[Question #1956] Herpes I and II

46 months ago
I am a 55 yr old female that recently got back into dating. I had been dating a man for a couple months and have had issues.  2/3 he did oral on me only, he was sick with a flu on 2/15 for about a week, 3/4 we had oral on both and he tried a brief penetration has ED so didn't work out too well.  Anyway since the first encounter I had been experiencing vaginal issues from itching in the entire vaginal area inner thighs butt area and burning in the entire vaginal area.  Went to doc 2/27 tested for STDs not herpes all negative but bacterial vaginosis positive and treated, same issues remain went back to doc 3/17 visual check of internal and external area told I had a fungus infection and candidia and treated, 3/30 went back to doc same issues with burning and itching same areas. They tested for STD and herpes this time.  All STD came back neg. but now positive for herpes and UTI.   I was told HSV1-11.9 and HSV2-2.3 not sure what test but it was from blood being drawn  and have been put on valcyclovir and macrobid. My partner claims he is clean.  I have never had all these issues in the past at all.  I asked questions at doc and I was told I am positive for herpes and it could have just come out from stress dormant chicken pox shingles etc.  Taking meds for 2 days burning gone but still have itching down legs thighs etc, I do not and have never had cold soars in or around mouth and do not appear to have any open soars,lesions, blisters, etc in the vaginal area just an odd odor.    Since the test came back positive I assume there is no chance for a mistake?  I don't understand this whole thing with the symptoms and not having the classic herpes soars etc but having all the itching etc.  Do I assume I just have vaginal herpes?   I am not seeing this man now but am dating.  Can I kiss a man and not worry about spreading this? I do understand precautions need to be taken for sexual encounters etc but am unclear on what happens going forward after taking the meds for 10 days.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Clearly whoever told you that you have herpes from stress or dormant chicken pox knows nothing about genital herpes. 
Your HSV 1 antibody levels clearly indicate and HSV 1 infection and at your age, it is most likely oral, even though you don't have cold sores that you recall.  So it is possible that you could pass this through kissing, but the reality is that most people in your age group already have HSV 1 infection, in which case, they wouldn't get it from you.

Your HSV 2 index value is in what we call the low positive range - that means, for everyone who tests with an index value between 1.1 and 3.5, half of those positives are false positives.  The CDC recommends confirmatory testing for every person who tests in this low positive range - there is about a 50-50 chance that yours is a false positives.  The best confirmatory test is the herpes western blot and it can be obtained from the University of Washington - you call them for a kit, they send it and then you have someone draw and spin your blood.  If you cannot find someone to do that for you, I can be the ordering clinician for you. 

Terri
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46 months ago
Hi Terri,  I realize HSV 1 is oral and HSV 2 is genital.  Since we had oral sex, is it possible that the HSV 1 is in the genital area and causing the low read on the HSV2?   You say kissing is not an issue at my age but I have other concerns about possibly spreading  the infection.  I will follow up on the Western blot for the HSV  2 and go from there with that outcome.  I am unclear if I am  at ask risk of spreading   HSV 1  if I have unprotected sex, oral sex etc,  with my partner.  Or since it is the mouth it stays in the mouth?  Sorry but I really don't understand all this and I actually don't feel my doctors office does either.  They put me on the valacyclovir for 10 days and I don't even think I have any sores in the genital area at all.  I do have a lot of burning and itching but I think it is possible something else, have had fungus issues in the past.  I appreciate any information you can give me to clarify the HSV1 risk etc.  They told me since I am HSV positive I can spread the virus. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
Well, actually the majority of new cases of genital herpes are caused by HSV 1 though the majority of recurrent disease genitally is HSV 2.  With your substantial HSV 1 result, you clearly do have HSV 1 but from the blood test, we cannot know if you have HSV 1 orally or genitally for certain, though as above, I think it is likely oral.  You ask if your higher HSV 1 value could influence the HSV 2 result, but from a large study that we conducted over the past several years, we see no influence of HSV 1 on the false positive rate of HSV 2.  If you have it orally, yes, it will stay oral but could be transmitted to a partner through giving him oral sex.  If you have it genitally, HSV 1 sheds infrequently and recurs infrequently - it sheds more from the oral area and recurs more there. 

I honestly think you need to clarify your HSV 2 status as quickly as you can as that is more infectious through sexual contact like intercourse.  It sounds like you will pursue confirmatory testing with that one. 

I'm not certain I'm answering your questions adequately - please - feel free to ask me clarifying questions so you can have the information that you really need.

Terri
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46 months ago
Hi Terri, I just got the herpes western blot test in the mail today.  On the lab order do I check under serologies-Herpes Group-HSV1 and HSV2 antibody by western blot?  I only need confirmation on HSV2 so will they still check both with 1 vial of blood?  I have a DX code from my docs office so I should be able to complete the other section on the lab order.  To be honest I seem confused about the wording HSV1-oral and HSV2-genital and how they test as compared to where they are in the body.   HSV1 is usually oral and from cold sores but can show up in the genital area, does it show up as HSV2 on a test because it is in the genital area? My docs office did visual check last week of vaginal area and state everything inside and out looks like healthy tissue, no lesions, blisters etc and now think all the burning and itching is from menopause.  None of this HSV1 stuff would have ever come out if they didn't test me so it is confusing on what is safe and what is not when I get the final tests from University of Washington.  My partner for the past few months denies having symptoms of herpes at all but did admit to having issues with cold sores on the mouth area in the past.  I assume since he has this he would be positive for HSV1 too?  Given this info and assuming my herpes western blot comes back negative for HSV2, I assume there would be little risk of spreading HSV1 to the genital area with oral sex when there are no cold sores on either of our mouths or is there still risk? Is the risk high, low, very low, rare? I completely understand all the precautionary issues if the test is positive for HSV2 and realize any of it could be spread to him since I don't really know his status either way unless he is tested.  If we both tested positive for HSV1 and 2 then I am under the impression it cannot be spread back and forth at that point.  Just trying to get all this straight, a little confusing on what is really a risk and what isn't especially with me testing positive for  just the HSV 1 and him having cold sores on his mouth in the past.  Thanks
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
So you know that you can't order this test yourself, right?  You have to have a clinician order the test.  The western blot automatically looks for both HSV 1 and HSV 2, you can't select one or the other.  But yes, that's the box you check.
HSV 1 can be an oral or genital infection.  If it is located in the genital area, it is still itself - HSV 1. 
I think you know but I will reinforce that if you have never had a cold sore on your lip or in your nose ever, you cannot know the location of your HSV 1 infection.  The only way you are going to know is  by swab testing positive an area that is symptomatic. 
If you are both positive for the same virus type (s), there is almost zero risk that either of you would get herpes in a new location on your body - of course, you don't know your location so it doesn't apply to you.  If you both test positive for both, no, there is not a concern about passing this back and forth.
I'm very glad that you decided to take the extra step of getting the western blot to clarify your actual situation.  Remember also that you could get an indeterminate result on this test - we see it about 15% of the time.  If that happens and you want to talk more about it feel free to renew here.

Terri
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