[Question #3903] HSV False Negative

33 months ago
Hi - I tested negative for both HSV-1 and HSV-2 before having sex with a new partner (no new partners for over ten years). This new partner also got tested and was negative for everything except HSV-1. Two days after the last time I had sex with this partner, I had a primary outbreak (HSV-2, confirmed swab). He then went and got re-tested and everything (including HSV-1) came back negative. Is there any way this could actually happen? I am pretty sure something isn't lining up but wanted an expert opinion. I know he had another partner a few weeks before but that would put him at ten or so weeks when he got tested the second time. It sounds like most people would get a positive HSV-2 by this point if he happened to get it from the other partner in the last week of their relationship.
Part two - as a woman of childbearing age the HSV-2 diagnosis is hard. It sounds like the asymptomatic shedding is most prevalent the first year after you get HSV-2? When does it go down? I know you can take antivirals or have a c-section but now I am terrified of infecting a baby with neonatal herpes.
Thank you for any thoughts.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
33 months ago
There are a few things that could be going on here.  The IgG test could have missed an infection in either of you.  Compared to the gold standard western blot the IgG test misses 8% of HSV 2 infections.  The other thing is that he could be a slow seroconverter and that he was infected at his most recent encounter and has not yet made antibody. 
Yes, viral shedding does go down over time.  It makes a statistical drop at 6 months and again at 2 years.  Taking antiviral therapy and having a well established infection when you deliver reduces the risk of transmission greatly.  Also your OB will direct you to come to the delivery center right away I would assume when your membranes rupture (water breaks).  Thousands of women with genital herpes deliver healthy babies every day.  This is really very manageable.  The women whose babies get herpes most often are those unaware of their infections - that's not you.

Terri
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