[Question #4572] HSV pregnancy

27 months ago
Hello

I'm a male who has had a few partners in the past and had a few sexual health check ups done over the years.  After receiving the all clear from those, I assumed I was clean of everything.  I currently have a wife who's half way through pregnancy, and I've just discovered that you can have HSV-2 and be asymptomatic.  My concern is that I could have it despite never having symptoms and pass it to my wife, who could then pass it to the fetus.  I understand congenital HSV is very rare but possible and serious.

1) I discovered this after we had sex where my skin around the top of my penis was a bit sore and a tiny amount of clear fluid (like beads of water) was forming on the surface.  Like any minor friction burn. It didn't hurt and there was certainly no blood. Would this type of bodily fluid make transmission much more likely, or would it have minimal effect because HSV-2 is more about the skin to skin rubbing rather than fluids?

2) Is congenital transmission really very rare even with a primary transmission during pregnancy?  I've seen figures like 1 in 100,000 or less. Would you be concerned?

3) A few months after being with my partner I got a bad rash on my genitals. I went to a sexual health centre who did swabs and the results were positive for HSV-1 which my partner knew she had already.  Would those swabs that picked up the HSV-1 have also picked up HSV-2 if I also had that type of the virus? Does this result suggest I am HSV-2 negative with any accuracy?

4) I know I can get an antibody test and would be inclined to if I could get confirmatory testing for any borderline results.  But in my country I can't see any option for a Western Blot.  Are there any alternatives, e.g. getting two antibody tests done from different labs if the first result is not clear..?

Thank you very much 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
27 months ago
It is possible to have HSV 1 and HSV 2 but you would need to have gotten the HSV 2 first as that appears to protect against HSV 1 acquisition.  You symptoms do not sound herpetic but there is no way to know for certain based on symptoms.  Congenital herpes is very rare indeed - that number sounds about right to me.
Does your partner have HSV 1 orally? 
If this is worrying you, you could start with an IgG test is your country and see what you get.  Based on the fact that you have HSV 1 genitally and you appear to have gotten it from your wife who has it, I think it is extremely unlikely that you had HSV 2 first (based on the severity of the rash). 

Terri
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27 months ago
Thanks very much for your response Terri.   Yes my partner had HSV-1 orally and she passed it to my genitals.  It was definitely a severe rash from my point of view with blisters and the positive swab test of course.  So, I'm very pleased to hear that you think it's extremely unlikely to have such a reaction if I already had HSV-2... I didn't know about that.   As an aside, do you think that swab test would pick up the HSV-2 as well *if* I already had it, or would they not necessarily be present together?                                                                                                                                                                                                                                                                                                                                                                    
 I'll be very grateful if you can confirm the following two points about having sex and testing, please -                                                                                                                                                   

  • I understand HSV-1 can be an issue in pregnancy too.  As my wife had HSV-1 orally and I got it genitally, is there any danger of me passing it back to her genitally now (bearing in mind she's pregnant)… or is it the case that she already has it in her body 'full stop' so we don't need to worry and can continue to have unprotected sex during pregnancy?                                                                     
  • If I did have an IGG test and it came out as a borderline positive for HSV-2 (potentially false positive), what would you do for confirmation in a country that doesn't offer Western Blot for HSV?                                                                                                                                                                                                                                                                                  
Thank you again for the brilliant service this site provides.     
                                                                                                                                                                                                                                           
(ps. the questions above are my important ones but if you have a spare second, can you please mention whether HSV is mainly caused by skin rubbing against skin, bodily fluids during sex (e.g. from friction), or a combination of the two? Thanks!)   
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
27 months ago
1.  There is very little risk of her getting this infection genitally since she already has it orally. I had only seen this happen once in 33 years of practice. So I think the risk is very very low indeed.
2.  That's a good question. The truth is, that you can have blood shipped from anywhere to the University of Washington for Western blot testing. All you need, is a provider in your country to draw and spin a tube of blood and a lab requisition for the Western blot.  If this is not possible, one might also look at the number obtained on the test which is called an index value. If the number is below 1.5, there is an 85% chance that this is a false positive. The closer the number gets to 3.5, the more likely it is to be a true positive.
Please let me know what else I can do to help you

Terri
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