[Question #3439] HSV-1 vs HSV-2

35 months ago
Someone I deeply love and  care about recently tested positive for HSV-2. This was based on a sample taken directly from one of the blisters. Needless to say, I was sure I must have given it to her. She has only had 3 sexual partners in her entire life (she is 32yrs of age). We had sexual intercourse without a condom over 2 weeks ago. Her lesions appeared 2-4 days afterwards. She received a confirmation of HSV-2 on Wednesday of this week. I was tested on Friday and my tests came back negative for HSV-2. I did test positive for HSV-1 but this was not a surprise. I experienced a cold sore as a teen (5 in my lifetime) before sexual activity. I expected to have antibodies present. However, does this make sense. Could HSV-2 been dormant in her for our entire relationship (3 years)? Could it be that my test is negative (ELISA)? I was told that it is 97-98 percent accurate. 
35 months ago
Also, I forgot to mention that she was tested in November and her HSV-1 and HSV-2 results came back negative.  Also, when I asked if my test could be negative, I meant to say inaccurate. Of note, I have never had any outbreaks in my genital area. Only cold sores referenced in my previous statement. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
The IgG test (be sure that was your test) misses 8% of HSV  2 infections compared to the gold standard western blot.  It is pretty possible, given all of this, that that could have happened.  Why was she tested in November and is she certain that the testing included herpes antibody testing?  Can you tell me more about her outbreak - multiple vs. single blisters?  Was an antibody test done as well?  If this was her first infection, her antibody test should be negative and her swab test positive.

Terri
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35 months ago
Yes, I can confirm that my test was an IGG test. So do you recommend me getting another one? She was tested for everything during her routine checkup after the doctor inquired whether or not she wanted a full panel. The November test was a blood test for herpes antibodies. In regards to her symptoms/outbreak, it was a single blister. The test performed was a swab test and not a blood test. She actually saw two doctors that day and both swap tests came back positive for HSV-2. This is her first outbreak. Based on your response below, her blood test would come back negative? 

Also, are you saying "YES" that the virus could have been dormant for all of these years. Or yes to my test being inaccurate. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Well, actually, either could be true - she could have been infected for a long time and the antibody test missed her infection OR the antibody test missed your infection.  One way to help sort this out is for her to wait about 6 weeks (while not taking antiviral medicine) and repeat the antibody test (since she had a negative test in November and you seem quite sure about that).  If it is then positive, that suggests that she did not have a missed latent infection because she did what we call seroconverted - when from negative to positive.  If she had been latently infected for years, and the IgG test missed her infection, we would likely not all of a sudden see a positive antibody test 6 weeks from her first recognized blister.  Another way to try to sort this out would be for you to get the gold standard western blot for herpes.   Does that make sense to you?  This can be quite a complicated situation so please feel that you can ask me for clarification.

Terri
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35 months ago
No, I understand. So if she seroconverted, this suggests that she had the infection before but it just did not appear in the November test? I will inform her to not take suppressive therapy for another 4 weeks. Isn't the western blot very difficult to obtain?

Based on this conversation, could I have it for years as well and it shows up in the future? If so, this virus is much more complicated than I originally thought.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
If she seroconverts in 6 weeks, to me, that suggests that she has a new infection. 
I can help you obtain the western blot or your own provider can help you - it's not very hard.  Just google herpes western blot University of Washington and you will find information.  If you want me to help you, you would need to set up a video conference with me at westoverheights.com first.  If you have had it for years, it would likely show up now in the western blot, if that is what you are asking.  If you are asking if you could have it now and it would present with no symptoms now but have symptoms later, then yes, that is possible.

Terri
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