Interesting and Confusing new HSV2 result

[Confused_65]

Hello all and thank you in advance for your guidance.  Here’s our story.  
My wife and I have been 100 percent monogamous for the past 7 years. I am 65 and she is 55.
Prior to this new episode in our lives, we have never had a detectable outbreak either orally or on the genitals.

About six weeks ago my wife had some sort of a painful and bumpy outbreak on her labia majora which lasted about a week. We initially thought it was shaving bumps.  She saw a gynecologist after it had resolved about two weeks later but there was nothing to swab but the doc suggested it may be HSV. She decided to get a blood test which came back HSV1 IGG positive 54 and HSV2 negative <1.  

About four weeks after her outbreak, I decided to get tested with a blood test.  I have never had any symptoms except what I assumed to be a recurrent canker sore in the tip of my tongue a few times a year.  We never had oral sex while I had a painful canker sore on the tip of my tongue (who would want to?) My first test came back negative for HSV1 and positive HSV2 igg 10.9 with reflex and inhibition confirming the results. So I went to my doc.  He ordered a full std panel. Everything came back negative except HSV2 this time with a 12.2 igg.  This was about five weeks after my wife’s out break.  At the same time, my wife got another little bump on her labia and her Ob gyn swabbed it and came back negative for HSV1/2 on the western blot test.  

My wife and I are sexually active both orally and intercourse but not since her outbreak. We are thinking that we should get her another blood test in a few weeks to rule in or out HSV2.  

Here’s the questions, I have 100 percent confidence we are both monogamous for 7 years.  I have never had an outbreak except for maybe a oral cold sore as a kid and what I assumed to be a canker sore on the tip of my tongue, this appears to be her first Ob on the genitals never orally.  Oh.. I did have bells palsy about 20 years ago.

What should we do to keep enjoying sex with each other? I don’t want to give her hsv2 if she doesn’t have it and she doesn’t want to give me hsv1 since I don’t have it.  This situation is truly distressing and buying a lot of condoms and dental dams will be a new thing for us.  We are confused, depressed, and looking for advice.  
Does my recent increase in HSV 2 antibodies indicate a recent infection without discernible symptoms? Getting her tested again for hsv2 after several more weeks seems prudent since it could take a while for antibodies to kick in.  Also, is it possible I have been carrying hsv2 for 7 years but never had an outbreak?  We have both had orthopedic surgery in the past year, but we are assuming we didn’t catch anything from a operating room.  It’s all weird and confusing to us.  Should we just ignore it all and get back to business? That doesn’t sound right to me and neither of us want to all of a sudden have oral lesions to explain away.  

Thanks again. I hope someone can help us make sense of this so we can get our lives back to normal.  Please feel free to ask questions for more clarity.
Kindest regards
-confused_65

[auntiejessi]

I can see why this is so confusing.

I do want to clarify something - when you say your wife had the Western Blot, do you mean she had it cultured? A Western Blot is a blood test, not a culture. If she has hsv1, the WB test would have been positive, so I'm guessing you meant she had the sore cultured and that came back negative?

Also, to confirm, since you and your wife have been monogamous for the last 7 years, I'd assume both of you had partners prior to that?

If you had a cold sore as a kid, that's hsv1. The problem with our testing is that hsv1 IgG tests - and make sure your tests are IgG - miss a full 30% of infections.

If you did have cold sores, that means you've had hsv1 orally for a long time, and the test is just missing it. Your Bell's Palsy might have been caused by the hsv1, but that can be caused by other things, too.

Canker sores aren't hsv1.

There is no difference in your hsv2 tests - I've had hsv2 for 20 years. I could test today and get a 15.9 and tomorrow get a 13.4 and the following day, get a 14.7. It means nothing. It could mean that the lab tech who read the report cut the test off when it was clearly a positive, that there was what we call "background noise" on the test, etc. Also, no one ever gets a true 0.00, so if they reported your negative with an actual value, it might have read .072 or .68 and those aren't any different either.

Your wife can get her hsv2 IgG test at 12 weeks. It takes up to 12 weeks to develop antibodies. If it's negative then, and you want more confirmation of what you both have, and I can see why you might, your doctors can order the Western Blot test. It's more expensive, but it's the most accurate test there is.

Now, assuming for this that you have hsv2, but not hsv1, and your wife has hsv1 but not hsv2. What does this mean for your sex life?

For you, not much. It is very unlikely that you'd get hsv1 after getting hsv2. The hsv2 antibodies offer strong protection against hsv1.

Transmitting hsv2 to your wife is a little different, though.

Transmission rates from a male to a female, assuming sex 2-3x a week, in a monogamous relationship, the stats are:

Just avoiding sex during an outbreak - about 10% a year

Adding daily suppressive meds OR using condoms - about 5% a year

Using both meds AND condoms - about 2-3% a year.

Transmitting hsv2 via oral sex to someone's mouth can happen, but it's uncommon, and unless you had an outbreak, I wouldn't worry about it.

I know it's a lot to take in. Take your time. There is a Herpes Handbook written by Terri Warren, a nurse practitioner with 35+ years of clinical and research experience in the field. You can read it for free on any device here - https://westoverheights.com/herpes/the-updated-herpes-handbook/

I'm happy to answer any questions you have. Just let me know.

[Confused_65]

Thank you so much for this information. It’s very helpful.  Yes… her second test was a swab and culture not Western  blot.  Hsv1/2 both came back negative.   We definitely will be careful with condoms, etc.   I also read that it would be less likely for me to pass hsv2 through cunnilingus?  Is that true?   This is quite new to us and confusing as well.  I remain asymptomatic and I feel lucky for that, but I want to avoid giving it to her. If her next antibody test comes back positive for hsv2, we will need to figure that out.  Many thanks again for your guidance.
Kind regards

[auntiejessi]

If you have hsv2, it is very likely that you have it genitally. Herpes is only contagious from the site of the infection, so you'd only be infectious from your genitals.

If she has hsv2 as well, then I wouldn't worry about anything except performing oral sex on her when she has an outbreak, even though the chances of you getting it again in another location is very, very slim.

Oral hsv2 is uncommon, and unless an outbreak is present, oral sex on someone with genital hsv2 is considered really, really low risk.

If you can take away any advice, please don't let herpes get in the way of what seems like a beautiful relationship. If condoms aren't your thing, consider suppressive antivirals, like Valtrex. They are safe unless you have established kidney disease, and even then, it's usually just a dose adjustment, but talk to your doctor.

You can read more about all of this in the Herpes Handbook I gave you. Ask me anything. I'm here to help. :)

[Confused_65]

Thank you again! You are indeed helping us and we appreciate it.   It’s been a few more weeks since her outbreak down there so we are planning on getting another IGG test to see if my wife has built up HSV2 antibodies that may have been missed soon after her first outbreak.   I on the other hand have never had an outbreak. It’s very strange.  I am in my 60’s and can’t remember a single instance of anything below the waste.  As I mentioned before, very rarely I will get what “appears” to be a single canker sore on the tip of my tongue, but that’s not herpes as far as I know.  Just in case, we’ve been taking lysine tablets which seem to get a high rating from users on the internet.  Maybe Moderna or a big pharma company would want my antibodies, since (knock on wood) I can’t ever remember having an OB!   I am definitely going to pick up that book.  

[Confused_65]

The plot thickens. So, my wife had her second blood test approximately 3 months following an episode of painful bumps on her labia. The IGG test came back again positive for HSV1, Negative for HSV2.  We retested to make sure that there was adequate time for antibodies to build up.  We are still so confused since I have never had an outbreak, and I have two IGG  blood tests showing negative for HSV1 and positive for HSV2 (9.0).   Coincidentally, just weeks before my blood tests, I received the new one-shot shingles vaccine.  Now I am wondering if that vaccine somehow interferes with the IGG results for HSV2. I can’t find any research on the topic, but I am assuming that the tests are smart enough to distinguish.   The good news is I have never had an outbreak, the bad news is, after 7 years we are now using condoms because I don’t want to take the chance of giving hsv2 to my wife.  I also wonder about my specific propensity for shedding. Each person is different and perhaps since my antibodies are on the high side, my system is more effective at controlling the virus.  I also dislike the idea of going on suppressive meds since I don’t want to cause another problem with kidneys, or something else.  If I were ever to stop using suppressive meds, would it kick start an hsv2 outbreak?  

[Confused_65]

I should add, that her outbreak looked a lot like hot tub folliculitis. She had recently shaved down there and the bumps may have become infected from an episode of intimacy in our hot tub.  At the time, I thought that the bumps were bumps and not clusters of cauliflower looking blisters. Her repeated tests confirm negative for hsv2 and I don’t have HSV1, so we are leaning in the direction of folliculitis. She has not had another outbreak.  I am still wondering about the likelihood of a false positive for me.  

[auntiejessi]

It's not likely with a 10+ result to be a false positive, but it's possible. There is a confirmatory test called the Western Blot, and I don't know where you live, but it's not easy to get outside the US.

Terri Warren, of Westover Heights, may be able to help if you live outside the US. She can definitely help if you are in the US. You can talk to her here - https://westoverheights.com/getting-a-herpes-western-blot/

[Confused_65]

Thank you Auntie! I am definitely going to arrange for the western blot test. It will put m mind at rest knowing one way or another.  It simply makes no sense to us that I tested positive for hsv2 with no symptoms my entire life, and she never caught anything from me after years of unprotected sex and still tests negative for HSV2.  I know it is a long shot but it is very suspicious to me that I had the new one-shot shingles vaccine in the weeks prior to my hsv blood work.  Your comments are very helpful. Thank you.  

[auntiejessi]

Good luck, and let me know what happens. :)