Thank you for this service, I really appreciate it.

I am a 39 year old male. Recently I had an STD test and, unbeknownst to me, the lab had changed the panel of tests that I normally get to include hsv-1 and 2 blood tests. I didn't know until I saw the results. Everything was negative except for hsv-1. I have researched hsv-1 and 2 in the past and understood that, based on the statistics, I probably already had hsv-1 (along with most of the population) and I was ok with it. No need to test unless there was an outbreak, as recommended by doctors. But seeing the actual results threw me for a loop. Its gotten in my head and given me a lot of worry and anxiety and I'm not sure how to process it. Regarding outbreaks (or absence thereof), I don't specifically remember having cold sores but it seems likely I had them when I was younger because my mom and brother sometimes had them. In the past I have had a pimple on my pelvis above my penis...I googled herpes outbreaks at the time and the pimple was nothing like the description or pictures of herpes outbreaks I found.

So I'm not sure what to do...it seems like all the medical guidance is for people experiencing outbreaks, and usually for hsv-2. Is this just something that people don't worry about?

You probably speak to people who are in my situation in your line of work, who are surprised and frightened by a positive hsv-1 blood test without any physical symptoms present. What do you tell them?

Thank you in advance for your time.

Good question.  You are correct that half the population has HSV 1 infection and most of it is oral, but not all of it.  Certainly some is genital.  The younger you are, the more likely it is to be genital.  However, genital HSV 1 tends (for most people) to be a minor issue, with infrequent recurrences, very unlikely transmission and rare shedding of the virus.  Since you've had no real outbreaks ( I don't count a pimple as an outbreak), you aren't going to be able to tell where your infection is until you have one.  So keep your eyes open, both orally (anywhere on the face) and genital (waist to mid-thigh).  it is possible that you may never experience an outbreak.  Totally possible.  and since about half the population is infected with HSV 1, it's highly likely that you'll be having sex with someone who also has HSV 1 and then it's not an issue. 

So here's my advice:  observe for any outbreaks so you can know where your infection is.  If you are going to give oral sex to someone, let them know about your HSV 1 status.  And if a partner is worried about it, they could get tested.  And if they are negative, you could consider doing daily antiviral suppression.  What other questions might you have?

Terri

Terri,

Thank you for your response.

I have a few other questions, the some things I've learned while researching over the past few months. Could you let me know if I have my facts straight?

1. If someone has an hsv1 infection in one place, it's highly unlikely (or maybe impossible) that they could be infected with it in a another place,  i.e. if someone has an oral infection, they likely won't also be infected in their genitals. Is that accurate?

2. Is it true that the hsv1 test misses about 30% of infections (i.e. false negatives)?

3. Do you think hsv1 blood tests should be included in STD panels of tests? I've seen a few posts from people who are almost suicidal after getting a positive test because they don't understand what it means. It seems irresponsible to include the test without any guidance, especially since so many  people will test positive. There's so much uncertainty involved in it...not knowing where the infection is, and the fact that so many people have it already and aren't even aware of it...I wonder if it does more harm than good.

1. If someone has an hsv1 infection in one place, it's highly unlikely (or maybe impossible) that they could be infected with it in a another place,  i.e. if someone has an oral infection, they likely won't also be infected in their genitals. Is that accurate?

Correct

2. Is it true that the hsv1 test misses about 30% of infections (i.e. false negatives)?

The IgG test misses 30% of HSV 1 infections compared to the gold standard herpes western blot, correct.

3. Do you think hsv1 blood tests should be included in STD panels of tests? I've seen a few posts from people who are almost suicidal after getting a positive test because they don't understand what it means. It seems irresponsible to include the test without any guidance, especially since so many  people will test positive. There's so much uncertainty involved in it...not knowing where the infection is, and the fact that so many people have it already and aren't even aware of it...I wonder if it does more harm than good.

Good question.  Certainly if someone has ever in their life had a cold sore, it's not useful to test for HSV 1.  On the other hand, because it can be a sexually transmitted infection, it's kind of optional, I think.  You are correct that there is a lot of uncertainty in knowing you are HSV 1 positive.  On the other hand, since you know, if you are having sex with someone who tests negative by antibody test, they may ask that you take antiviral medicine to reduce the risk of transmission.  But the test could also have missed their infection.  It is indeed a complicated question.  I personally think people should have an HSV 2 antibody test as part of an STD screen, or at least be told its not being tested for, but HSV 1 is quite another matter, I agree.

Terri

Terri,

Thank you for your guidance in helping me navigate this, its comforting to speak with an expert.

1. Where is the statistic from that says 50% of adults are hsv1 positive? I have seen numbers between 45% to as high as 80%.

2. I have read quotes from some doctors who say that basically 100% of people tested would be positive for hsv1 antibodies. Is that true? And why wouldn't they be considered "positive"? Whats the difference between having antibodies and actually having the infection?

 

3. So opinion seems to be divided on whether someone with hsv1 but no outbreaks needs to share it with anyone. I don't know if its necessary but it seems sensible to at least talk about it with partners. To use your example above: If I want to give oral sex to a partner, I could let her know that I probably have a common oral infection (I don't know for sure but its usually oral so I can assume it) called hsv1, that its unlikely to transmit it to her in the absence of an outbreak but its possible,  that its common and she most likely already has it, and if she has ever had a cold sore she can be certain she has it and that its highly unlikely (if not impossible) for her to also become infected in her genitals. And if she wants to know her status, she can get a blood test but factor in the 30% false negative rate. Are all of these statements true?

1.  It's ABOUT 50%, actually 47% from the NHANES study which is done by the federal government every several years.

2.  This doctor is incorrect.  If you accurately test positive for HSV 1, you are infected with HSV 1

3.  All of those statements are true.  But it is also true that people are divided on whether this needs to be disclosed or not.  I sort of fall in the middle, thinking that at a minimum, before giving oral sex to someone this should be discussed BECAUSE this can be a sexually transmitted infection and that is loaded with legal issues as well as psychological and social issues.  Just my personal take on things.  I think you've got it right

Terri

A few more I forgot to ask:

1. I read that a genital infection usually has an outbreak soon after being infected, is that correct? If that's the case, can I reasonably assume that what I have is the standard oral infection?

2. Also, aside from the examples you mentioned above, is it typical for people with asymptomatic hsv-1 to be on antivirals or is that considered going overboard?

3. Should I get a confirmatory test or is that not necessary? I believe my level was >20.

You are out of questions, but I'll give some quick answers.

1.  IF someone is going to have symptoms with a new infection, it will happen within 2-10 days, most always

2.  It is not going overboard.  Antivirals will be excreted unchanged from your body if there is no herpes virus present

3.  No confirmatory test is needed with that index value.

Terri