[Question #4757] Testing Question

25 months ago
I most recently tested negative for HSV1 & 2 via IGG a few weeks ago. I did so because I had relations with someone who is confirmed positive for HSV1 &2. The last time we had unprotected sex was in late July. We resumed some relations in the fall but no vaginal intercourse outside of a brief protected encounter in early November. I had planned on getting one last follow up test done at 8 weeks next week. A few weeks ago after my last test we fooled around some but again no vaginal intercourse. She performed oral on me a few times so at that point I had a concern for contracting HSV1. She had no cold sores at the time. No symptoms have appeared and it's been over two weeks now. While I know an IGM test is never recommended I ordered one. This was 11 days past contact. I understand it's not type specific and there's potential of cross reaction. My plan was if it did come up positive then I'd IGG test in a few months. Thankfully it did come back negative. I would have produced IGM antibodies if I was infected correct? Is it a good sign that I showed absolutely no igm antibodies therefore ruling out any false positives? If I test negative next week via IGG for HSV1 & 2 can I put this to rest? Would there be any need for future testing and is there any need to disclose any of this to future partners? I'm just ready to put all this behind me and move on. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
If you did the IgG now, assuming your last potential exposure was July, the test would pick up 92% of HSV 2 infections and 70% of HSV 1 infections (that is the sensitivity of the IgG test in a screening population compared to the gold standard western blot).  In terms of the oral exposure in November, it's a bit early for greatest accuracy but a single contact is a very limited risk.  And honestly, I wouldn't rely upon the IgM for anything - not sensitivity and not specificity.  It's just been such a troublesome test, I don't know what to make of it but I would not make the assumption it indicates lack of infection. 

Terri
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25 months ago
Thank you for the information. Let me ask you this. My last exposure was receiving oral sex almost 3 weeks ago. I’ve had no sores appear. Given the risk factors should I just assume I didn’t contract HSV1 genitally? If I test next negative next week via IGG for both  which would be 3 weeks post last HSV1 exposure and way past recommended window for HSV2 can I safely say I don’t have either? Would there be any need for disclosure in the future? I’d probably test again before having sex with a new partner just to be safe. This is more for peace of mind in terms of dating. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
I think you can reasonably assume, since you've had no sores or genital skin abnormality, that you did not acquire HSV 1 at this latest encounter.  Is that a guarantee?  No but I seriously doubt it
If the test is negative for HSV 1 and 2 if you retest next week, the statistics that I gave you above apply, particularly to HSV 2  
I think if you have not been diagnosed with either virus through either blood test or swab test, you don't need to disclose that you have had sex with someone who is HSV 1 and 2 positive. 

Terri
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25 months ago
So would there be any reason you see to test for HSV1 past the 3 week mark? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
25 months ago
A test at three weeks out is not definitive - not long enough to make antibody.  But you need to balance that against the fact that it's been since July with any meaningful contact with her.  And this brief encounter ended up with no symptoms.  So my answer is not as clear as you might hope for - but you need to remember what I said about the test missing 30% of HSV 1 overall, even for a test done in July or now.

Terri
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