[Question #1229] HSV-1 goes "Dormant"? No need to repressive Valtrex?

47 months ago
Hello, my wife has HSV-1 in her Genitals and has had exactly one outbreak two years ago, with nothing since.  She has been on Valtrex 500 since the first outbreak to avoid spreading it to me.  I am currently still negative. Her doctor has told her that because it's HSV1 and genital (which is unhospitable to HSV1) and that there has not been a second outbreak that the virus has gone essentially dormant and my wife need not take the Valtrex any longer, as she is not shedding and the Valtrex at this point does not decrease my risk of infection.  I've found no support for this idea on line.  All I've seen is that the virus lives and is contagious forever.  Please, I understand this is a very specific question and I need expert advice here - I don't want exposure.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
Hi David,
There are several things to address here.  First, the screening IgG test for HSV 1 misses about 30% of infections, according to our latest study.  Second, it is difficult to know what her "natural history" might have been with her HSV 1 infection, had she not gone on suppression right away.  I'm wondering how her diagnosis was made and am curious about whether she got this while you were together?  If yes, then I'm curious about whether you might be infected already and not know it.  Have you ever in your life had a cold sore on your lip or in your nose?  The herpes western blot is a far more accurate test for HSV 1 than the traditional IgG testing,  It is done at UW and if you are interested in that, I can tell you more.  HSV 1 genitally  is an infrequently recurring condition for most people, and after the first year of having it, recurs about 0.7 times per year, without medication intervention.  I would disagree with the doctor that she is not shedding.  We would assume that she is likely shedding some at some point in all of this, even if she is not having any outbreaks, though shedding is infrequent for sure.  Is she having difficulty with the medicine at all?  Does she want to stop?  Do you want her to stop?  Perhaps you can clarify a bit for me about your situation and both of your thoughts about this.  Thanks so much

Terri
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47 months ago
Thank you so much for your reply!

She had an initial outbreak and had both a culture and a blood test at the same time.  The culture was positive for HSV1 and the blood test was negative.  I'm not sure if the blood test was IgG or IGM.  I had a IGG blood test then, one the year after, and once very recently.  All negative.  I was under the impression that false negatives for IGG were  very rare (1%).  However I have also read that IGM tests can give false negatives for old infections, and she is maintaining that someone gave her herpes as a child.  I'm checking on this separate issue to see if her test was IGG or IGM.

The real issue is whether I am going to be exposed to her herpes MORE if she quits Valtrex.  I've taken three IGG tests and all negative, even the one just this month, so I'm inclined to believe it, and I'd like to stay clean.  She is not experiencing any side effects of the Valtrex and its not a cost concern, but she says her doctor says Valtrex is not meant for long term use.  Again, not what I've read on line.    

So the question is whether her doctor has a valid point, that HSV1-genital which shows up only once and then not again two years later is sufficiently inactive to stop taking valtrex to avoid spreading to a partner. The only reason she was taking it was to prevent spreading via shedding.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
So let me ask you this:  has your wife had an antibody test (IgG) for HSV 1 since her diagnosis?  If yes, and she is now positive (and was previously negative), that indicates that that outbreak, that was swab test positive, was a new infection.  Positive swab and negative antibody test usually means new infection - the virus is present on the skin but no enough time has passed for antibody to have been made.  Now if she still tests negative on the IgG test, that could mean that she was infected with HSV 1 prior to her first recognized outbreak and the test is just missing it still.  If someone gave her HSV 1 genitally as a child, that is certainly disconcerting, at best, right?  That's sexual abuse, is that what she is thinking?  Had she never had sex with anyone other than you in her lifetime?  And that includes receiving oral sex? 

The problem with IgM tests is not false negatives (though I'm sure that happens too) but rather false positives.  The CDC says never to do them. 

Also, in my 33 years experience with IgG tests, once the test misses an infection once in a person, it misses it most every time so repeating tests is not helpful when you have a test that is not very sensitive, as the IgG for HSV 1 is not.  Our paper comparing the IgG test to the western blot was presented at the CDC STD prevention meeting last week in Atlanta - your information about the sensitivity of the HSV 1 test is inaccurate (and the HSV 2 test is better - it misses 5-8% of HSV 2 infections). 

So I think there is a lot there is still unknown in your marital situation. 

If she stops taking Valtrex I would say that your risk is greater of acquiring her HSV 1, if you don't have it already.  It probably isn't a lot greater because HSV 1 shedding is already infrequent so the benefit is not going to be huge but I would say some benefit.  I would disagree that Valtrex is not meant for long term use.  In discordant couples (one is infected and the other is not), Valtrex is a great tool for reducing transmission, long term as well.  

Terri
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47 months ago
Yes, My wife has never had sex (oral or otherwise) with anyone but me.  I have had many sex partners, so when she got it we both figured I'd contracted it and was asymptomatic and shedded to her, but when I turned up IgG negative I figured she'd either had an affair or  caught it from some toilet seat or pool recently,  or been kissed on the vagina as a baby by someone with herpes (my doctor told me that this used to be a custom).  I'm not trying to find out if she had an affair (of course I'd like to know), rather  I'm trying to make her feel better about being touched as a baby.  That's what started this part of the issue. What I hear you saying is that if she repeats the same test, or has repeated the same test, and the second test comes out positive then the infection is definitely new. If it's negative, then there is no way to know.  Correct?

So are you saying that even after 3 negative IgG tests 1 year apart that there is still a substantial  chance that I am positive?

Back to my original issue, is there reasoning behind the assertion that because there has been no outbreak since the first one, that we can conclude that  the virus has gone so inactive that the liklihood of shedding is decreased to the point where I need not worry about contracting the disease any more than I would if she were still on valtrex? Does the timing matter?   Rare shedding is still scary for me, assuming I'm clean, and if Valtrex reduces it more I am inclined to ask her to stay on it if valtrex makes "rare" significantly less rare.

Thanks so much for your help!


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
47 months ago
Yes, I am saying that even after three negative test, you could be HSV 1 positive and have infected her.  The way to find out is by having a herpes western blot. 
I think given your concerns, that would definitely be the thing to do.  You can contact the University of Washington for the herpes western blot  What state do you live in?  They will ship you a kit and your doctor can draw the blood and send it back.  If you realize that the test misses one in three infections, it should encourage you to pursue this option. 
I have never ever heard of a custom of kissing the labia of female babies, not ever, unless she is from some other country with a custom I don't know about. 
If you do test negative by western blot, then she should stay on Valtrex given your concerns about infection.
Given all of this I truly hope you will pursue the best test for yourself.  I think there is much at stack for her as well as you.
Terri
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