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Avatar universal

transmission

I have been unsuccessful in searching the literature to find answers to my questions re: HSV-2.  I'm hoping you can answer my questions.

I am in a relatively new relationship.  My partner and I are in our mid 40's.  We both underwent STD screening, and were found to be negative for GC,Chlamydia,syphilis and HIV. Neither of us had a history of cold sores or genital sores,therefore,HSV screening was not done.  Seven days after unprotected vaginal intercourse  and oral gential contact, I developed unilateral labia minora itching, burning and tingling sensation, severe extravaginal pain with urination,  progressing ot labial swelling/skin slouphing with exudate and one small painful small papule. No evidence of vescicles, ulcerations or crusting.
Due to symptoms suggesting HSV, I was started on acycloivr until test results were available.

Lab results: UA neg, wet mount:neg, clue cells: neg,
HSV PCR:neg, HSV1/2 IGM:negative, HSV1 IGG:neg, HSV2IGG:neg,
3+ lactobacillus on genital culture.

When my provider found everything to be negative, I was empirically started on Keflex for treatment of suspected gential infection and within 24 hours my symptoms had improved significantly, and in 48 hours most sypmtoms resolved. I then dicontinued the acylovir. I will be retested HSV1 IGG and HSV2 IGG 3 months after my initial ? outbreak. My partner was tested and HSV1 IGG: neg  HSV2 IGG positive.

My educated guess is that I clinically had atypical symptoms of a primary outbreak of HSV.  I was most likely tested too early to develop antibodies. My partner has never had an outbreak, therefore, HSV was transmitted via aymptomatic shedding. I was taking acyclovir for 48 hours prior to starting antibiotics, so I may have improved on antiviral therapy and not antibiotics.
Assuming my educated guess is correct:

1. If I test positive to HSV2 IGG in three months and my partner is HSV2IGG positive: what precautions do we have to take when there are no signs of an outbreak i.e., condoms, oral sex, hand to gential contact?.  Can you keep reinfecting each other in different sites?

2. Can HSV2 infect the oral mucosa and lips.? (My partner has complained of chapped/dry lips but no hx of lesions)

3. Is there a role for suppressive therapy in HSV2 in concordant couples for the peace of mind of decreasing outbreaks/viral shedding?  

4. If I test negative to HSV IGG 1 & 2 in 3 months, and since my partner has never had a known outbreak, it would seem appropriate that he would use suppressive therapy with the use of condmens to reduce risk of transmission.  Please coment.


Thank you

5 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
I'll try to help.  You also can find some of the answers on other websites, e.g. the Westover Heights Clinic (www.westoverheights.com), the American Social Health Association (www.ashastd.org), and the herpes article in the link "STD Quick Facts and Articles" on the STD Forum home page.

From your description, the symptomatic episode you had was consistent with genital herpes but not classical.  The follow up serological test will tell the story - if you have the right test.  IgM results are completely useless; disregard them entirely.  (Search this forum's threads and archives for "herpes diagnosis" and "herpes IgM test" for more information.)  IgG is what you want, but not all IgG tests are reliable.  You need to be sure you have IgG serology that detects antibody to HSV glycoprotein G (gG, not the same as IgG, don't get them mixed up in your mind).  The most widely available has the trade name HerpeSelect (you can also search this forum for "HerpeSelect test").

My responses to your questions will assume you have had (and/or will have) a gG-based test and that you won't have, or will ignore, any IgM results.

1 and 2) If you become positive for HSV-2 and your partner is as well, you will not transmit the infection back and forth. Once seropositive to either HSV type, a person is immune to new infection of any part of the body with the same type.  If exceptions occur, they are rare.  Dually positive couples need not worry ever again about transmission between each other.

3) There is no role for suppressive therapy to prevent transmission in HSV-2-concordant couples.  There may be a role to control symptoms, however, depending on frequency and severity of recurrent outbreaks.

4) Do not assume your partner is inected unless/until he also is tested.  As per my opening comment, it isn't certain you have genital herpes at all.

I hope this helps.  Best wishes--

HHH, MD
Avatar universal
Hi Doc,

When you say the other tests aren't reliable, do you mean in terms of giving false positives, false negatives, or both?
Avatar universal
Avatar universal
In terms of reliability, the Doctor is probably referring to sensitivity, the percentage of the result that is positive when hsv is present. And specificity, the percentage of the result that is negative when hsv is not present.

If you look at http://www.herpesdiagnosis.com/blood.html you'll see some less accurate IgG tests.

Avatar universal
I don't think you should make the assumption you have
herpes.  If you did you would be extremely unlucky
if it's true your partner did not have outbreaks.

However, since your partner tested positive to HSV2
you are susceptable to getting HSV2 in the future even
if you don't have it now.

So, I would use condoms and have your partner on suppressive
antiviral therapy until this is sorted out.

If in fact at the three month point you are HSV2 Positive then he can stop the therapy, but in the meantime why take a
chance.

Let us know how it turns out.
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