[Question #7031] HSV-2 and multiple partners

10 months ago
Hi, I'm a polyamorous man, married to a woman. I have a girlfriend of 2 years (who is also married and fully open), and my wife and I have a newish girlfriend (from a monogamous LTR so little chance she brought it in). 

My GF recently tested positive for HSV-2 (index value 4.3), which prompted testing all around. My wife tested negative (<.91), as did the husband. I tested positive from the LabCorp "HSV1/2 Spec Ab, IgG with Reflex" test, with a value of 1.81; however, the reflex supplementary test came in negative. Everyone so far is 100% asymptomatic--no lesions, fevers, headaches...no "bloom" whatsoever.

I plan to retest in 2-3 weeks to confirm, and would love to know about the (more accurate?) Western blot and how to go about getting that, should my test come back with such contradictory results.

Also, seeing as the situation above involves many people, can you enlighten us all on precautions, practices, and statistics? It's hard to find good info for this type of asymptomatic HSV2. For instance: shower sex without protection, having washed outer genitals with soap, and on valacyclovir? I know oral transmission is next to zero. Assuming both myself and my GF are positive, on Vatrex, using condoms--anything there to worry about? What about my triad at home? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
The western blot is by far the best antibody test for HSV 1 and 2 and with your index value of 1.81, it is highly recommended for you by the CDC. 
Any kind of sex without a condom is far more likely to transmit virus.  But taking antiviral medicine reduces transmission by about half.  If you only have sex with the infected partner, and if you confirm as truly positive, then there is no risk. But there is risk to your wife and to her husband.  We certainly have seen false positives at her level of 4.3, so since none of the rest of you have symptoms, it might be worth her getting a western blot as well, just to be sure.  You can all work with your own providers and the University of Washington. You can call 206-685-6066 to obtain the kit for testing.  If you can't work that out with your own providers, I can work with you as well at westoverheights.com.  You just need a licensed provider to get this test.  There are many tests you can obtain without a clinician order - this is not one of them

Terri
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10 months ago
Thanks! I've called and am getting my Western Blot kit mailed. Hopefully my doctor will order it; if not, I'll get in touch with your clinic.
One more question: my gf's husband is on PreP (for MSM-related activity), and there seems to be some evidence of protection against HSV-2? This is one place I've seen that info:

Is that worth looking at to further reduce possibility of contracting it by uninfected persons? Or is condom use and Valtrex good enough to take viral loads down to tiny enough amounts not to worry about?
Also, the newer member of our MFF triad is slightly immunocompromised (ankylosing spondylitis, she takes biologics)--how worried should we be there?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 months ago
Dr. Celum is a highly respected physician in the STI field, very highly regarded and this study was significant.  In fact, this drug is being considered for a study looking only at HSV 2 prevention.  I seriously doubt that at this point, someone would prescribe you this medication for this purpose.  Condoms used with every single encounter and daily antiviral medicine are going to give your way more than a 33% reduction in transmission. 
Any person with an immune-compromised condition is likely to be at slightly great risk of acquiring HSV infections.

Terri
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9 months ago
Hi, so I've gotten my Western Blot results and they're negative. 
That's very surprising, as I've had LabCorp and Quest Diagnostics tests both come back with that 1.81/1.78 results (positive) with IgM negative reflex tests. 
Should I take the Blot results as gospel, and also check with other partners to see if they'd like to do that test too to confirm their statuses? Or is there a chance that it's too early to tell. I don't really know how sensitive that test it (and I can't find out anything about the accuracy of other tests from the lab companies, which is frustrating!). 
Since we're all asymptomatic  in our little polycule, this is very frustrating stuff. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
9 months ago
I would definitely believe the Western blot over any IgG test. The false positive rate of IgG tests in the range of 1.1 to 3.5 is very clearly documented in the literature. The Western blot is a far superior test to the IgG. It is essential that you waited 12 weeks from any concerning encounter or symptom to do this test as the antibody is not made immediately. The person who had a positive antibody test at 4.3 could also be a false positive although that is much less likely.
When you look at the stated sensitivity of the IgG test in the literature that comes from the manufacturer of the test greater than 95% sensitive. However, this statistic is not based on the population of people who used the test to be screened but rather it compares the positivity rate of the IgG test to a population of people who have documented herpes positive swab tests.  That is a very different population.  Research confirms that the IgG test is nowhere near that sensitive in a population of people simply doing screening for herpes infection.

Terri
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