[Question #593] Follow up on [Question #564] Herpes/HIV/Other STD risk?

104 months ago

Please direct to Dr.Terri as she was handling the previous question too.

Hi,

This is a followup on question #564,

I got the tests done[5 days post encounter] and everything [HIV, Chlamydia, Gonorrhoeae] came back negative but for HSV1 [IGG type specific AB > 5.00H], done by Quest. I do not have any symptoms whatsoever, never remember having any symptoms, neither oral or genital, and I've only gotten unprotected oral by two women in my life, my ex and a person in between, both before 2013, always had a condom on after that, could this be oral or genital HSV1??
HSV1 Igg type specific ab > 5.00 H and HSV2 Igg type specific ab <.90 H, could HSV1 be a false positive ?, should I retest for HSV1 again using the igg or test with the western blot at Seattle. I have had chicken pox as a kid, would that have interfered with the results?
I understand that 5 days post last encounter is too early to test for most of what I tested [this was more of a test to get my existing status before i test further], which out of these should I retest for at 6 weeks and then at 3 months to have a conclusive idea of my complete std status, I want to know exactly what my health status is and am definitely not going to be involved in anything physical till i know [3 months conclusive for all tests?, Hep panel could not be run, too much cholestrol, going to the doctor today on a separate note for that]
I keep hearing that HSV1 is prevalent orally in 80% of the population in the US, and up to 90% of the population above 30, is that a true stat, if so, if I have HSV1, what is the accepted norm on when to disclose when you date?.

H. Hunter Handsfield, MD

104 months ago

Welcome back to the forum. Questions are answered by all three of us, regardless of specific requests. I reviewed your previous thread with Ms. Warren.

Your result is not likely to be false positive. That's rare for HSV1 (more common for HSV2), and especially rare for strongly positive results like an ELISA ratio over 5. You are infected with HSV1. Having had chickenpox is not a cause of false results; that's an urban myth without scientific basis -- left over from distant past uncertainties about HSV antibody testing.

Based on the information available and the nature of your recent exposure, as described in your earlier thread, this has nothing to do with that event; as you already know, 5 days is much too soon for a positive result. Your statistics are a bit outdated; the best and most recent studies show about 50% of US adults have positive HSV1 blood tests, roughly 60% of those over 30 years old (http://www.ncbi.nlm.nih.gov/pubmed/24136792). Still, the take-home message is the same: having HSV1 simply means you are a typical member of the adult population. The large majority of these infections are oral, mostly acquired in childhood, even though most persons have no recollection of any particular illness or symptoms, nor ongoing oral herpes (cold sores, etc).

Accordingly, it is highly likely that your HSV1 infection is oral. Having not had symptoms to suggest oral herpes, probably you never will. Could your infection be genital? Yes, but probably not. The only way to know the anatomic site with certainty is to have an outbreak consistent with herpes, which can be tested for the virus. If you ever develop a blister or sore on or near the mouth or genital area, it would need to be tested within 2-3 days for an accurate result. But really, you shouldn't worry about having genital. Most genital herpes due to HSV1 does not recur at all, and asymptomatic shedding of the virus is uncommon -- very different than HSV2. As a result, genital HSV1 is rarely transmitted to partners. You need not say anything about this to current or future partners. To the extent there is some risk of transmission, it is much more likely by oral contact with them, i.e. kissing or performing oral sex. Even this is probably unlikely in the absence of a visible outbreak.

As far as other STD testing is concerned, I really don't think it's a high priority, nor would I repeat the herpes blood test. The chance you caught anything from this event is simply too low after only a single condom protected exposure. Reducing it to a personal rather than professional level, if somehow I were in your circumstance I would be continuing unprotected sex with my wife without worry, and would not be tested for anything.

I hope this information is helpful. Best wishes-- HHH, MD

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Terri Warren, RN, Nurse Practitioner

104 months ago

I'm not sure if I'm supposed to chime in here or not, so I will. I completely agree with Dr. Handsfield that your positive HSV 1 status has nothing to do with an encounter 5 days previously. And I would agree that further testing is not required. Whether you need to tell people that you know you are HSV 1 positive is an interesting question. There is very little agreement about this question, even among experts. And if you do tell, when should you do that, before you kiss, before you give oral sex? I'm not clear that there is a right answer here for everyone. For example, what if you know that you have oral infection (which you personally don't know) and you give oral sex to a partner when you don't have a cold sore and they get HSV 1 genitally? This is a topic of a lawsuit I'm involved in right now as an expert and it will probably be precedent setting. Would the woman who got the HSV 1 genital infection preferred to have known her partner had a history of cold sores before becoming infected? Probably. Would she have done anything differently about it, like refused to receive oral sex from him? Unclear. Did he have a responsibility to tell her about his infection? Unclear. Did she have a responsibility to ask him to get tested to know what he had? Maybe. Would he then have been tested for HSV 1 as part of an STD screen? Probably not. It goes round and round and I feel like it is going round and round more as more HSV 1 infection is genital, particularly in people in their 20's. Why? Because their parents figured out that cold sores are actually caused by the herpes virus and they stopped kissing their kids when they had cold sores. So then those kids grow up, have sex (and lots of oral sex), have no immunity to HSV 1 because of no prior cold sore infection and they get it genitally by receiving oral sex. and because genital infection has more stigma, this issue has come more to the forefront of discussion. I'm not claiming to have any answers at all here - just talking about the issues that we see in our practice these days. Interesting stuff.

Terri
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104 months ago

Hi to both of you,

I think the right thing to do is to disclose HSV1 status, which I will be doing,

which means my chances of dating are now effectively cut to half or lesser.

Before that, I'd like to put this to sleep once and for all, so could you let me know how to get a Western Blot test which will effectively close this for me, I'd like to get one of those now and one 4 months from now to rule out the last encounter [Is it 4 months or 5 months?]

Could Lipid interference have any effect on the antibody test for HSV1, my Hep panel could not be run and was sent back due to lipid interference.

And now to the rest of it:

It seems to be a weird conundrum here: I might feel that even though I now most probably have oral HSV1, it's the best deal out of the other three, gen HSV1, oral HSV2, gen HSV2, and this whole thing seems to be more difficult for responsible people, as: if I had not tested at all [I asked for the test, without any symptoms, i was not asked to test ever!] I would never have known and gone about happily, which I probably should, but now cannot, due to my own curiosity of the flora and fauna in my body and my duty to disclose, so that morally and legally I can sleep well.

About the part you wrote: Don't you think : At present, isn't it probably better that you get HSV1 from your parents orally so that you have enough time to build the antibodies to never get it genitally and also save you a bit from HSV2 , knowing you will be encountering HSV1 in your adult life, unless you get test results from every one of your potential mates at the end of 4 months of close watch by you AND they are negative for HSV1 and HSV2.

HSV1 education needs to be ramped up: if i knew the consequences and the stigma, I'd just never kiss anybody, come what may [i'm very well read, but i never ever thought i'd end up with Herpes], this should be the highest up there in terms of threats and education about this should be the highest...The clap and chlamydia are immediately curable, but I think the clear idea that HSV1 IS Herpes and IS transmissible orally AND does not have a vaccine or cure needs to be made clear, at least 50% of the population below 25, I am wagering a bit here, would not know......

Back to my question: how do I get the western blot, I'd like to close this for peace of mind, so would like a western blot now[for HSV1 and HSV2] and also at 4 months [or is it 3?- for conclusive results on last encounter] and Could Lipid interference have any effect on the antibody test i took for HSV1, my Hep panel could not be run and was sent back due to lipid interference.

Terri Warren, RN, Nurse Practitioner

104 months ago

We are conducting a study at Westover Heights clinic comparing the results of the ELISA test to the western blot results. We've been doing it for a while now and I can tell you that 100% of people who test at greater than 3.0 on the HSV 1 test have confirmed by western blot. So you can do it through us (look at the website under herpes for study details and review of the consent form) but I would strongly suspect you will confirm on the western blot. Lipids do not interfere with this test but what's up with that anyway? Did you check on on that with your provider? And we like to wait 16 weeks from the date of possible exposure to do the western blot.

And I would strongly disagree that you dating chances are decreased! Since the majority of the population has HSV 1, I think this will go far better than you are imagining - far better!
About your question is it better to get cold sores as a child. Yea, its an interesting question for sure. But it is purely academic because at this point, no parent that I know will intentionally give their child oral herpes. And the testing of potential sex mates ideally would occur before sex but after they've waiting long enough since their last relationship. Which is tricky in itself but certainly not impossible. In this sexual climate, I am aware that this is unlikely to happen for most couples.

So let me be clear - if you knew you had HSV 1, or someone else did, you would avoid kissing them? See, I think that's too much caution. Everything in life that's worth anything comes with a few risks. A cold sore that is fully treatable a few times a year vs. kissing? I think that's a risk I would willingly take! But I do agree that herpes education is lacking, for sure.

Terri
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H. Hunter Handsfield, MD

104 months ago

Thanks to Terri for her insightful comments and advice as alway. I will just add that I agree entirely with her about dating. I hope you don't really believe that half the entire population (those with HSV1) have or should have more trouble findings partners, either romatically or just for sex. Most of those people don't know they are infected; and those who do know are less likely to infect their partners than those who don't, assuming a couple of very simple precautions (no oral contact during an outbreak). As for telling partners, by all means do so if it makes you feel better. But do it with care and sensitivity.

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104 months ago

Thanks, I sure will get the western blot exactly 16 weeks from the possible exposure that got me here, I'll be getting the 6 week HIV test before that nd the 12 to rule it out completely.

Once the results of the Western Blot are out , I'll make sure to post them here.

As I said before, the reason I am asking for the western blot is that even though HSV1> 5 H, in my lifetime I have only had a couple of aphthous ulcers / canker sores and one round of eczema downstairs which the derm treated successfully, other than that during routine screening anything that my doctor thinks remotely resembles hpv downstairs, he takes down with liquid nitrogen. [NO Herpes symptoms to date] So I'm thinking how could I have contracted it with a total of 2 women giving me unprotected oral and a total of 4 women that I would have kissed in my lifetime, this seems to be one heck of a virus ....

Last questions before we meet again in 14 weeks:

I am a fairly social person, when I'm not banging my head for contracting HSV1....and I really value my family and friends, so what risk do i pose to them now: can i still be around children- nephews, nieces and elderly and kiss them on the forehead and hold their hands, share food, use the same furniture or am i not to, i need serious answers on this, no middle of the road please, I'd rather feel really bad now and not endanger them at all than feel horribly guilty later
Cure / Therapeutic vaccine for HSV1 and Vaccine for HSV2: how much of a possibility is it in the near future?
Any way that I Can be 100% sure that I have oral HSV1 and not GHSV1- any tests?, what do you think I probably have?

My doctor, a GP, and a very learned man, had to listen to all of this and his advice was that almost everybody born in the 80s has antibodies to HSV1, move on, this is a non event...

I am still arguing with him why its a non event , when clearly I can give it to someone who does not have antibodies.....

You really have to tune up the sex ed everywhere- snogging can give you incurable herpes for which you will need to broadcast your HSV status everytime you want to snogg someone again - clear instructions - on every school textbook please- period.

H. Hunter Handsfield, MD

104 months ago

I still see no need and recommend against Western blot. Even if negative, I would conclude you have HSV1. WB misses some infections positive by IgG testing.

Active and somewhat promising research is underway on therapetuic HSV vaccines, but if successful, such products are many years away from general availability. Prevention vaccines also in research but effectiveness is difficult to predict and also some years away if successful.

As I said in my original reply, it is probable that your infection is oral and not genital. I also said "The only way to know the anatomic site with certainty is to have an outbreak consistent with herpes, which can be tested for the virus."

Your GP is correct in his attitude and advice, although not in some details. It certainly is not true that "everybody born in the 80s has antibodies to HSV1". As I also said above, it's cloer to 50%. But the remainder of his advice is correct, and Terri and I also would encourage you to look at this as a "non event". The large majority of people with asymptomatic HSV1 infections never infect anyone else. To repeat yet another part of my replies above (and Terri's), you definitely do not "...need to broadcast your HSV status everytime you want to snogg someone".

That completes the 3 follow-up questions and replies included with each question, and so ends this thread. Do your best to follow the reasonced, science based advice you have had both on this forum and from your doctor.

Best wishes and thanks again for your confidence in our services.

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