Confused about typing

[Vtiny145]

In 2001 I had a sexual encounter with M to F oral sex and unprotected vaginal sex. I had 2 shaving nicks.  I noticed that the guys lip was swollen and had a sore. 2 weeks later I become very ill: swollen glands, flu symptoms; and swelling on 1 of the shaving nicks. This lasted for 2 months. In 1st 9 months I had 3 OBs. My OBs are where there were shaving nicks and 1 on my lower back. I have no internal sores.  I then fell pregnant and had OBs every 3 weeks.

I have been treated with valtrex 500mg daily for 8 years. I ceased valtrex to acquire symptoms for typing on insistence of my sexual partner who is HSV 1+.

Western blot said I was + for HSV 1 and not HSV 2  (no numbers). This fits with above. I also had a pcr test on a lesion which was + HSV 2.  The nurse says this fits with my OB pattern (I have 1 OB p.a. on valtrex—which she says is impossible with HSV 1).  The type is important to my partner.

Can a person have recurrent HSV 2 on their lips?
Or b virally shedding gHSV2 simultaneously to a symptomatic HSV1? If so why no internal symptoms
Can I have HSV 2 symptoms but no anti-bodies in my blood?
Could I have g HSV 1 and then got infected with HSV 2 in exactly the same place?
How accurate are the tests (western blot v pcr)—possibility of human error and in which test is it more likely?
Would gHSV 1 infection be less likely to cause break through OBs on valtrex?
Have you seen many people who have got herpes from a partner on valtrex? My GP says condoms do nothing, valtrex and avoiding sex during OBs = negligible risk, is this accurate?
Does valtrex stop virus and therefore not give my immune system a chance to learn how to fight it. If I stopped would my body eventually suppress the virus to the point of no more OBs?

[Vtiny145]

I thought I'd post an update...just in case there are other people with a similar issue out there looking for answers.

I saw a std specialist here in Australia. He said the same thing as Dr Hook, the Western Blot is the A-1 test and at this point is almost certain I have HSV 1.

He said based on my exposure, the fact that I get single external lesions and the results of my western blot test irrespective of my outbreak frequency it would suggest with a fair degree of certainty that I have gHSV 1. However he wants to eliminate the possibility that I have a recent HSV 2 infection and am yet to seroconvert. Also clinic protocols will not allow me to have another western blot until 3 months after my dodgy pcr. I am pretty confident though as the swabbed lesion was in the same area I have always got them (and what are the chances of a second infection in the identical location), also the only person I have slept with in the last six months tested HSV 1 positive only.

The Dr has said he will type and culture any other lesions that I get but in his opinion regardless of those results if my next western blot is only HSV 1 positive then he will be prepared to sign off 100% that I only have HSV 1. In my case the use of suppressive therapy in treating gHSV1 has reduced outbreaks from 4-6 per year to 0-1.

Thanks for your help Dr Hook, and it looks like the Australian Western Blot is pretty "gold standard" too!

[Edward W Hook, MD]

Most of the evidence you mention suggests an infection consistent with HSV-1 but, of course, it is difficult to be completely sure.  The chance that you had a single HSV-2 outbreak due to oral contact and then did not produce antibodies just seems quite unlikely.

Herpes is an STD which has a lot of undeserved emotional energy attached to it.  It is not all that big a deal.  Remember, whether they know it or not, over 20% of adults have genital HSV (80% of persons with genital HSV o not know it).  while no one wants to have HSV, I am inclined to agree with your doctor- it is not a serious illness for aults.  EWH

[Vtiny145]

Thank you, your comments are helpful--definitely. Unfortunately my test was done in Australia at the Westmead hospital in Sydney. I suppose until I have another outbreak there is just no way of knowing. I'm inclined to request that the swab not be identified as vaginal so as to mitigate the possibility of the lab assuming it is HSV 2--that could be being paranoid but it is very important to me...as my current partner although HSV 1+ and despite me taking valtrex does not want to take the risk with HSV 2. He has been looking at pictures on the internet.

My GP says herpes is herpes it won't change the symptoms or precautions. That generally the medical profession consider it to be a inconvenience more than a series condition, is this true?

I feel very unlucky to be a person that may have got HSV 2 from oral it seems by all accounts to be exceptionally rare. And then not to generate anti-bodies too.

I suppose its back to late nights and chocolate coated peanuts...heres to hoping santa brings me a herpes OB for christmas!

Thank you again.

[Edward W Hook, MD]

Welcome to the Forum.  This is a rather perplexing situation.  while it appears clear that you have genital HSV, the big question is which virus is the culprit.  One important possibility is that one of the tests is wrong.  I see you are in Australia.  Was your Western blot done in the U.S at the University of Washington or elsewhere?  While I don't want to be too nationalistic, the UW Western Blot for this disease is the gold standard and it is reasonable to worry a bit about tests done in other locations.

A few comments, then I will address your remaining questions:

1.  Oral HSV-2 infections do occur. They are not common but they do occur.
2.  In general, your course, with rather frequent recurrences is more suggestive of HSV-2 than HSV-1.  There are however persons who do get recurring HSV-1.


Now for your questions-
a.  Yes, people can get recurrent HSV-2 orally.
b.  Anything is possible but I would guess the possibility that your partner was simultaneous shedding HSV-1 and HSV-2 is tiny and not a realistic concern.
c.  A very small proportion of persons can have HSV and not develop antibodies. this is more common with commercial tests like the HerpeSelect than it is for the Western blot.  with your frequency of recurrences, I would think you would have antibodies.
d.  The chance of having dual infection is close to zero.
e.  See my comment above about the Western blot.  There is a greater likelihood of error in typing a PCR result than in the Western blot.
f.  There is little experience in suppressive therapy for genital HSV-1.  In treating oral HSV-1, higher dose of valacyclovir are needed than for genital HSV-2.  Not sure how this relates to your situation- sorry.
g.  Partners of people taking valacyclovir do occasionally become infected.  The valacyclovir reduces the risk by about 50%.

My advice is that you need a “tie breaker”. I would stop taking the valacyclovir and see if you have a recurrence.  At that time I would repeat the culture/PCR.

Hope these comments are helpful.  EWH

[Vtiny145]

Just to clarify, the reason why I I asked about unprotected sex is that the condom broke--so I wanted to cover the possibility that, that brief exposure was enough. I had to abbreviate quite a lot, because of the word limit!

Thank you for any light you can shed...

I went to get typed to try and answer some questions and ended up with more questions!