[Question #48] Asymptomatic Exposure to HSV

41 months ago
What is the likelihood of being exposed to HSV-2 and NOT developing any reaction? It's been 11.5 weeks since a possible exposure, and I've yet to develop any noticeable sores. I've been tested twice (IGG and IGM), once 2 weeks after (results equivocal), and once 7 weeks after (results still equivocal, but slightly lower), and still nothing.

I'm just trying to understand if asymptomatic "acquisition" of the virus is common or not? I realize there's a possibility she could have shed asymptomatically, but how common is also acquiring it during that and never reacting to it? And how often I should keep getting tested before realizing I may just be equivocal forever due to some previous minimal previous exposure or something?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
About 80% of those infected with HSV 2 are unaware that they are infected.  Now one might ask why.  Some have symptoms that are consistent with herpes but are really minor and go unnoticed.  Some are having symptoms of herpes but are in places people might not look or think that herpes could show up - buttocks, thigh, belly.  Others really don't have any symptoms at all.  Other attribute symptoms of herpes that they might have to other things - it itches so it is probably yeast, there's a bump on my penis so I must have caught it in my zipper, etc, etc. 
Do you know that this partner has HSV 2 infection?  You mention that you second test had a lower index value than the first?  I would expect if you had new infection that your index value would be going up, not the other way around.  You can take a final test at 16 weeks and see what happens. I would say that if you are still in the same range of index values, equivocal, that infection is very unlikely.  If you feel the need for more clarity, you can have a western blot antibody test performed and I can help you get that arranged.  But I would suggest waiting it out a bit and see what the next test shows.  My guess is, given the lower of the index value, that infection in your situation is really unlikely.

Terri
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41 months ago
The partner claimed to only had previous exposure to HSV-1 (which I've already been exposed to), but did have it as a genital outbreak, which I know is definitely possible. I was just trying to understand my risks assuming she may have been unaware of her HSV-2 status at the time.

Do you know what the percentages are for people exposed to and then reacting with physical symptoms to HSV-1 and HSV-2?

From the research I've read, it seems like roughly 50-70% of adults in the US have exposure to HSV-1, and roughly 16-20% of them have had exposure to HSV-2, but I'd love to know of those exposed, how many actually present with symptoms (as you say up to 80% of those exposed to HSV-2 may not ever know/realize)?

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
People can be "exposed" to herpes for years and never acquire it.  I can't tell you if you've acquired it or not without a positive antibody test.  If you are still in the equivocal range at 7 weeks, that is a good thing - there is a 70% chance that you did not acquire the virus if you are not positive at this point.  I think a final test at 16 weeks post exposure will hopefully give you the answer that you seek.

terri
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41 months ago
Thank you for your considered response. I plan on getting tested again at 16 weeks as suggested and believe that will settle the issue.

My final follow-up here is just curiosity about the percentage of people who may test positive for either HSV type who just end up staying asymptomatic. I know there's no way to tell if you're immune or just asymptomatic to the infection, but is there any data about the percentage of those who may test positive who never show any recognizable symptoms?

You mentioned previously that 80% of those who may test positive for HSV-2 may never know it, either by ignorance or them just being asymptomatic/immune. Is there any data for HSV-1 folks?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
So about 70% of those infected with HSV 1 as I understand it, don't have symptoms of HSV 1. 
The thing is that most people who have herpes of either type don't know they have it so they are not acting as though they do so they are far more easily infecting others.

Terri
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