[Question #543] Hsv 2 and hsv 1 positive

44 months ago
I had a risky exposure with a csw June 10. Had unprotected oral and protected vaginal sex.  I came down with a severe sore throat on 14 June. Seen doctor on 15 June. Told him my story. Tested positive for strep throat.  He ran blood test for hiv and hsv. No visual sores present. 10 days later doctor told me positive hsv 1 (3.2 Igg) and hsv 2 (3.3 igg). He said impossible to score that high 5 dAys after exposure and he believes it is long standing. 9 September developed rash on scrotum. Doctor examined and prescribed clotrimiZol for fungus. Started to work but rash kept coming back in various places on scrotum. Seen dermatogist at different hospital and she diagnosed herpes with no knowledge of previous test. I asked for her to swab but she said could not since no sores were present. Prescribed valtrex. Rash went aware in 5 days. I asked for suppressive therapy to protect current negative partner. I stopped the therapy for 2 weeks during business trip and 5 red spots appeared but did not hurt or exhibit any other typical herpes symptoms. Took valtrex. 5 days later spots went away. For the last 3 months taking daily meds but experience tingling sensation on scrotum everyday for those 3 months. Usually okay in the morning but about later tingling begins. No obvious sores or spots anywhere. 1) can I be shedding the virus everyday? 2) can I test that high after 5 days? Btw I retook hsv blood test 7 months post exposure (8 igm) I am overseas and they only use igm over here. Igg test taken at military hospital. Thank you.
44 months ago
Also what is transmission rate to negative partner if on suppressive valtrex ( male to female)
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
I would completely agree with your doctor that 5 days is too soon to have an accurate HSV 2 antibody test with an index value of 3.3.  That 3.3 is in the low positive range where there are some false positives though at that level, the risk of a false positive is lower.  If you did acquire HSV 2, I think it happened well before the June incident that you describe.  And I'm not at all clear that all the things on your scrotum are due to herpes.  Usually, herpes symptoms don't focus on the scrotum, but rather on the shaft of the penis.  I would encourage you to have the symptoms on the scrotum swab tested if possible.  However, if you are taking daily medication, it may influence the swab test results.  Will you be back in the states any time soon?  If yes, upon the CDC recommendations for the low positives, getting a herpes western blot would help to clarify your situation.  Until then, the use of daily medication will reduce the risk of transmission to your partner.  The rate of transmission from male to female, while on suppression AND using condoms, having sex about twice per week, is about 2-3 percent, that is, 2 or 3 women (on average) will acquire HSV 2 under these circumstances.

Terri
---
44 months ago
Sorry for the bad explanation. The red spots were on foreskin. Not the scrotum. The rash was on the scrotum. So 5 days after exposure is too soon to test positive for antibodies to appear? I will not be in the states anytime soon but if so, where can I get test?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
Five days is too soon to get an accurate reflection of this current situation, yes, but it would give you a baseline from which to compare future testing to see if you might have newly contracted herpes.  I find this quite helpful for many patients who wonder if they acquired herpes at any given encounter or had it already.

Terri
---
44 months ago
Thank you for your response. I had asked if it is possible that I shed the virus 100% of the time with no visible sores? What is the shedding rate for individuals? Thank you again for your response
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
44 months ago
oh , sorry, missed that.  NO, you aren't shedding 100% of the time.  The normal shedding rate for people with HSV 2 is about 15 out of 100 days, more at the beginning of infection, less as time moves along.

Terri
---