[Question #11498] Validity of non-specific PCR and transmission rate

Avatar photo
14 months ago
Case: 
1. Initial presentation with genital rash (not clustered) after running in extreme heat and shaving genitalia with facial razor and had intimacy with new partner and symptoms present within 2 days of intercourse. 
2. Partner tested IGg positive for HSV-1, and my blood IgG test negative for both HSV-1 &HSV-2 
3. Positive PCR result but not type-specific. One year later, Subsequent blood test result: HSV-1 with a lower range of ? 11-13. And since always negative for HSV-2. 
4. Zero recurrence or symptoms since initial episode. ( 4 years ago)
5. Confusion about HSV-1 being primarily oral herpes and concerns about transmission, disclosure and stigma. (New partner concerned with *online indicates high risk of transmission) 
Are PCR- non specific test valid and what is risk of transmission of genital HSV-1 F-M ? 

Avatar photo
14 months ago
Additional info: Never have taken suppressive med’s and on visual appearance Dr thought folliculitis but PCR showed positive. 
Avatar photo
Terri Warren, RN, Nurse Practitioner
14 months ago
If one year later you are positive for HSV 1 only, then it is most likely that your genital positive PCR was HSV 1.  We don't have the transmission rate of genital HSV 1 because it is so rarely shed after being infected for a year or two.  

Terri
---
Avatar photo
13 months ago

I am confused, you say that I most likely have HSV1, but it was only a blood test was not western blot and same blood test showed twice negative. My confusion is if Dr. did a type specific PCR and yet the lab and Dr. could not give the type, and I am currently showing negative for HSV 2, we are just assuming an HSV 1 positive 48 hours after exposure. My tests for HSV 2 have repeatedly been determined negative. Dr.’s notes indicates that since I’m asymptomatic, not recommended to repeat test for HSV 1 and that I believe PCR was invalid. The reason I believe PCR was invalid is because I was also testing blood negative and it clearly presented as folliculitis as hair folic was present at site and Dr visually examined and said this is Not Herpes. 

 PCR that was supposed to be type specific should have cleared that up, except they didn’t present me with full lab result in omitting the type. I asked about that and was told that it didn’t matter because once its genital herpes they are treated the exact same way. I was told that I would most likely show positive in blood and clinical guidelines to join Herpes groups and dating sites.

Avatar photo
13 months ago
 As a side note it was during height of covid, and I question the efficacy of labs during that time frame. Another side note is that in the past labs have made errors by giving me someone’s else’s results. I have even had false positive blood tests for other diseases, with repeat subsequent testing showing negative. I don’t believe HSV test is full proof, and I truly believe I am not carrying HSV. Even if I do carry HSV-1 there is no way to confirm genitalia since I have zero outbreak or symptoms. Since, I have never presented with anything that appears as genital HSV and am what one would say is asymptomatic for the last four years since, should I disclose to partners that I had a possible exposure because I had intimacy with someone who presents as HSV 1 positive.
Avatar photo
13 months ago

While this could be in his cornea, finger or other parts of body HSV.  I have explained this to new partners and require testing from them for HSV. New potential partners are telling me they never had exposures and therefore don’t test for HSV and like me say their doctor says that unless you have symptoms, they don’t recommend test for HSV 1. 

 

Basically, I strongly feel I am repeatedly subjecting myself to extreme stigma and shame over an exposure to HSV 1 but not certain that I have contracted the virus and am asymptomatic years later. 

Avatar photo
13 months ago

 From my research (please correct if inaccurate) I have concluded: 70% of the population has HSV1. The rate of transmission of genital herpes from an infected female to a healthy male is 4% over one year.  The HSV-1 virus prefers to reside in its usual place (trigeminal ganglia of the head) between outbreaks and therefore the chance of transmission is lower if it resides in the genital area. Since most herpes transmission occurs between outbreaks with virus shedding, the HSV-1 shedding from the genital area is 11%. Recent data, particularly for HSV-1 genital shedding frequency, suggests that shedding declines as time post-infection increases. Therefore, a four-year-old possible infection would be low or even rare. Unless you have symptoms, testing is not recommended, and that most of the population is asymptomatic. Therefore, why would one go around disclosing a 4+ year old “possible” infection/ exposure, if they are asymptomatic when the rest of the population is told they don’t need to test for it since they are asymptomatic.  

 

 

Avatar photo
13 months ago

In dating, NO one is willing to move forward after I have said I had exposure and previous singular intimate experience with HSV 1+ partner. Furthermore, they comment that it would not have been an issue if we were in a long-term relationship, and it came about later.  Yet, If I start the conversation by asking them for their STD results, I am being told they have not had to test for HSV since they are asymptomatic, and it’s not recommended unless you have an outbreak.  Which is the story I got after said exposure scare, mind you he was a  medical professional and said who tests for HSV.  Basically, NO one wants to test, have this stigma as it’s so prevalent.

Avatar photo
13 months ago

Are we really to go around and disclose exposure to viruses that present with a blister on the lips and/or possibly other part of the body? How bad can HSV 1 outbreak really be for a healthy human, is HSV 1 truly a risk or a stigma!? I am certain that I have come across it in previous relations and I am healthy and asymptomatic, yet I am noticing that men would openly have casual sex with me prior to any discussion on HSV, and later if I ask them, they may tell me they too have had exposure with previous partner and asymptomatic. However, if I start the conversation with disclosure of my very rare, and inconclusive testing they will not want to proceed with even kissing. 

Avatar photo
13 months ago

In conclusion, I want to speak with confidence, I am asymptomatic and never had a western blot test for HSV 1 and therefore don’t want the continued shame and the HORRIBLE stigma of disclosing that I had a previous experience with an HSV 1 exposed male. If I went to a doctor today, I would recommend that I don’t run the test unless you have symptoms. It appears to me that that HSV exposure has infected my mind, not my body. 

Avatar photo
Terri Warren, RN, Nurse Practitioner
13 months ago
There are so many posts here, I'm not sure I will be able to address everything you've asked and said.
Maybe I got your information wrong.  What I read was this:

you had a positive PCR from a genital lesion that was not typed HSV 1 or HSV 2.
you now have an IgG test with an index value of somewhere between 11 and 13 (low positives are 1.1-3) and you are negative for HSV 2.  
If you were recently infected with HSV 1 when you got the rash, your blood test would be negative - it takes time to make antibody, it doesn't happen instantly.  So testing too soon after a new infection would result in a false negative result
It appears that no typing was requested?  Do you have a copy of your actual result?  You can see if typing was requested or not.  And sometimes, for various reasons, typing cannot be completed on a positive sample.  Someone who says it's genital herpes and typing doesn't matter (which is totally false) is more likely not to have ordered typing as they don't understand HSV.

In our research studies, virtually 99% of people who tested positive for HSV 1 on an IgG test with an index value below 3.5 confirmed as a true positive by western blot so with your value between 11-13, I would suspect you would likely confirm positive for HSV 1 as well.
Since you tested negative for HSV 2 (the IgG test picks up 92% of HSV 2 compared to western blot), I think we can likely trust that negative with a fairly high degree of certainty.
48% of people in the US between 14 and 40 have HSV 1 infection
HSV 1 genital infection rarely recurs and I"m not surprised that you don't have recurrences.
The rate of transmission that you quote is for HSV 2 - we have no numbers for HSV 1 transmission but it is way way lower
If you have sex with someone who already has a history of cold sores, they are very unlikely to acquire HSV 1 in a new location (genital)

You seem angry and upset here.  I'm not here to tell you what to do about your situation  - I'm here to give you facts.  I hope they are helpful

Terri Warren



---