HSV-2: Testing, Symptoms, and Transmission Concerns

Q: HSV-2: Testing, Symptoms, and Transmission Concerns

SadMan： Hello, even if you are infected with herpes, so what? There is really no need to worry unless your immune system is compromised, such as in the case of HIV patients; otherwise, treatment is not necessary. <br>Note： In Taiwan, over 50% of adults are carriers, just not show

Herpes Simplex Virus Type 2 (HSV-2)

Dear Dr.
Hsu,
I would like to consult you regarding my condition and some questions I have.
I hope you can take the time to respond:
1) I have only had one sexual partner, my wife.
However, in 1998, I had an incident of unprotected sex after drinking, and three months later, I underwent a series of STD tests, all of which were normal.
This included an HSV test using the Elisa method, with Type I showing a result of 3.56 (reference value <4.5) and Type II showing a result of 1.32 (reference value <3).
The laboratory technician said everything was normal.
2) For peace of mind, in 2000, I went to another laboratory and underwent testing again using the EIA method.
The result for Type II was 1.34 (reference value <0.9 indicates no infection, >3 indicates active infection).
The technician at that lab suggested that I had likely been infected at some point.
3) I have continued to have HSV-2 tests done at various labs, with results consistently around 1.2 to 1.3.
4) I found information online stating that serological tests can only serve as a reference, and without visible symptoms, one cannot solely rely on test results to determine if they are infected with Type II herpes.
There is also a suggestion that Type I and Type II are very similar, and it is possible that my higher concentration of Type I could affect the Type II test results.
5) I have never experienced any symptoms such as blisters, ulcers, or crusting on my genitals.
I have read that some infected individuals may not show any symptoms initially but can have recurrences later.
However, I have truly never had any symptoms.
6) I underwent a circumcision in 1999.
Prior to that, I occasionally had small red spots (2-3) on my foreskin or glans, which were not blisters, ulcers, or crusts.
After proper cleaning, they would naturally disappear in about 5-7 days, and if treated with tetracycline hydrochloride ointment, they would clear up in 3-4 days.
After the circumcision, this phenomenon has not occurred again.
This should not be indicative of herpes, right?
7) I have been worried about the HSV-2 test results (1.2 to 1.34 > reference value 0.9).
Is the reference value of 0.9 an absolute standard for determining infection?
8) Could individual variations in physiology lead to results exceeding this threshold?
9) Is it possible that the concentration of Type I could influence the reading for Type II?
10) It has been over a decade, and I have never experienced any symptoms.
11) Earlier this year, my wife tested for HSV-2 IgG, and her result was 0.5 < 0.9 (-).
12) Dr.
Hsu, what is your opinion? Am I truly infected?
13) If I am infected and have never shown any symptoms, could I still transmit the virus to my wife?
Thank you!

Sāi Dì, 40~49 year old female. Ask Date: 2016/01/28

Dr. Xu Weikai reply Urology

SadMan: Hello, even if you are infected with herpes, so what? There is really no need to worry unless your immune system is compromised, such as in the case of HIV patients; otherwise, treatment is not necessary.
Note: In Taiwan, over 50% of adults are carriers, just not showing symptoms.
Your wife may have also been infected and is currently a carrier without symptoms.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Answers found online should only serve as a reference; if necessary, it is still important to seek medical attention at healthcare facilities.
This response is from Dr.
Hsu Wei-Kai, Director of the Urology Department at Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/01/28

More Info

Understanding HSV-2 (Herpes Simplex Virus Type 2) involves a multifaceted approach that includes recognizing symptoms, interpreting test results, and understanding transmission risks. Based on your detailed history and concerns, let’s break down the key aspects of HSV-2 infection.

1. Testing and Interpretation of Results
Your test results indicate that you have had some exposure to HSV-2, as evidenced by the IgG levels (1.32 and 1.34) which are above the reference threshold of 0.9. However, it’s important to note that IgG tests indicate past exposure rather than an active infection. The fact that your results are below the higher threshold (>3) suggests that you are not currently experiencing an active infection.
The reference values for HSV testing can vary between laboratories, and while a value of 0.9 is often used as a cutoff for determining infection, it is not an absolute standard. Individual variations in immune response can lead to different interpretations. Additionally, cross-reactivity between HSV-1 and HSV-2 can occur, which may explain some of the confusion regarding your results.

2. Symptoms and Asymptomatic Carriage
You mentioned that you have never experienced symptoms such as blisters, ulcers, or lesions, which is significant. Many individuals infected with HSV-2 remain asymptomatic or have very mild symptoms that go unnoticed. It is estimated that a large percentage of the population may carry the virus without ever showing symptoms. This asymptomatic carriage is common and does not necessarily indicate that you are infectious.

3. Transmission Concerns
Regarding your concern about transmitting the virus to your wife, it is crucial to understand that HSV-2 is primarily transmitted through direct skin-to-skin contact during sexual activity. If you have not exhibited symptoms or had outbreaks, the risk of transmission is significantly lower. However, it is still possible to transmit the virus even when asymptomatic, albeit at a reduced rate.
Your wife’s negative test result (0.5) suggests she has not been exposed to HSV-2, which is reassuring. If you are concerned about transmission, discussing safe sex practices and possibly using antiviral medications during intimate contact can help mitigate risks.

4. Psychological Impact and Support
It’s understandable to feel anxious about your HSV-2 status, especially with the stigma surrounding herpes infections. Many people experience similar feelings of worry and uncertainty. It may be beneficial to seek support from a healthcare provider or counselor who can help address your concerns and provide reassurance.

5. Conclusion and Recommendations
In summary, while your test results indicate past exposure to HSV-2, the absence of symptoms over many years suggests that you may not have an active infection. The risk of transmission to your wife appears low, especially given her negative test result. If you continue to have concerns, consider discussing them with a healthcare professional who can provide personalized advice and possibly recommend further testing if necessary.

Maintaining open communication with your partner about your health status and any concerns you have is also essential. This can help alleviate anxiety and foster a supportive environment as you navigate this situation together.

Similar Q&A

Understanding HSV-2 Transmission Risks and Testing Recommendations

Hello Doctor, two weeks ago I had intimate physical contact with my boyfriend. Although his genitalia did not penetrate my vagina, there was oral sex and digital penetration involved. Afterward, he received his previous medical examination report which showed a positive result fo...

Dr. Liao Yaopan reply Family Medicine
Hello, unprotected sexual intercourse can be a route for HSV transmission. According to an educational article by Dr. Tsai from National Taiwan University Hospital, the incubation period after initial infection typically lasts from three to seven days, though it can extend up to ...

Understanding Herpes: Concerns About Transmission and Family Planning

Hello Doctor: I had a blood test that showed positive for both HSV-1 and HSV-2 IgG, but I have no symptoms and have not had vaginal intercourse. The only sexual encounter I had was oral sex during a one-night stand. My HSV-2 value is 35.7 and my HSV-1 value is 102.2. My wife has ...

Dr. Li Yufen reply Dermatology
Hello: The herpes simplex virus can be transmitted through bodily fluids and can remain latent in the human body, making it difficult to determine when the infection occurred. Typically, treatment is initiated only when clusters of small blisters appear on the skin. If you are pl...

Understanding Herpes Simplex Virus Type 2: Transmission and Blood Donation FAQs

Hello, doctor. I have the following questions: 1.) Is it true that herpes simplex virus type 2 (HSV-2) is transmitted through contact, and can it still be transmitted when there are no symptoms? 2.) Can a person who has had HSV-2 donate blood? 3.) HSV-2 is most contagious before ...

Dr. Li Xinyi reply Urology
Whether it is type 1 or type 2, in all cases of symptoms (in recurrent cases, some patients exhibit almost no symptoms), infectiousness can occur shortly before the symptoms appear, making it difficult to rely on symptoms to prevent infection. Blood donation is possible.

Understanding HSV-2: Symptoms, Testing, and Treatment Options

Hello, my boyfriend experienced frequent abdominal pain in May of this year. After seeing a doctor, he was told it might be due to a gastrointestinal infection and was prescribed some anti-inflammatory medication, which helped him recover. However, recently he has been experienci...

Dr. Huang Ruiyun reply Dermatology
If the blood test shows positive for HSV-2 and there are no symptoms, treatment is not necessary, and there is no need to worry, as it cannot be changed to negative. As for children, just avoid kissing them or sharing towels during an active outbreak of cold sores.