[Question #619] HSV-1 transmission and testing

41 months ago
I am a lesbian with a new partner who was recently diagnosed with genital HSV-1 but according to her doctor, she has not yet developed antibodies for the virus. I am her only partner in the last six months and I have never had  symptoms of Herpes.  How likely is it that  having had no  symptoms and being over 60, I could have passed the virus to her?  In any event, I assume I should be tested ....what is the gold standard test for HSV-1 and how long should I wait before being tested to ensure that a. if i passed it to her i will know or b. if i have contracted it from her i will know?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
Good morning, Ellen. 
The traditional IgG screening test for HSV 1 misses one out of four infections, so it is possible that no matter when she tests for antibody, it will not be detected.  May I ask how she was diagnosed with HSV 1 genital infection?   I'm thinking it must be by swab test.  In my clinical experience, more HSV 1 is transmitted when no cold sores are present than when they are.  I think that's probably because people with cold sores or their partners may recognize that the cold sore represents some sort of risk.  I've also seen it happen the other way around - people giving oral sex with a cold sore, not knowing that that is a risk for transmission of HSV 1. 
Is the concern that you may have infected her or was she infected before you were her partner?
The gold standard test for diagnosing HSV 1 is the herpes western blot antibody test.  It is available only at the University of Washington.  our clinic is currently doing a study comparing the traditional screening test to the western blot and you can obtain the western blot through this study if you wish at https://www.westoverheights.com/herpes/getting-a-western-blot
 or you can get it directly through the UW.  It may be helpful for you to do this so you both know where you stand.  If she has new infection, she will not have antibody for a while, perhaps even up to four months by western blot and it will take longer if she is taking antiviral therapy. 
Please let me know what other questions you might have.
Terri

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41 months ago

Hi Terri,

I don’t think we are terribly concerned with who gave it to whom but I do want to be tested to know where I stand.   I will go thru the site you provided and thank you.

The test my partner took was a blood test through her gynecologist.  If it helps i can find out what type, etc.   She had very small genital lesions and other symptoms which is why she sought help.  After thinking it was a yeast infection and being treated for one which did not go away,  a blood test was done revealing HSV-1 but no antibodies were present so she was told by the doc that it was likely a very new infection.   What are your thoughts / opinions here as to the likely efficacy of the test (blood test),  and her docs conclusion as to reason for the lack of antibodies being present; that it was because it is a new infection? How/will she ever be able to know when she might have contracted this by testing?

We certainly want to  a.  validate her diagnosis with the best / most reliable test.  But she is being treated now with an antiviral so should she wait until that is done and then in a few weeks/months take the Univ. of Washington test or something else?   

and b. we want to have a game plan as to the best way to handle intimacy going forward.   While we have read almost every page of the handbook Managing Herpes Living and Loving with HSV, we are still unclear as to how best determine when HSV-1 'shedding' is occurring. It is clear that it is not evident and so you don't really know when that is happening?    I am completely asymptomatic as she will likely be when the antiviral has taken its course and we are concerned about how to avoid passing it to me assuming i do not have it.  What are your thoughts here?

If there is anything you need to know to better answer these questions,  please let me know and i will get those answers for you.  Is there a way to pay to speak with you directly if we need that time?  My sense is that there are few 'specialists' that are as clear about this.

Thank you in advance.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
Wait - if no swab test was done and only a blood test, what blood test was done if it wasn't an antibody test?  Can you find out what blood test was done if not an antibody test?  I'm pretty confused about your situation, honestly.  Is it possible to get a copy of her lab test results and summarize them here on line for me?  A short course of antiviral therapy (1-2 weeks) is not going to impact the antibody test - longer courses could. 
It would be best for you to go ahead an get a western blot soon so you can sort out your own status so we can know if you two even have to worry about transmission.  Remember that the majority of the US Population already has HSV 1. 
If you decide to do the western blot study, we can talk more when we are doing the consenting phone calls.  And if you happen to be calling from Oregon (not necessarily an Oregon resident and we don't ask for proof of your location), I can certainly do a phone consultation with you outside of the western blot study consenting visit).    These are Oregon board of nursing rules.  Not everyone thinks this makes sense to restrict good advice to people calling from Oregon but it is what it is. 
let's get me the kind of testing that was done for her so I can sort this out more accurately.

Terri
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41 months ago
Terri...i have confirmed the following without many details: (let me know if this is sufficient)     We are not from Oregon.
1. Swab was administered on genital area using Herpes culture 1 & 2 and....
2.  HSV Blood test was administered with positive results for HSV-1 with no antibodies.  

I assume these were both standard igG / PCR tests because they were done in the docs office.  But without the Western blot I guess we are guessing about the results correct? (I may be confused about what tests are conclusive but it appears neither one in the docs office would be)

 I will sign up for the study through the clinic today.  I have a call into one of the Quorom review folks to ask a few questions about the consent form.  My partner will likely have it done but administered by her doc. thru U of Washington but I will know that later.   

When can  I speak with you as part of the consenting phone call?  I have a few simple remaining ones as asked in my previous notes.  
Thank you for your help in advance.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
41 months ago
You see, the blood test for herpes DOES look for antibody unless they erroneously did a PCR from blood.  Herpes virus is extremely rarely found in blood so that test is totally not recommended by the CDC for screening, but it's possible that's what they did by mistake.  It would be clearer to get a copy of the labs that were done rather than just "blood test" for herpes .  Your partner (and so can you) can send for a kit at UW and they will ship it and she can have her doc draw her blood and ship it back for her.  Or if you want to do it through our study you surely can.  We'll talk when you call about the study - if she has it and you don't then she could take daily antiviral therapy to reduce the risk of transmitting to you.  HSV 1 genitally is shed infrequently so transmission is less of a concern than if she had HSV 2, or sure.

Terri


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