[Question #4669] HSV1 test

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80 months ago

Hi ASHA, thanks so much for everything you do and taking my question.

 

So I’m really unsure and anxious about what to do with an HSV1 IgG result that my gyne just took. When I first had myself tested in July, she mentioned that it wasn’t necessary because I had no symptoms and was not active with anyone who had signs of herpes. I insisted anyways and now really, really regret my decision. The HSV1 IgG was exactly 0.90, which made the test just barely ‘equivocal’. She mentioned I could retest (same lab) in a few months, which I just did and got a 1.10, which is now the absolute minimum for positive. The midwife who called me with the new results just offered to retest me in 6 months, but my anxiety about this is paralyzing. I’ve read a lot of Terri’s helpful comments to other questions about the usefulness of this test and how a good amount of low-positives (50%) are really false positives. She also said that two low-positive results may just be where someone sits and not do anything else.  I don’t know how to explain to my partner (whom I told about the borderline result before) that I “could be positive?” without the Western Blot test (that I can’t afford) to confirm it. We perform oral sex, and I could not live with myself if I gave him genital HSV1 if I am someone who sheds HSV w/out a cold sore. 

 

1. What do I do now? This test is 21 weeks after the first equivocal result. If this was a higher index (like 5-6), I’d accept it, but getting barely-negative and barely-borderline results has been awful.

2. Do I tell past partners about this? I want to be a good person and do the right thing, but I don’t want him to get a useless call like “I may or may not have the cold sore virus” and then go through all of this for nothing and deal with the anxiety.  

3. If I date in the future, how do I explain this “maybe positive?” test before becoming intimate? Is it necessary before confirming the HSV?
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Terri Warren, RN, Nurse Practitioner
80 months ago
If you cannot do the western blot, I'm afraid I don't have a clear answer for you but the issue with the IgG test for HSV 1 is not false positive as much as false negatives.  You could have a false positive here but I'm afraid there is no other way to know for certain.  I wish there was a way to know other than the blot because now you are in a bit of limbo.  Has your partner been tested for HSV 1?  If he is positive then this is a non-issue (if yours is a true positive, which we don't know.)  While the CDC says HSV testing should be considered as part of an STD screen, they do not address HSV 1 testing - probably because 1) the test isn't great and 2) if positive, you cannot know the location of the infection and 3) because almost half the population has HSV 1. 
I guess my recommendation that you are not going to want to hear is to save up for the blot when you can do it.  And to see if your partner would be tested.  You could talk with your partner and see if he would want to contribute to paying for the blot (now that you are in this limbo) so you could both have clarity.  Wish I had a better answer for you but I don't see what it would be. 
The answer to the 50% false positives thing applies to HSV 2 results between 1.1 and 3.5  - it does not apply to HSV 1 testing which is less clear.
Let me know what else I can answer for you

Terri
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80 months ago
Hi Terri, 

Thanks so much for your response. My partner is now confirmed negative, so what do I do now without the Western Blot to know if I have it? Start Valtrex even if I've never had any symptoms? My gyne said that I didn't need to do that. 

Also, what does this mean for past and maybe future partners? Until I get the Western Blot, what do I tell people from years ago? What would I say moving forward if I'm single and meet someone new? "I may or may not have herpes?" 
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Terri Warren, RN, Nurse Practitioner
80 months ago
I can't say what this means for past or future partners if we don't really know your status.  I don't feel it is necessary to tell past partners you might be infected - about half the population has HSV 1 so many are infected already.  I wish I had a better answer for you about what to tell people or what to do about your partner but without knowing if you have herpes or not, I do not have an answer for you.

Terri
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