[Question #3200] Lack of Generation of HSV 2 Antibodies and Future Transmission

39 months ago
A leading sexual health clinic confirmed genital HSV 2 by swab test 4 to 5 years ago. However, multiple ELISA antibody tests over subsequent years were in clear negative territory including as recently as a few months ago (the test index value U/ml was higher than in a test conducted before the swab confirmation, but far from the subjective threshold). Recurrent outbreaks were very minor and I think 2 in number. The initial outbreak itself appeared to affect a small area (5mm by 5mm) and I recovered rapidly; some medication was prescribed (I forget which) to hasten the recovery.

Does the lack of detectable antibodies, the passage of time since initial infection and my own infection characteristics described above have any bearing on the probability of transmission to a partner?

I have a new partner who has neither HSV 1 nor 2. Whilst I have found the condition to be trivial, she wants to avoid it at all cost. I would feel terrible if I infected her. 

Thank you very much for providing this service.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
The traditional IgG test misses about 8% of HSV 2 infections, compared to the gold standard herpes western blot, so I'm not shocked that your infection was not picked up by the IgG test.  But lack of serconversion by IgG does not indicate lack of antibody - it just wasn't picked up by the test that isn't terrific.  This has no impact on transmission.  The fact that you have infrequent recurrences does suggest that you shed virus less often than someone who has a more typical recurrences pattern, 4-6 per year.  The fact that you are five years out, vs. 6 months our or even two years out, also suggests that you are shedding less often than someone with brand new herpes. 
The test accuracy also applies to your partner (the IgG test misses 30% of HSV 1 infections).  But assuming for a moment that she is truly negative, you best bets for reducing transmission include daily antiviral therapy (either 500 mg once a day of valacyclovir or 400 mg twice a day of acyclovir), absolutely consistent condom use with every intercourse,  you telling her about your infection and you being aware of any prodromal symptoms and avoiding intercourse when you have them and obviously avoiding intercourse with an outbreak, even with condoms as they do break or come off from time to time

Terri
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39 months ago
Terri,
Thank you very much for the quick reply. I would like to give my partner a perspective of the probabilities involved. If I were to take the supressive medication you mention and avoid intercourse during prodromal symptoms, what would the probability of transmission be? I think I saw studies stating it to be under 5% per annum with no condom use and close to 0% with a condom used consistently. I saw that, in a seperate context, Dr Handsfield had mentioned that such studies involved people with more recent infections than mine hence the individuals would be more susceptible to transmission (as you also alluded to).

Thank you again for the useful perspectives.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
I think the multiple studies examined lots and lots of people with varying duration of infections.  Your statistics are correct.  Those statistics are based on intercourse about twice per week - more sex more risk, less sex, less risk - which makes sense. 

Terri
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39 months ago
Thank you again. I also had a question about being apparently twice infected with genital HSV 2 at different points in time and the implications of this. I submitted it as a new question, but just saw this may exceed my 6 month quota. Perhaps you could answer in this thread if all possible.
- Is being twice infected at different times and different places linked to the negative IgG results?

I will seek the Western Blot test.

Thank you again.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
39 months ago
NO!

Terri
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