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Confusing HSV 2 Diagnosis
Dr.-
I was trying to do the right thing by getting tested before having sex with my new girlfriend, even though I'd only been with 2 partners. I have never had a symptom of herpes, and I'm pretty neurotic when it comes to those things, so I would have noticed and certainly not have ignored it. I tested positive for HSV2 antibodies, but the Igg score was a 1.3 or so (I don't remember the exact score, I was so shocked). I was retested, and the second score was closer to a 2.0, and then a third time with a result of a 1.68. The tests were done within a month of each other. My Igm scores were all well within the normal range every time. I'm assuming the exposure was about 12 years ago.
I recently saw a doctor who specializes in HIV, STD, and immune system diseases. He looked at my results and said the positive antibody score only says that I was exposed to the virus, not that I have it. That the viral load may have been low enough, and my immune system strong enough, that I was able to avoid actually getting it since I've never had any physical symptoms of the disease. This would also mean I wouldn't be able to transmit to anyone else because I never actually got it, but that I was only exposed to it, and the two don't go hand in hand 100% of the time. Can you confirm any of this, or do you have a different opinion? Thank you very much.
I was trying to do the right thing by getting tested before having sex with my new girlfriend, even though I'd only been with 2 partners. I have never had a symptom of herpes, and I'm pretty neurotic when it comes to those things, so I would have noticed and certainly not have ignored it. I tested positive for HSV2 antibodies, but the Igg score was a 1.3 or so (I don't remember the exact score, I was so shocked). I was retested, and the second score was closer to a 2.0, and then a third time with a result of a 1.68. The tests were done within a month of each other. My Igm scores were all well within the normal range every time. I'm assuming the exposure was about 12 years ago.
I recently saw a doctor who specializes in HIV, STD, and immune system diseases. He looked at my results and said the positive antibody score only says that I was exposed to the virus, not that I have it. That the viral load may have been low enough, and my immune system strong enough, that I was able to avoid actually getting it since I've never had any physical symptoms of the disease. This would also mean I wouldn't be able to transmit to anyone else because I never actually got it, but that I was only exposed to it, and the two don't go hand in hand 100% of the time. Can you confirm any of this, or do you have a different opinion? Thank you very much.
MEDICAL PROFESSIONAL
Dr. Hook and I do not comment in each other's threads, except infrequently when either of us asks the other to do so. Although our writing styles differ, we have worked closely together for a quarter century and rarely disagree on our medical opinions or advice. You can be sure that Dr. Hook would agree entirely with my advice above.
You say in the follow-up comment that your HSV-1 test results were negative. That makes it very likely that your HSV-2 result is true. The Western blot will either confirm or refute it. There is nothing left to do but wait for that result; all else is speculation. In general, we recommend against playing the "where did I get it?" game -- but in any case, you need to put that off until you have the WB result.
You say in the follow-up comment that your HSV-1 test results were negative. That makes it very likely that your HSV-2 result is true. The Western blot will either confirm or refute it. There is nothing left to do but wait for that result; all else is speculation. In general, we recommend against playing the "where did I get it?" game -- but in any case, you need to put that off until you have the WB result.
Dr. Hook-
You've talked about false positives in numerous posts, and I was wondering if you think it's likely that what I described to Dr. Hansfield could also be an example of that. I tested negative each of the three tests I took for type 1, but my type 2 scores were all on the low positive side of things. I have no idea what could make me test pos. falsely three times like that. I've ordered a Western Blot test, so I'll have to find one of the doctors that I've been to that won't think I'm being overly neurotic about all this to ok the lab work, but I have to get the test done. Your thoughts? Since type 1 is neg., would you still say that the cutoff for me should be raised any, or does it appear I do have type 2, even with my history of no symptoms and 2 partners? In fact, the only thing I've ever had was a red bump on my lip that came out in the same place a few times last year, but it only lasted a couple of days the first time and about 4 or 5 the next, and this happened after I kissed someone who then told me she got cold sores. Is it also possible that she had type 2 orally and that's how I developed antibodies? That red bump I had never really developed into a cold sore and I figured it was just an acne blemish, although it did reappear in the exact same spot a total of 3 times that year.
Thank you for any response.
You've talked about false positives in numerous posts, and I was wondering if you think it's likely that what I described to Dr. Hansfield could also be an example of that. I tested negative each of the three tests I took for type 1, but my type 2 scores were all on the low positive side of things. I have no idea what could make me test pos. falsely three times like that. I've ordered a Western Blot test, so I'll have to find one of the doctors that I've been to that won't think I'm being overly neurotic about all this to ok the lab work, but I have to get the test done. Your thoughts? Since type 1 is neg., would you still say that the cutoff for me should be raised any, or does it appear I do have type 2, even with my history of no symptoms and 2 partners? In fact, the only thing I've ever had was a red bump on my lip that came out in the same place a few times last year, but it only lasted a couple of days the first time and about 4 or 5 the next, and this happened after I kissed someone who then told me she got cold sores. Is it also possible that she had type 2 orally and that's how I developed antibodies? That red bump I had never really developed into a cold sore and I figured it was just an acne blemish, although it did reappear in the exact same spot a total of 3 times that year.
Thank you for any response.
MEDICAL PROFESSIONAL
Most likely you are infected with HSV-2, but not necessarily. As you suggest, it is unusual for someone with only two lifetime partners, and no symptoms of genital herpes, to have HSV-2. Was an HSV-1 test done at the same time? Sometimes when the HSV-1 test is positive (as it is in half of all adults in the US), mid-level positive HSV-2 results like yours are false. If that is the case, you could ask your provider to send a confirmatory specimen to the University of Washington clinical lab in Seattle for an HSV Western blot test. WB is the final gold standard for uncertain HSV blood test results.
MedHelp asks the forum moderators to not criticize people's doctors and to avoid correcting them when possible. However, your doctor is wrong about being "exposed but not infected". There is no such thing; with this virus, the two things (antibody and infection) always "go hand in hand". People with positive HSV-2 antibody tests are infected with HSV-2 and, whether or not they have symptoms, have the potential to infect their sex partners. (This is not opinion, but proved scientific fact.)
Bottom line: Check up on the HSV-1 antibody test results, if they were done; and discuss the possibility of the WB test with your provider. If WB confirms you have HSV-2, then you are obligated to assume you have asymptomatic genital herpes, with the potential to transmit the infection to sex partners.
I hope this helps. Best wishes-- HHH, MD
MedHelp asks the forum moderators to not criticize people's doctors and to avoid correcting them when possible. However, your doctor is wrong about being "exposed but not infected". There is no such thing; with this virus, the two things (antibody and infection) always "go hand in hand". People with positive HSV-2 antibody tests are infected with HSV-2 and, whether or not they have symptoms, have the potential to infect their sex partners. (This is not opinion, but proved scientific fact.)
Bottom line: Check up on the HSV-1 antibody test results, if they were done; and discuss the possibility of the WB test with your provider. If WB confirms you have HSV-2, then you are obligated to assume you have asymptomatic genital herpes, with the potential to transmit the infection to sex partners.
I hope this helps. Best wishes-- HHH, MD
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.
