[Question #2096] HSV2

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85 months ago
I would like to know in your expert opinion what the odds are that you can be infected with HSV2 and NEVER have an outbreak. I have read so much on this and I get frustrated because none of the literature explains WHY this is the case...Is that because the immune system keeps it fully in check in some people? I have read HSV2 is very virulent so it's hard for me to understand how most people never have an outbreak with this virus. I am asking this because I had an unfaithful partner years ago and I had got a pretty bad infection which at the time seemed to be a severe yeast infection (no sores, no blisters ever) and since then (10 years ago) I have never experienced any type of recurrence. I have read volumes that people can be completely Asymptomatic and then I have read other articles that stated that people are not truly asymptomatic with HSV2 ... they actually DO have symptoms of some type they just do not correlate it to herpes. My doctor was against blood testing unless I had blisters present. I think I am worrying myself sick over the possibility of this. I would also like to note that I do get cold sores from HSV1 from time to time. Can you tell me if that prevents outbreaks from HSV2? Or do people with HSV1 orally still have classic outbreaks with HSV2, only "milder" Thank you so much for your time and help with this.
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Terri Warren, RN, Nurse Practitioner
85 months ago
Well, 80% of those infected with HSV 2 don't know it so it is common to be infected and not be aware.  However, many of those infected do have symptoms but they are not aware that their symptoms are due to herpes - they might be confusing the symptoms with other things like yeast infections in women, UTI, friction burns in men, getting their penis caught in their zipper, teeth bites, irritation from rough sex or too much sex or not enough lubrication with sex.  Outbreaks can ocur anywhere from waist to mid-thigh, not always genital, clinicians confuse herpes and shingles.  These are just some of the reasons that help explain why 80% of those infected don't know they are infected. 

I actually would not describe HSV 2 as "so virulent".  Some people get bad first outbreaks but others, particularly those who are already positive for HSV 1, have very minor symptoms with new infection HSV 2. 

If this is driving you nuts, then I think you should test.  And you only want IgG tests, no IgM, and be certain they are type specific tests, not a combined test.  If your resulting index value is between 1.1 and 3.5, you will need another confirmatory test, just as you would if an initial HIV test was positive.  You can obtain these tests yourself by ordering them on the internet - there are a number of reputable services that do this - you do not need your doctor's order to do this any longer. 

I am going to end this note with  what the CDC STD screening guidelines are for herpes testing.  Please let me know if you have other questions: 

Type-specific HSV serologic testing should be considered for women presenting for an STD evaluation (especially for women with multiple sex partners)

Terri
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85 months ago
Thank you Terri, this helped me a lot. I was just trying to understand if the majority of people infected with HSV2 actually never have any outbreaks or symptoms with HSV2 and those that do are in the minority? I agree I need to do the type specific test since I know I will already test positive for HSV1.
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Terri Warren, RN, Nurse Practitioner
85 months ago
So I think the answer is above.  I actually think that the majority of people with herpes DO have symptoms, there are just a lot of things getting in the way of them recognizing what it is, including the fact that it can be very subtle.

Terri
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85 months ago
Ok, in closing I would just like to ask if you think you could give me the odds that I would be infected with HSV2 based on the fact I have never had an outbreak. Would you recommend testing from a medical standpoint or do you only recommend for "piece of mind" standpoint. Again, I know I am done with my question limit and I can't thank you enough for all you do to help people on this site.
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Terri Warren, RN, Nurse Practitioner
85 months ago
If you are a sexually active female between 14 and 49, there is a 25% chance you have HSV 2.  The more partners you've had, the more likely you are to be infected, the fewer partners, the less likely. If your partners have always used condoms when having sex with you, the risk of being infected is a lot lower.  I'm not sure what you mean by "medical standpoint" exactly - herpes isn't dangerous normally to infected adults but it is a risk for transmission to other and possibly to neonates.  I guess it depends upon what you are going to do next and how concerned you are about the possibility of infecting someone else.  If you're screening or have been screened for other STI's, the CDC says "herpes testing should be consider, especially for women who have had multiple partners"  I don't know how or if that fits for you.  I personally included herpes testing in all STD screens for people who presented for that procedure.  This must be an individual decision. If you do screen, use only IgG testing and if your index value is between 1.1 and 3.5, obtain confirmatory testing by western blot. 

Terri
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