[Question #4959] Hiv and hsv index values

26 months ago
Hello doctor, It is hard to find doctors in my area who are knowledgeable about STIs, so I am seeking your expertise again on a few different questions:

1) How soon after acquiring hiv would persistent vaginal yeast infections be a symptom of hiv?
2) How soon after acquiring hiv would persistent vaginal bv infections be a symptom of hiv?
3) Is it common for persistent vaginal yeast and bv infections to coexist?
4) What does the hsv1 index value mean/measure? What is the range?
5) Can a hsv1 index value become 51.2 after only four months of infection, or does that value mean an older infection?
6) Do hsv1 index values of 6.3 and 51.2 (same type of test), respectively, of two sexual partners mean they acquired the infection at different times? Could individuals with such different index values have acquired hsv1 at the same time?
7) Can someone get an hsv1 index value of 6.3 after one month of infection?
8) Are there any strains of hiv not picked up by 4th gen duo test at four months?

Appreciate your service. Thanks in advance for your time and attention.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome back, but sorry you found it necessary, especially given the replies in your three recent threads a month ago. For the most part, these quesitons are repeats of ones already asked and answered.

1) It has been proved you do not have HIV, so questions about symptoms related to HIV are irrelevant. HIV test results always overrule both symptoms and exposure history. Anyway, yeast infections are never valid indicators of new HIV infection. Yeast can be a problem in longstanding HIV (overt AIDS); even then, it almost never is the main or only symptom indicating HIV.

2) BV is not a sign of HIV.

3) Yeast and BV often coexist. This is irrelevant to your concerns about both HIV and HSV1.

4-7) The index values on HSV testing are widely variable and do not primarily reflect the amount of HSV antibody present. If the value if over the positive cut-off, it's positive; below is negative, and that's all that can be said. If someone is tested at say weekly intervals in the weeks after catching HSV (either HSV1 or HSV2), there can be a trend from lower to higher numbers, but even this often doesn't happen. The very same blood specimen, tested 10 times in the same laboratory (with different lots of test kits) will give 10 different numbers which can vary from just over the cut-off index to high above it. Therefore, height of the index value cannot be used to conclude how long someone might have been infected. Your and your partner's different values say absolutely nothing about how long either of you has been infected or who was infected first.

8) There are no HIV strains not detected by the duo test. Your test results are conclusive.

Given your herpes concerns, I'll add that HSV1 does not increase the risk of HIV if sexually exposed. Only HSV2 does that, according to numerous research studies.

Please note the forum does not permit repeated questions on the same topic or exposure. This being your fourth about this exposure, HIV, and HSV, it will have to be your last; future new questions along these lines will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and is intended to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 


26 months ago
Thank you doctor for your reply. I was reading commentary in this forum and other literature that hsv index values can provide insight as to how old an hsv infection is. In other words, index values generally are lower at the onset of infection, and get progressively higher as the body builds an antibody response. In my case, here is the progression of hsv1 index values post encounter:

4 weeks - 6.03
8 weeks - 5.26
12 weeks - 6.28
16 weeks - 6.34

1) Would a four month old hsv1 infection yield an index value at 6?

2) Do these relatively stable values suggest a longstanding hsv1 infection prior to this encounter?

3) If my partner has an hsv1 index value of 51.2 four months post encounter, does that likely suggest hers is a longstanding infection older than four months, perhaps from childhood?

4) I am just trying to rule out the likelihood I contracted an hsv1 infection from my encounter and whether I subsequently gave to my partner, or if she already had it from long ago.

5) Any thoughts about potential reasons for persistent vaginal yeast and bv infection in an individual with no prior history of such and not reponding to medication?

Thanks in advance.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
You're asking the same questions in different words. I haven't changed my mind. As for "commentary in this forum and other literature that hsv index values can provide insight as to how old an hsv infection is", that simply is untrue. See my reply above and concentrate this time.

1) Yes.

2) Yes, probably a longstanding infection.

3) Probably her HSV1 also is longstanding, but the index value has nothing to do with that probability.

4) Almost certainly you did not acquire HSV1 during the encounter. In addition to the blood test results, your symptoms were not typical for herpes. As for transmitting it to your wife, there's at least a 50% she has already had HSV1 herself, either from a childhood infection or because she has been living with you (and your chronic infection) for many years. If she has had HSV1, she is immune from catching it again.

5) Persistent yeast and BV are very common problems and almost never have any particular reason for it. Yeast should be curable; 10% of infections are resistant to the most commonly used treatments but respond to alternate treatments. BV is more difficult. Your wife should keep working with her gynecologist on this; or perhaps ask for referral to a gyn who subspecializes in infectious diseases. In any case, this has nothing to do with your HSV1 test results or your other sexual contacts.
26 months ago
Thanks for your reply. This is my last question.

I made a mistake in one of my earlier questions.

I asked if a four month old hsv1 infection would yield an index value of 6. I intended to ask if a four week old hsv1 infection would yield an index value of 6. How likely is it that an individual would yield an hsv1 index value of 6 only  four weeks after an infection?

Btw, my symptoms resolved a few weeks ago. Strange and still a mystery what was the cause. Thanks for all the advice.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Actually, I answered on the basis of the list of result you showed, not that specific question. The stable values of your 4 tests, including the one at 4 weeks, is more consistent with a longstanding infection than a newly acquired one.

Genital irritation is common. I wouldn't classify it as a mystery, any more than it's a "mystery" why someone gets a cold or a heart attack at any particular moment rather than some other time. That it happened to occur soon after a sexual exposure doesn't necessarily implicate that event.

I'm afraid you're never going to know when you acquired HSV1, but I don't see that it matters much at this point.

I'm glad the discussions have been helpful. But as noted above, this does have to be the last one.