[Question #5839] HSV-1 Location

72 months ago

Good morning, Doctors. I am in my mid-30s and recently received results for a 10-test panel. All were negative except for HSV-1 (IGG, 8.0). When I did the same panel over 13 years ago, I had the same results (HSV-1 pos, all others neg). At the time, I was not all too bothered as most sites discussed how HSV-1 caused cold sores and didn’t mention much about GH HSV-1. However, when I read up on HSV-1 recently, I see the current evidence suggests HSV-1 GH is quite common.

With that, the question that keeps playing in my head is whether or not the HSV-1 I got over 13 years ago is of the traditional/oral variety, or if it was acquired via sexual means. After going through the anxiety of waiting on test results 13 years ago, I have been paranoid and hypersensitive to just about anything that might be an STD. So, if there were abnormal symptoms, I would like to think I would pick up on it. I also can’t recall if I ever had cold sores as a kid, which would obviously make me feel more confident where the HSV-1 entered.

1) If I did acquire HSV-1 down there, would I most likely have noticed it? I read somewhere HSV-1 GH almost always results in a true primary outbreak, which is usually severe.

2) Again, since becoming active, I’ve been super paranoid about STDs, so I believe if there was an outbreak, I would have noticed it. With that, would you say it’s unlikely my HSV-1 was caused via sexual transmission below the belt?

3) If I haven’t had a noticeable HSV-1 outbreak (oral or GH) in at least 15 years, is it safe to say the chance of seeing one in the future is quite low?

4) I informed my fiancé about the HSV-1 result, who has been really supportive and okay with it all. She says it’s not a big deal. Should I just stop worrying so much about this? As you can tell, I tend to overreact...

Thanks so much for your time.

Terri Warren, RN, Nurse Practitioner

72 months ago

1) If I did acquire HSV-1 down there, would I most likely have noticed it? I read somewhere HSV-1 GH almost always results in a true primary outbreak, which is usually severe.

In my experience, people with a primary genital HSV 1 outbreak so notice it, yes

Yes, I would say it is unlikely that you have this genitally BUT one cannot be 100% certain unless you have something orally or nasally that is swab test positive for HSV 1

3) If I haven’t had a noticeable HSV-1 outbreak (oral or GH) in at least 15 years, is it safe to say the chance of seeing one in the future is quite low?

Yes, AND a recent study showed that people who have had genital HSV 1 for at least 2 years shed about 4 days out of the whole year.

LOL, as long as she knows (has she been tested as well?) then I think you can put this worry to rest.

Terri

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72 months ago

Terri,

Thanks so much for the quick reply and answers. Three follow-up questions...

1) You said I would most likely notice a primary ghsv1 OB if it occurred, which I understand. I was more specifically curious if most people who get infected with ghsv1 actually have a noticeable first OB. Again, I never noticed anything strange down there. I read almost all people who get infected with ghsv1 have a severe (or at least noticeable) OB if they are infected via sexual means? Is there truth to that?

2) My first test was 14 years ago. Negative for HSV-2, positive for HSV-1 (4.42 IGG). My recent test was negative for HSV-2, positive for HSV-1 (but this time with a 8.34 IGG). Both were from Quest, but not sure of the specific test/methodology. I believe Dr. HHH has discussed not focusing all that much on the specific numbers (i.e. - a positive is a positive), but was hoping you could expand on that a bit. Does that look like a new infection (the 4.42), or possibly normal variations for IGG testing?

3) Lastly, with the HSV-1 in my system for at least 14-yrs, what are the chances of autoinoculation?

Thanks in advance and for all you do for us nervous guys/girls. Have a great night.

Terri Warren, RN, Nurse Practitioner

72 months ago

1. I think we are saying the same thing using different words. In my personal experience, adults with no antibody to either HSV 1 or 2 who acquire new HSV 1 genital infection have noticeable symptoms, yes. But I cannot say that is true for everyone. And if someone has a genital infection, then they obviously have been infected through sexual means.

2. I think looking at index values is very important and I think Dr. Handsfield would agree! Anyone with an index value of 1.1 to 3.5 on an HSV 2 antibody test needs confirmation - this is a CDC guideline. You don't list the index value for your HSV 2 positive result. But neither 4.42 nor 8.34 need confirmation for your HSV 1 result. It is not possible to know if the result of 4.42 14 years ago was recent infection or not but it was not brand new infection.

3. Autoinoculation would be extremely unusual with that long standing infection.

Terri

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72 months ago

Terri,

Thanks again for the quick response.

Makes sense for questions 1 and 3. Thanks for clarifying.

For question 2, to clarify, I was NEGATIVE (<0.90) for HSV-2 both times I was tested. I was positive for HSV-1 both times (4.42 IGG 14-yrs ago, 8.42 IGG last week).

My specific question is: Does the 4.42 14-yrs ago followed by the 8.42 last week (both Quest IGG; again, unsure if they were the same tests) indicate the 4.42 IGG 14-yrs ago was close to an initial infection? Or, again, can both of these Index Values represent old infections, but with differing values due to normal Index Value variations between tests? Again, my understanding is the Index Value can fluctuate from test to test within the full positive range...

At the end of the day, I’m just curious if that indicates if I was infected shortly prior to the 4.42, with the Index Value growing over time to 8.42.

I know I am overthinking all of this, but I’m just trying to isolate if this was something acquired during my active adult stage, or was something that’s possibly been around since I was a child. Obviously, I know the true answer will never be known, but was just curious how you and the Docs interperet the Index Values stated above.

Honestly, I don’t know why STD tests even show patients the Index Values (definitely seems to cause confusion and a lot of “what ifs”). Oh well...

Thanks in advance. I promise to be out of your life soon! Have a great day.

Terri Warren, RN, Nurse Practitioner

72 months ago

I understood the question the first time you asked it. The difference between the values has no meaning in particular at all. This variation is normal for something with established infection. In addition, labs change brands of tests that they are using from time to time so the ranges can be different, all sorts of things can happen. Make nothing of the difference in index values

Index values are shown, and should be shown, as there are false positives in the low positive range (1.1 to 3.5) that need confirmation by another test. Half the positives in the range are false positives. Thankfully, we have index values on most antibody tests for herpes so we can sort out those folks with false positive results. Hope that helps you understand the need for reporting out index values

Terri

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