[Question #7659] HSV-2 - Likelihood of an outbreak

14 days ago
Hi,

Back in early to mid November 2020 I had sexual intercourse with a woman 2 separate times without a condom. The second time was over the course of the entire evening so we technically had sex multiple times that evening. In total, all the intercourse was for several hours (I don't know if this is necessary information). Anyway things ended after that and she texted me in December of 2020 that she developed an outbreak of HSV2 on the outside of her vagina and tested positive. She said the outbreak started in the first week of December. I did the math and there was about a six week period from when we last had sex to when she broke out. I have not since then had any breakout or anything of note on my genitals. 

I went and got tested in late December 2020 and my IGG blood antibody test was negative. The doctor told me this didn't matter and I could break out at any time down the line. In fact, she advised me to not even get the test. I went ahead with it. I got tested again on 2/06/2021 to see if more time would make a difference and again this IGG test (HSV 2-SPEC AB, IGG W/RFX)  was negative with a value of less than 0.91 and a ref range of 0-0.9 (I hoping I'm giving the info correctly) According to the test
Negative <0.91
Equivocal 0.91 - 1.09 Positive >1.09 Note: Negative indicates no antibodies detected to HSV-2. Equivocal may suggest early infection. If clinically appropriate, retest at later date. Positive indicates antibodies detected to HSV-2.

So, my question is what is the likelihood that I have HSV-2 and tested negative twice on the IGG antibody test? Can you give me any insight to cases you know of where people break out from herpes months down the line. Its been over 3 months now.  I just want to know what the chances are that I break ou
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
12 days ago
The IgG test picks up 92% of HSV 2 infections, when you wait 12 weeks from a concerning encounter, compared to the gold standard herpes western blot.  It looks like you've done that appropriately.  This means that the IgG test misses 8% of HSV 2 infection, compared to the better test.  But you've had not any symptoms.  Do you know if she had ever tested by antibody test prior to her outbreak in December?  And I am assuming she was positive by swab test?

Terri
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12 days ago
Hi Terri,

Thank you for your response! Your expertise on this site is amazing compared to what I have found elsewhere. I will be going to my doctor to order the Western Blot test. I have not had any symptoms and is has been 3 months and about 1 or 2 weeks to be exact since my last sexual encounter with this person. I have had no other sexual partners since then. According to her, she never was tested for HSV 1 or 2 prior to her breakout which was six weeks after our encounter. I believe she had a swab test. I mean, she said she had an outbreak in the first week of December 2020 and she tested positive for HSV 2. We weren't that close and honestly had only dated a couple weeks so afterwards it was difficult to squeeze information out of her. For instance, she had a sexual partner soon after me, but when I asked her if she thinks she got it from him after me, all she said was it's possible. So she maybe didn't know if her partner after me had it, or she thought it must have been dormant in her for a while. That was basically what she told me, that she thought it had been dormant in her body. I appreciate you giving me the statistics of 92% but still it's difficult for me to let go of the anxiety with just that. I mean, in your experience how likely is someone to breakout after this much time elapsing? Will I have symptoms other than just visible herpes on my genitals? Like I said, I'm going to get the Western Blot test, but I'd just like to get an idea from someone who has been around this a while. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
12 days ago
The western blot is only done at the University of Washington and you need to call them to send you a kit for the test - 206-685-6066.  Then you and your provider can get your blood drawn and spun and shipped back to UW.  Since you've had no symptoms, herpes is less likely and 92% certainty is quite good, but that's the best I can do for you right now.  Six weeks is long - the average time from acquisition of HSV 2 to symptoms, with a new infection, is 2-10 days, 14 at the outside.  But people can get infected and not develop symptoms right away.  It's a bit of an inexact history thing, unlikely some simple ones like gonorrhea.  You've waited long enough to do the blot from your last encounter with her.
Peace of mind can be so valuable, right?

Terri
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12 days ago
I will definitely be calling my doctor and that number first thing tomorrow to order this Western Blot test! Peace of mind is what I'm looking for for sure. I mean, I feel mostly confident that I don't have it but the doubt creeps in now and then, which is no fun. 

And I read that as well that 2-14 days is the usual time of outbreak from exposure. It's such a strange virus, I've never heard of anything else like it that can be in your system like this and flare up a year later? I guess HPV warts are similar in the sense that they come and go for an entire lifetime. You would think that if you caught a virus your body would immediately fight it causing the breakout. Unless your body fought it and kept it at bay, then years later your immune system is weak or something and you break out. I don't know. I also found it weird that this girl thought she had it dormant in her system for over a year or something. I don't know if she just wasn't able to find out from past partners or what, but you would hope that you'd be able to pinpoint where you got it. To me, it makes more sense that she would have gotten it from her next partner and then had her outbreak basically in the two week period after that. I think she slept with this other person in the couple weeks after we ended, so the six weeks sort of makes sense. Anyway I am just speculating with you, after all it would be hard for her to tell if she got it from him because if they both test positive and he didn't know if he ever had it before. Who knows. 

Another question, is it much harder to transmit if someone isn't having an outbreak? Because she definitely wasn't having an outbreak when we had sex. When we had sex we spoke of the fact that we both had been recently tested for std's so we thought unprotected sex was safe enough. But obviously I didn't understand the Herpes risk. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
11 days ago
All of the herpes viruses are lifelong infections.  For example, chickenpox can flare up in older age as shingles.
So are you saying that at the time your partner tested positive when she had an outbreak, she tested positive by antibody test or by swab test?  If she tested positive by an IgG antibody test, then this was not a new infection. Perhaps you can find out more, and if it was a positive antibody test, you might ask what the number was associated with the positive result.
It is not harder to transmit when someone isn't having an outbreak.  We know that most transmissions occur when people are not seeing symptoms, probably because people are less likely to be having sex when they have an outbreak.  If your provider is unable to work with you to get the blot done, you can contact me at westoverheights.com and we can do a video conference and get the test going in that way.

Terri
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10 days ago
Well, when she had her outbreak (six weeks after our last sexual encounter) she told me that she tested positive for HSV-2. But I didn't find out if it was antibody test or swab. I didn't know enough back then to ask. And she will not return my text message I sent her this week. I haven't been in communication with her for the past three months, so I think she will probably just ignore my message. 

And really, HSV-2 is just as contagious even when there is no outbreak? I assumed you were more contagious during the outbreak. That is somewhat unsettling. I spoke with a friend who has herpes after all this happened and he told me that in his experience he thinks its hard to transmit without an outbreak. 

I just ordered the Western Blot test today though, so hopefully in a week I'll send it in and be on my way to knowing for sure. Do you think with a negative test from the Western Blot that I can put my worry to rest for good? How long does it usually take to get the results? I appreciate all your help!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
10 days ago
We know that when people do daily home swabs and we quantify the amount of virus present on a swab, people can have a million copies of virus present when they are having an outbreak and a million copies present when there is no outbreak, as an example.  The thing is, when one has an outbreak, that is a KNOWN viral shedding time. 
Don't forget that you can order the kit on your own but you need a provider to order this test, it is not one you can order on your own.  If you have a negative western blot and it's been 12 weeks since you last had sex with anyone, you can count on your negative.  Once you get your blood drawn, spun and sent, usually we get results in one to three weeks.

Terri
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