[Question #10850] Should I consider myself positive for HSV1 genital?

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19 months ago
Thank you for your time.  I listened to Terri's interview on ASHA which was insightful. I am writing for an expert opinion on my test results as I find them confusing.  In 2021 my boyfriend said he was HSV1 positive.  Unfortunately, I did not get a baseline blood test at that time, but I had never experienced an oral or genital outbreak. A few months later, I experienced a genital lesion high up in the hair follicle area and asked for it to be swabbed.  The swab was negative, and I do not know if it was PCR as the results do not say.  I asked that my blood sample be tested for HSV1 antibodies.  It came back with a value of 4.37. I've lived in confusion for 2.5 years.  Then after a tetanus booster and flu shot in Dec 2023 that I think instigated this, I experienced a second genital lesion again high in the hair area. I asked for another swab that was again negative and I can see from the results that it says PCR.  I again asked that my blood sample be tested for HSV1 antibodies and I can see the test says IgG.  It again came back positive but this one did not provide a value.  All other STI tests including HSV2 are negative.  To summarize, 2 negative swabs, 2 positive blood tests. Should I consider myself positive for HSV1 genitally?  I appreciate your advice and let me know if you need additional information.
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Terri Warren, RN, Nurse Practitioner
19 months ago
With an index value of 4.37, I would say it is almost certain that you have HSV 1 somewhere.  Since your swabs were negative, I don't think you can say you have genital HSV 1.  You might, that's true, but with negative PCR swabs, you really can't be certain.  The good news is that HSV 1 genital infection rarely is shed from the body and is very rarely transmitted through intercourse.  So even if you do have it genitally, it is questionable what impact it will have.  I think you can dislose to future partners that you have the cold sore virus but you don't know where it is - only that you tested positive for it.  How does that sound?

Terri
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19 months ago
Thank you for the insight Terri.  I am glad to hear, "The good news is that HSV 1 genital infection rarely is shed from the body and is very rarely transmitted through intercourse," but I think it was transmitted to me through that type of contact with my ex.  Still, I agree with, "I think you can disclose to future partners that you have the cold sore virus but you don't know where it is - only that you tested positive for it."  I appreciate the work that you do and only wish I had found it sooner to know about a baseline test prior to exposure and other preventative measures you spoke of.  It was not easy to get the answers I have now and as you can see, I was still confused.  As a final ask, is there more I can read up on HSV1 in particular?  I've visited H Opportunity and am working through Adrial's material.
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Terri Warren, RN, Nurse Practitioner
19 months ago
well, you are assuming you have it genitally, which is possible but not confirmed.  If you do have it genitally, you could have gotten it from anyone who gave you oral sex ever in your life.  If you've never received oral sex in your lifetime, then surely it was through intercourse, which is uncommon.  But it can happen if someone has newly acquired genital HSV 1 and has intercourse unprotected with someone who doesn't have HSV 1.  People with new infection with HSV 1 genitally do shed on about 13% of days until about 6 months when it drops to about half that.  The majority of people who have HSV 1 would say they don't have symptoms, just like with HSV 2. 

Terri
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19 months ago
Thank you for the additional insight Terri!  I have no further questions.
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Terri Warren, RN, Nurse Practitioner
19 months ago
You're welcome

Terri
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