[Question #5194] HSV 2 Test Results and Antibodies

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77 months ago

March 2010, had vaginal irritation, some bumps but no open lesions or pain. Doctor tested me for Herpes.  IgG test results came back negative for both HSV 1 and 2 (<.90).  October 2018, had neck/back pain, fatigue, and within a couple days broke out with painful vaginal lesions. Tested positive for HSV 2. IgG results were 3.38 for HSV 2 (positive) and <.91 for HSV 1 (negative). Complete surprise because only partner I had been with since the last test was my husband. Was also my only partner in March 2010. Prior to that, was abstaining from sexual activity and hadn’t been with anyone else since October 2006. Since never had any herpes like symptoms prior to March 2010, thought I contracted it from my husband. Recalled that my husband had a cold sore on his mouth back in March 2010. Husband tested positive for HSV 1 but negative for HSV 2. Raised questions about when I contracted the virus. Have NOT cheated on my husband and he has been my only sexual partner since October 2006. How could I test negative for HSV 2 in 2010 and positive in 2018? I know you can have a false negative test result if you get tested too soon after contraction. However, with my husband testing negative for HSV 2, wouldn’t it mean that I would have already had the virus in 2010 from a prior exposure? Does your body automatically generate antibodies to the virus upon exposure/contraction, even if you don’t have an outbreak or any other symptoms? If so, why wouldn’t I have tested positive in March 2010?

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Terri Warren, RN, Nurse Practitioner
77 months ago
This is a confusing situation.  It is possible that your IgG test missed your infection in 2010 - it misses 8% of HSV 2 infections, but picked it up in 2018.  I don't see any other way that this could have happened.  I take it you have actually seen his negative results.  The IGG test could also have missed the infection in your husband.  If he is curious about that, he could obtain the herpes western blot as the gold standard herpes antibody test.  Nothing else reall makes sense here, would you agree?

Terri
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77 months ago

Yes, I agree that the situation is confusing and doesn’t make sense.  That is why I am reaching out.  And yes, I have seen my husband’s results.  24.7 for HSV 1 (positive) and <.91 for HSV 2 (negative).  Due to another medical condition, my husband and I have had limited sexual activity over the last several years.  I think this has helped keep him from contracting HSV 2 from me.  

Can you please address this question from my initial post?  I haven’t been able to find the answer anywhere. -- Does your body automatically generate antibodies to the virus upon exposure/contraction, even if you don’t have an outbreak or any other symptoms?

 Also, everything I’ve read indicates that your initial outbreak is typically the worst one.  My most recent outbreak in October 2018 was far worse than the symptoms I experienced in March 2010.  It was definitely more indicative of an initial outbreak with the whole body symptoms.  Any explanation about why this would have occurred?

 Lastly, what are the chances of my husband contracting the virus from me? With/without taking a daily suppressive treatment?  With/without a condom?

 As you can imagine, this has really taken a toll on my marriage.  My husband has taken the diagnosis really hard and also questions whether I have been faithful.  I know I haven’t been with anyone else, but I too am at a loss about figuring out the different test results.  I appreciate any additional thoughts or explanations you can provide.  Thanks

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Terri Warren, RN, Nurse Practitioner
77 months ago
The body make antibody even if you don't have an outbreak or symptoms, yes, if a person is infected.
While for most people, the first outbreak is the worst, that isn't always true.
The only way I can see the October 18 outbreak being a true primary is if your husband is infected and the antibody test missed his infection
If you take antiviral therapy AND use a condom and have sex about twice per week, there is about a 1% chance he will become infected.
If you only use antiviral therapy OR only used condoms, it's about 2% and if you do nothing, about 4%.
I think your husband needs a western blot to find out what is really going on here.

Terri
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77 months ago
Thanks for you response.  How do we go about getting a western blot?  Can our regular doctor provide it?  I'm not familiar with it, but I take it it's supposed to be more accurate than an IgG test?
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Terri Warren, RN, Nurse Practitioner
77 months ago
Yes, it is far more accurate than the IgG, especially for HSV 1 and also it picks up 8% more infections with HSV 2 than the IgG test.  It is done at the University of Washington only and you can work with your own provider to do this or I can work with you to do this at westoverheights.com.  Depending upon where you live, it can be easy or a bit more challenging.

Terri
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