[Question #2037] HSV 2 with multiple cold sores at the same time

46 months ago

I have had HSV1 for many years with a cold sore occurring once every few years.  Recently I came down with 4 cold sores all at the same time.  The roof of my mouth was numb as well.  I went to the doctor and she said it's likely to be due a NEW herpes infection.  So my doctor ran the antibody test and sure enough, I was positive for HSV2, when that test was always negative in the past. (I get tested every 6 months because of my lifestyle).  I had recently given unprotected oral sex to a few different men whose statuses were unknown.  Because of the severity of my cold sores, my doctor thinks that it's an oral HSV2 infection and I tend to agree, especially with my history of giving unprotected oral, but always using condoms during intercourse.  My doctor did not culture the cold sores though. I have never, as far as I know, had an outbreak of genital herpes.

My question is:  How likely is it that the major cold sore outbreak I described was due to the HSV2?    After I tested positive for HSV2, my husband was tested and he is also positive for HSV2 but has never had an outbreak, neither orally nor genitally.  However, I give him oral sex a lot, and I even did so while I had the cold sores.  If we have sex with people, do we need to be warning them about genital herpes if neither one of us has ever had a genital herpes outbreak?  As I understand things, I am at great risk of transmitting my HSV2 to a partner via oral sex, thus giving them genital herpes, so I am aware that this risk would need to be communicated with potential partners.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
I'm wondering if you could provide with a bit more information - do you know if your HSV 2 antibody test was an IgM or IgG test?  Only the IgG test is reliable.  And even then you need to pay attention to whether the index value, the number associated with the positive status, is greater than 3.5.  If it is below 3.5 and higher than 1.1 and it is indeed an IgG test, then you need a confirmatory test.  These are the CDC STD treatment guidelines. 
So let's assume for a moment that you did have an IgG test done and the value was >3.5.  This indicates a well established infection, not a new one - at least not in the past few weeks. 

The sores in your mouth should have been swab tested and it would have allowed you to know if your infection was oral or genital.  We know that if we have people who test positive by IgG for HSV 2 at >3.5 and you ask them to swab their genital every day using PCR, the most sensitive swab test, within 4 months 95% of people will recover virus from the genital tract.  So you can see that it is more likely to be genital but we cannot know for sure since the lesions were not swab tested.  That's such a bummer. 

Can you let me know the answers to my questions, please?  Thanks

Terri
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46 months ago
It was the IGG test and the result was 3.47.   I am curious as to whether I might have had a genital herpes outbreak and not realized it. I have a mild case of hidradenitis supportiva and perhaps those are similar in presentation. Anyway, my husband recently tested positive as well but we don't have a copy of his results. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
46 months ago
So at 3.47 you are testing in the low positive range and normally, according to the CDC, should obtain confirmatory test, preferably a herpes western blot - it's kind of  two tier testing recommendation for people who test between 1.1 and 3.5 because some of those are false positives.  However, since your husband also tests positive for HSV 2 by IgG, and you are almost at 3.5, confirmation is not absolutely necessary.

Given that 95% of HSV 2 is at least genital (some have it orally and genitally, thought that is uncommon), I would suggest that you need to disclose your infection yes but I think it would be an error to be certain that your infection is only oral.  It could be, but you don't even know that this infection was caused by HSV 2.  People can have considerable variability in the severity of their cold sores (and genital herpes as well).  My recommendation would be the next time you get a cold sore, have it swab tested and typed.  And if you get any symptoms in the genital area, like blisters or sores, have them swab tested immediately as well.

Terri
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