[Question #308] Should I Get Tested for HSV 2?

35 months ago
After an ambiguous PCR test, my girlfriend had a type specific blood test done which came back positive for HSV 2 with a very high antibody count.

I am faced with the decision of whether or not to get tested. I have never shown typical symptoms for either HSV 1 or 2. My girlfriend and I have had sex probably 50-75 times and I would guess that roughly 15 of these instances have been unprotected. I understand the low likelihood of transmission from a female to a male during any one instance of exposure, that 1 out of 5 people have HSV 2 and 80-90% don’t know it, and that routine screening is not protocol because it is not clear if the benefits of knowing one’s HSV 2 positive status outweigh the mental health costs associated.

I do not want to act unethically, but at the same time I am worried about the psychological/emotional cost of finding out I am HSV 2 positive - knowing myself they would be considerable. I have obviously been exposed via my girlfriend numerous times, but the likelihood is I have also been exposed via past partners who were unaware of their status. If I get tested and test positive for HSV 2 it could very well have been transmitted to me from one of these past partners (and I had no reason to test after them in the past!). I realize HSV 2 not a serious condition and that it is overly stigmatized, but I want to make sure I’m responsible while also practical about if there is a realistic need for testing in my scenario. 

I have seen you guys recommend not getting tested after a single exposure, whereas I have had numerous exposures. I am planning on continuing this relationship, but I may have other partners later in life if it doesn’t work out. 

1. Do you recommend that I get tested due to my girlfriend’s new found positive status?
2. If yes and I test negative, how often should I get tested?

35 months ago
Was there an issue with my original query? I submitted my question 48 hours ago, which ASHA states is the absolute longest amount of time before a reply from one of the experts. I would greatly appreciate feedback as soon as possible!

Thank you for your time and the invaluable service that you all provide. 
35 months ago
Over three full days later and I have not received a reply from one of the experts. This is extremely disappointing. I am hoping to receive some feedback ASAP, as this matter is of utmost importance to me; otherwise, I would not have purchased a question! Thank you. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
I agree this is very disappointing, A.  For both of us, but mostly for you!  I spent a long time thinking through my response to you and somehow it got lost.  We were having website issues the day you posted and I was in Mexico on vacation posting so I'm not sure which is to blame here but I will do it again.  My sincere apologies for your wait.

Here is what the CDC has to say about HSV testing

"Type-specific HSV serologic assays might be useful in the following scenarios: 1) recurrent genital symptoms or atypical symptoms with negative HSV PCR or culture; 2) clinical diagnosis of genital herpes without laboratory confirmation; and 3) a patient whose partner has genital herpes. HSV serologic testing should be considered for persons presenting for an STD evaluation (especially for those persons with multiple sex partners), persons with HIV infection, and MSM at increased risk for HIV acquisition. Screening for HSV-1 and HSV-2 in the general population is not indicated."

Clearly you fall into number 3. 

If you are staying with this partner who has HSV 2, I see just a few reasons for you to get tested if you don't want to know.  One would be that if you tested positive for HSV 2, you would not need to worry about becoming infected.  You could be freer with your sexual expression, you could avoid the use of condoms and she could avoid the use of antiviral therapy.  I'm taking a wild guess that you don't know if you might have infected her?  I don't know anything about either of your sexual pasts and if either of you have been tested for herpes in the past.

So what if you don't stay with her and move on to have another partner at some point.  Would you test then?  THEN I would say you most certainly should test. 

Which situation are you thinking about here? 

If you have more than three questions in this discussion, I will certainly be comfortable answering more, given this odd circumstance and the inconvenience to you. 

Terri
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35 months ago
Terry,

Thanks so much for your reply. As for our background, I was last tested for HSV 2 about 6 years ago when I was in my early 20s, and I tested negative. However, I have had numerous partners since then so those results are not relevant anymore. I don't believe my girlfriend had ever been tested before her recent test, and she too has had multiple partners in the past. Consequently, if I do test positive it is impossible to know if I infected her or vice versa. 

I have read through as many official, empirical sources about HSV 2 as possible, including the CDC information you quote in your response. I definitely do fall into category 3, but I just wasn't entirely sure if my exposure to my girlfriend  merited testing any more so than the exposure I almost certainly - though unknowingly - experienced in the past via partners who were unaware of their status. Since most people are indeed unaware of their HSV 2 status and 1/5 people are HSV 2 positive, the odds are that I have been exposed before. Yet despite the likelihood of exposure people don't normally get tested due to concerns that knowledge of one's HSV 2 positive status may in fact have detrimental value due to the mental health costs associated, and the real question is what do you do with the knowledge when it is a benign, incurable, lifelong disease. My girlfriend was not even intentionally testing for HSV 2 - she had a PCR packaged in with another health procedure she was undertaking and the results indicated cell abnormalities associated with HSV 2. She then had a type specific IGG blood test done which showed she was positive; however, had the PCR not been packaged in with an unrelated medical procedure, she would never have been tested for HSV 2 and would never have found out (as she is asymptomatic). We would therefore, like most people, not be dealing with this situation since we simply would not know our HSV 2 status since it is not part of typical testing protocol.

That said, I was leaning towards testing for the reasons you outline in terms of my relationship with my girlfriend. You seem concretely sure that I should get tested if indeed I do have future partners, and I understand that. 

I am planning on getting tested in the next couple of weeks. If I test negative, how often should I retest while I am with my current HSV 2 positive partner? 

I really appreciate your flexibility in allowing me additional questions given the circumstances -  thank you for being so considerate and thoughtful in your response. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
If you test negative, then you and your partner should talk about what each of you want to do to reduce transmission in the future - and remember, your test results are always about 3 months old  - that is, if you have been infected in the past three months, the test might not pick it up.  So the options would be:  1) you do everything you can do reduce the risk of transmission - that is, condoms with every intercourse and you giving her oral sex - male condoms or dental dams/Saran wrap, awareness of any symptoms of an outbreak and avoidance of sex if there are any, her on daily antiviral therapy or 2) any variation on the above, including some but not all of these activities.  Usually people make these decisions based on the seriousness of the relationship but there are other factors as well - how well you do with condom use, how she feels about taking daily medicine, etc. 

In terms of how often to test, that's gotta be your call.  If I was in your situation, I likely would test every couple of years or if I had symptoms or if I was out of the relationship and starting a new one.

The thing is, if you she didn't know she had herpes, there would be nothing to do to reduce the risk of transmission because you both wouldn't know you should be doing something.  Many people who prefer to know that they have herpes via a blood test rather than by infecting another person.  Also, a study I co-authored with Anna Wald found that most people who are diagnosed by antibody test will recognize a herpes symptom within 4-6 months, so this may be the case with your partner. 

I am concretely sure that you should get tested before beginning a new relationship, absolutely, and I know that Dr. Handsfield would agree as well, and I think Dr. Hook as well.

Terri


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35 months ago
Terri, 

I really appreciate the information, feedback and perspective. I value and respect your expertise on this matter, and thank you for laying out clear answers to my questions. I am getting tested for HSV 2 and will proceed accordingly once the results are in. If negative, we will pursue all possible avenues to reduce transmission going forward. My girlfriend and I have not had sex for nearly 3 months so the results should be quite accurate. Keep up the great work and I know I am not alone in saying that the services and information you guys provide here are critical for many.

All the best!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
You are most welcome.  When you get your results, if you would like to post them, I would be interested in what you find, and I will leave this thread open for that purpose for a month.
(and again, so sorry for the snafu!)
Best
Terri
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34 months ago
Hi Terri,

Thanks for keeping this thread open. I got my results back:

HSVI Type Specific IgG: < 0.2
HSVII Type Specific IgG: < 0.2

The attached interpretation chart indicates that "< or = to 0.9" should be interpreted as negative. As I have consistently read from expert sources, including yourself, that retesting is only necessary if one were to receive something from around 0.9 to 1.9, I am not planning on retesting at this point and I am interpreting my results as negative. Would you agree?

Many thanks again for your advice and help over the past month, and happy holidays to you and yours!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
Yes, your tests are definitely negative.  I do not see any point in you retesting for HSV 2, I would certainly believe your results. 
There are two things I will say here for greatest accuracy.  The first is that the HSV 1 test misses about 1 out of 4 infection, but that is not your issue here so unless that result is very important to you (if it is you can do western blot), I wouldn't bother with retesting.  Remember that about 56% of the US population has HSV 1 already.  The second thing is that I want to be certain that you waited long enough after your last contact with her to have this testing done.  Or if it has been recent, I want to be certain that you understand this is a moving "target". 

You are most welcome for the help, sorry we got off to a rough start.

Terri
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34 months ago
Terri,

Thanks a lot for the quick reply! I am aware that over 50% of people have HSV 1, most without being aware of it, and since that wasn't the focus of my testing I won't be pursuing a Western Blot or a retest at this time. 

I had not had sex with my girlfriend (nor anyone else) for about three months prior to my being tested, which fits exactly with the recommended window post-exposure for receiving accurate test results. I have received oral sex from her within the three months prior to my testing, but to my knowledge this would not have any impact on the validity of my test results since HSV 2 is not transmitted in this manner, and the likelihood of HSV 1 being transmitted orally to genitally is extremely low. Since I did not perform oral sex on her and we did not have sexual intercourse of any type for the three months prior to my testing, I feel confident that my test results are accurate. Would you still agree? 

Thanks!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
Given all of that, yes, I would totally agree that your results for HSV 2 are accurate - we waiting long enough for an accurate result and the oral sex does not present a risk for HSV 2.  So what are you doing to about this relationship now?

Terri
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34 months ago
I will continue in this relationship and we will utilize all of the methods of protection that you advised in an earlier post on this thread (antiviral therapy for her, condoms for me, etc) , and I will get retested before any sexual partners/relationships in the future if this relationship does not work out. I don't believe that being discordant means this relationship needs to end right now, as the likelihood of transmission from female to male is so low, especially when taking all protective measures. The last thing I am interested in doing is contributing to the unnecessarily and ignorant over-stigmatization of HSV, but I plan to be exceedingly careful and attentive to taking protective measures going forward.

As I've said before, I appreciate your thoughtful assistance immensely! All the best for the new year.   
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
34 months ago
Sounds like an absolutely perfect way to proceed. Good for you.
You have a great New Year, too.  I'm going to close about this post now, but if you have other questions, don't hesitate renew.  All the best.

Terri
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