[Question #1717] HSV 1 and 2

43 months ago
Negative hsv 2 at 12 and 15 weeks post exposure. Equivocal hsv 1 at 15 weeks. Value was .95. Assuming that I do have hsv 1. Will that delay me from seroconverting for becoming positive for hsv 2. I've read that you have said that it can. But how much? Past 15 weeks? I also have read that Dr. Hansfield has said that an equivocal result that low can be considered negative for practical purposes. Again, trying to find clarity with this confusing testing process. I know about the western blot but at this time cannot afford it. Can you still reassure that I don't have hsv 2 even with that possiblity of delayed seroconversion?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
If you truly do have HSV 1 (and we cannot know that from your current test alone), it will delay seroconversion to HSV 2 slightly, yes.  But an IgG at 15 weeks is about 95% accurate for HSV 2.  While I agree that an equivocal at 15 weeks for HSV 2 is most likely a negative, I don't think we apply that to HSV 1 because the IgG for HSV 1 is such an inferior test, in terms of sensitivity, to the HSV 2 IgG.  I think with a very high degree of certainty you don't have HSV 2 - about 95%, yes.  HSV 1?  Not as certain, no. 

Terri
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43 months ago
Okay thank you so much Terri. If I have hsv 1 either genitally or orally, at what rate could I possibly transmit to a new partner? I know hsv 1 sheds quite infrequently from the genital tract. But how often from the oral tract?  Do you know what types of things could trigger hsv 1 tests to read higher?  What is the missing 5% for the hsv 2 results not being conclusive? Your forum and discussions have been something that have helped give me piece of mind so I thank you for having them. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
HSV 1 orally sheds on about 1/4 of days sampled.  A high index value simply represents a robust immune response.  It is not related to frequency of viral shedding or anything like that.  What do you mean, what is the missing 5%?  The test misses 5% of HSV 2 infections compared to western blot.  Is that what you mean? We don't know why the test misses those 5% of cases.

Terri
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43 months ago
Yes that is what I meant by 5%. I've read some people never develop antibodies that the herpeselect tests for. I know it's rare. But why is that? If no antibodies develop wouldn't symptoms be present? I've never had a symptom. Other than the 2-3 second tingle/spasm in my penis that has happened a few times but that's it.  Can I put hsv 2 to bed and quit worrying about it? Thank you for all your help Terri. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Antibodies DO develop - we know that because the western blot picks them up.  Remember that the 5% missed is in comparison to western blot which is also an antibody test.  Yes, I believe, given what you already know about the sensitivity of the test, that you can put HSV 2 aside.  If you cannot stop worrying, then the next step would be western blot would be the next step
You are most welcome.

Terri
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