Hi Dr.--Thank you so much for this forum! I recently wrote to you about HSV-1 transmission; thank you for your very helpful response. As a follow-up, to verify my type and to have something in writing recently to show my partner, I had a blood test. However, the test came back inconclusive for either type; the lab said I was not producing enough antibodies to measure. My gyn, though, said, based on my initial culture in 2000 at the time of my first--and only--outbreak, I have HSV-2, something I did not know until he told me following this inconclusive blood test. I have been on suppressive therapy, most recently 500 mg. of Valtrex once-a-day, ever since the first outbreak, and, as mentioned, have had no outbreaks since. Questions:
1. What does the lack of antibodies actually mean? Just that I am not having any actual outbreaks or infections that would produce antibodies? Is this the result of the Valtrex?
2. Could the test have been faulty? My gyn even called the lab to inquire about the test, and they just said there were no measurable antibodies.
3. Should I have the test repeated? A different test? (I'm not sure which test, but I said I wanted to know which type. I've requested the paperwork, but haven't received it yet.)
4. What does this mean regarding transmission to my partner? Does it indicate that transmission is less likely?
5. Does asymptomatic shedding still occur? Or would there be antibodies present if there were shedding?
6. Is it possible to have "silent" outbreaks that still would produce little or no antibodies but that could transmit the virus to my partner?
I have read all the recent threads about HSV-2 transmission in cases similar to mine, and that has all been extremely helpful, but could find nothing about lack of antibodies, etc. I would greatly appreciate your insights on this, Dr.
Thank you very much!
The report of 'inconclusive for either type...not producing enough antibodies to measure' suggests you might have had an older, non-type specific test. I also have to question the reliability of your prior diagnosis of HSV-2, if the blood test was a proper one. So my main advice is to be sure you had the right kind of test, such as HerpeSelect; search the threads for 'HerpeSelect' and/or 'herpes diagnosis' for many other discussions of the tests and labs to use. If you in fact had a truly type-specific test with borderline results, request a Western blot test by the University of Washington clinical laboratories in Seattle.
1) If you had the right kind of test and truly have no HSV antibody, it suggests you were never infected with HSV-1 or HSV-2. 2,3) See above. 4-6) Can't tell (yet) what all this means for the likelihood of transmission, for asymptomatic shedding, etc. Obviously, if you don't have HSV-2, there is no risk.
Thank you, Dr.! According to my doctor's nurse, it was a HerpeSelect test. When I had the outbreak in 2000, I certainly had all the classic symptoms, lesions on my vulva, urinary discomfort, etc., and the culture came back HSV-2. According to one source I found, once the viral culture shows a clear positive type (in this case 2), there is no need for a Western Blot. In my case, if it comes back positive, then I know, but if it comes back negative, I'm right back where I started: with herpes, but in that 1% or so of people who don't produce significant antibodies, apparently, which still leaves me wondering about my risk of transmission. Is it the same regardless of whether or not I am producing antibodies?
I agree the Western blot won't necessarily solve the riddle. If it is negative, it will be compatible with either possibility: you don't have herpes and never did (your original test for HSV-2 was falsely positive); or you are one of the rare people who does not develop measurable antibodies (by any test method) after an HSV infection. However, if WB shows positive to HSV-2, it will confirm the prior diagnosis.
Unfortunately, to my knowledge there are no data to answer the question you ask, i.e. to know whether HSV-2 infected people who have negative antibody tests are more infectious, less infectious, or average in terms of risk of transmission to partners. The conservative (and kind) thing to do would be to assume you are infectious and to warn partners.
There is one other option that might help sort things out: Stop taking Valtrex for a few months. If you get outbreaks, the lesions could be re-tested for HSV-2. During that interval, of course, you would have to be especially careful about warning partners, avoiding sex when you have symptoms, and using condoms.
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