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Understanding HSV test results

I was recently tested with a HSV type specific test from lab corp and was negative for both HSV-1 and HSV-2. The girl I am dating mentioned to me that when she was younger (14 years of age) she had received a cold sore from sharing a soda with her mother. She has been under the impression that she had gotten a cold sore from her mother because she formed a blister that had all of the signs (self diagnosis) I didn't think anything of this and she had told me this after we had already engaged in oral sex before.

I did some reading and found out that it can be transmitted orally to genitals. Her and I went to the same doctor and had a type specific herpes test done on her.

Her results are as followed

HSV-1 .92 (equivocal)
HSV-2 .72 (negative)

She tested negative for all other STD's but her white blood cell count was low. He also regarded her HSV-1 status as negative.

So, my question is, could she have been mistaken about having a cold sore all along? She says that was the only time in her life she had ever experienced that. I have been reading other posts and it seems the doc's are pretty confident that a result being that low on the equivocal side is clearly negative.

Also could the equivocal results be due to what ever other infection she is fighting (white blood cell count low)? Do lower results in the equivocal range me less likely rate of transmission or the fact that she has (supposedly) one self-diagnosed cold sore in her life?

I'm not to worried about anything, but the girl is convinced she has oral herpes from the one outbreak over 10 years ago and I am not show sure she does.

And as far as the transmission rate, in the months that we have dated, we have had oral sex only twice, but kissed almost daily. I would imagine the first place I would have seen a sign that I have contracted it would be orally than genitally. I have absolutely had no symptoms what so ever. Thanks to everyone who can help this confused guy out.
7 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Yes, your partner could be mistaken; most likely her problem at age 14 was something other than herpes.  However, with the borderline HSV-1 blood test result, I cannot say for sure.  (However, low-positive or equivocal test results have nothing to do with 'other infections' or low WBC counts.)

As to whether you could catch herpes from her, either orally from kissing or genitally from oral sex, there are no data to tell you the risk of either one.  But clearly the risk is very low.  And what would be the big deal anyway?  If you catch oral herpes by kissingher, you will just join the half of the adult population infected with oral HSV-1.  And genital herpes due to HSV-1 isn't all that important for most infected people, since recurrent outbreaks and sexual transmission to other people are uncommon.

I would just stop worrying about it and take no special precautions, except for the obvious one:  if your partner develops a symptoms suggesting an oral herpes outbreak, wait until it heals before kissing her or having oral sex.

Good luck--  HHH, MD
Avatar universal
"But clearly the risk is very low. And what would be the big deal anyway? If you catch oral herpes by kissingher, you will just join the half of the adult population infected with oral HSV-1."

When the big toe theory of purposeful HSV-2 infection was proposed. It was said that the potential risk of more serious HSV-2 infection (i.e. herpes encephalitis) outweighed the balance of avoiding HSV-2 genital outbreaks by deliberate infection of another body site. However, most adult herpes encephalitis is caused by HSV-1 (according to emedicine http://www.emedicine.com/neuro/topic159.htm). Therefore is aquiring HSV-1 orally anymore of a big deal than purposeful HSV-2 infection of another body site (e.g. the toe)? Or am I missing something about the nature of HSV-1 encephalitis vs HSV-2 encephalitis - i.e. is HSV-1 herpes encephalitis less likely to cause death/serious neurological problems compared to HSV-2 encephalitis?
239123 tn?1267647614
MEDICAL PROFESSIONAL
Englishman has a good point; not all HSV infections are benign and HSV-1 encephalitis is a bad disease.  There are other serious complications as well, from either HSV-1 or HSV-2.  That's why I have said that nobody should intentionally get infected with HSV of either type (the big toe business).  On the other hand, the risks of those bad outcomes are low enough that nobody should take unrealistic precautions against infection.  If everyone were to decide they were going to avoid HSV-1 infections at all costs, they would never kiss a child, or anybody else, for that matter, and would never have sex with someone unless the partner were tested and negative for both HSV-1 and -2.  Those steps are obviously unrealistic on a broad scale and they are ridiculous as common-sense, everyday advice.

In other words, don't confuse advice about intentional exposure with advice about common-sense, real-world precautions.

Leaving aside herpes in newborns, HSV-2 rarely if ever causes encephalitis. Central nervous system HSV-2 infections in adults generally are limited to aseptic meningitis--unpleasant but usually harmless.  HSV-1 is the opposite:  it rarely causes meningitis but can infect brain tissue (encephalitis), which can be fatal or crippling.  I have never heard of HSV-1 genital infection leading to encephalitis, however.  It might happen, but I believe encephalitis is pretty much a complicatio of orally acquired HSV-1, probably because of the short path to the brain from facial infection and cranial nerves.
Avatar universal
I don't want to sound pedantic but what are the potential side effects of HSV-2 infection of another body site - i.e. the foot. During the previous discussion - several months ago now- it was mentioned that potential serious side effects exist. I assumed this to mean HSV encephalitis. If it is so rarely caused by HSV-2 i.e. the risk is so overwhelmingly small then surely it carries the same risk as a side effect from the vaccines that school use to immunise children with throughout the world. Does this mean that a potential future herpes vaccination program could be as simple as finding a site on the human body which is least succeptable to HSV-2 producing a clinical expression (lesions/tingling etc)? Since HSV-2 does not particularly like infecting the oral area, there must be other sites on the human body which are in even less favour but produce the antibody reponse required to become immune.
239123 tn?1267647614
MEDICAL PROFESSIONAL
Too theoretical and not likely to ever be studied.  I wouldn't hold my breath.
Avatar universal

I like your idea.  I think we need more "out of the box" thinking.

There are genitically modified versions  of HSV-1 being tested
for cancer treatments.  (Medigene).  You might visit their
website.  I think you would find it interesting.

Maybe some version of HSV could be developed that would be
safe to do what you suggest.
Avatar universal
Yeah, I heard about the modified HSV a few months ago now. It appears to be able to selectively kill tumours of the central nervous system - but is obviously in early stages.

This is a much more serious use of HSV than for protection against genital/oral herpes.

Seems a shame that no one will investigate purposeful infection of both HSV-1 and HSV-2 on body sites that they do not like. This could potentially prevent oral outbreaks, genital outbreaks and other more serious outcomes such as herpes encephalitis.

I am not an expert in medicine so assume that the profession has good reasons for not investigating this. Last time it was discusses, the Mr Handsfield said that it would require a large and time consuming study.

It seems theoretically sound to me. Perhaps some animal studies could offer some insight (without wanting to raise controversy over animal testing). The post a few months ago was from a man in a situation where he purposefully wished to infect his wifes foot in order for her to gain genital immunity. I must admit, the idea seems very tempting - if only someone could say whether it would or would not work. No one on this forum (the doc included) has ever answered that critical point.

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