to some other exposure in the distant past.)
Bottom line: Relax; almost certainly you don't have it. But follow through with repeat testing if you remain concerned.
I hope this helps. Best wishes-- HHH, MD
A related discussion, Follow-up to HSV Infection Assessment Question post of 3-June-2008 was started.
Thank you for this. Will follow advice and re-test at the 6m window. Cut and past error in initial post; correct data for HSV-1 was
HSV 1 IgG, Type Spec <0.91
Will post again with follow up test results for the record. Many thanks!
HSV 1 IgG, Type Spec <0.91
Will post again with follow up test results for the record. Many thanks!
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
