[Question #13623] Asymptomatic hsv1 & hsv2 positive antibody tests and discordant couple
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23 hours ago
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My female partner of 10 months went to a new primary care doctor who tested her for hsv1 & hsv2 as part of her initial check-up despite having no herpes symptoms or known exposures. Her Labcorp Roche antibody test results came back positive for hsv1 & hsv2. She retested 2 more times over the next month and each time results were positive for hsv1 & hsv2. At least one of these tests was in the range of < 3.5 however. I also got myself tested 3 times (twice w/ Labcorp Roche, once w/ Quest) over a 4 week period after she told me, and I tested negative each time for hsv1 & hsv2. My primary care physician told me based on these antibody test results that I should conclude that I'm negative for hsv1 & hsv2 and that she is positive for both types. Neither of us has ever had any herpes symptoms as far as we know, but we have never been tested for herpes prior to this either. We have had previous sexual partners prior to this relationship that may have exposed us to herpes. Before we became sexually active in this relationship, we both got a STD panel of tests (which did not include herpes testing). We've been having unprotected sex in this monogamous heterosexual relationship for the past 7 months so it's surprising that, if she had hsv1 & hsv2 during this time, that I haven't tested positive for it too. I'm concerned about the antibody tests being a false positive for her, or possibly a false negative for me. Do you recommend either of us getting a confirmatory Western Blot test since neither of us have any symptoms and we cannot do a swap test without a lesion? For discordant couples, what is currently the best method to reduce hsv1 & hsv2 transmission from a female to male besides abstinence - is it condoms and her taking a daily dosage of antiviral medication such as Valtrex? What is the transmission rate for using both condoms and antivirals, assuming this is what you would recommend for transmission prevention?
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Terri Warren, RN, Nurse Practitioner
21 hours ago
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I'm confused because the Roche test only gives reactive or non-reactive, not index values, like <3.5.
False positives on the Roche test are quite uncommon but she could certainly do a herpes western blot to get greater clarity on her herpes status.
If she is indeed positive, then she can take daily antiviral medication and you can use condoms to greatly reduce the risk of transmission to you if you are indeed negative. Yes. The tranmission rate using both strategies religiously is about 1-2%, having sex about twice a week.
Double check that Roche issue - the numeric value just doesn't fit with results that they give.
Terri
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19 hours ago
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Thank you Terri for this info. Sorry for the confusion. Her Roche test results show "reactive" for both hsv1 and hsv2.
I'd pay for her Western Blot test if you think it can give us some peace of mind or a way to move forward. I also don't want to put her through anything more, unnecessarily. This news has been a huge strain on her especially, and in our relationship.
I double checked my own Roche Test results, and for my two sets of Roche IGG Tests they both say "non-reactive" for hsv1 and hsv2. The tests were spaced about 3 weeks apart My most recent Roche IGG test would have been at least 4 weeks from a possible exposure. We've not had any sexual contact besides kissing on the mouth since getting this news over 3 months ago. Neither of us have had any symptoms during this period. Does this eliminate any doubt about my status? Or do you recommend that I get tested again to confirm that I am negative for hsv1 and hsv2?
My partner's primary care doctor is reluctant to prescribe her antivirals since she is asymptomatic. If she wants to take antivirals, how can she persuade her doctor to prescribe them? Is reducing the risk of transmission to a partner a reasonable argument to get a daily antiviral prescription from her doctor? She could possibly show him this email thread as well.
Thanks for all that you do. I've read through many of the herpes Q&As here and really value this as a resource.
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Terri Warren, RN, Nurse Practitioner
4 hours ago
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The western blot would confirm these results, yes, but I think there is a very good chance that they are correct. The Roche test has about a 2-3% false positive rate, so there is a small chance that this is an error.
We know that people who accurately test positive for HSV-2 shed virus on about 10% of days - so on 10 out of 100 days they give off virus, not in any particular grouping or pattern. And we know that Valtrex 500 mg once a day reduces transmission by 48% (Corey et al, 20024, New England Journal of Medicine). I am also an author on this paper. So to me, it is reasonable for her to be on suppressive therapy to reduce the risk of transmission to you. Condoms also reduce transmission from women to men by 65%. This medicine is safe and effective for long term use. An alternative is acyclovir 400 mg twice a day. When using both of these methods, the risk of you becoming infected is very low indeed. I think reduction of transmission to you is a very reasonable reason to take antivirals daily. Also, our research shows that once someone is identified as being infected with HSV 2, by 3-6 months, most can now identify symptoms of herpes in themselves.
In terms of your testing - The Roche test misses 15% of HSV 1 infections as compared to the western blot. 48% of US adults are infected with HSV 1 so there is a chance that the test missed an HSV 1 infection in you.
Let me know how else I can help . There are also online prescribers who can arrange a prescription for her.
Terri
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