Wife has HSV2

[confused231]

About a month ago my wife told me she had a rash, saw the doctor and was swab tested for herpes.  She told me this, asked if I've ever had any symptoms, affairs... I hadn't.  We were both screened for sti's before getting married, both negative.  But apparently they don't always test for herpes?   A couple days after her test her results came back positive for hsv2, genital herpes.  We've been married for 8 years, together for 11.  She says she didn't cheat, I believe her, we figure after some googling, I must be asymptomatic or something and gave it to her without knowing?

So I went to the doctor and got a blood test specifically for hsv1/2 and they tested some others too.  Got the results back last week and negative for everything.

So I guess my wife's been asymptomatic this whole time and has never passed it onto me?

Is this possible?  Is there anyway for sure to know if she has a new outbreak or she's had this for some time? 

In my gut I don't believe she's cheated on me, but my brain is telling me it doesn't make sense.  How likely is it to have an initial outbreak after 8 or 11  years?   How could she have it that long and not pass it on to me?


 

[WilsoInAus]

Hello @confused231 and welcome to the website!

This is a little complex, but let me start with the most common explanation for married couples that end up in this situation. That is that you have an oral HSV-1 infection and infected your wife through giving her oral sex in the week before this rash appeared. The next most common explanation is that you or your wife have a previosuly unknown genital HSV-2 infection. It is best that cheating is off the table for now as a result.

Whoa you might say! This doesn't match what has happened with the test results. Read on though as the test results may not be what they are purported to be. And that is what must happen now for clarity. It is best to check exactly what tests have been performed here - there are a few incorrect ones! This will tell us what are possibilities and what additional testing might help.

For your wife:

• I'd be curious as to whether she actually had a culture test performed on her swab and being taken from the genital location the lab assumes HSV-2. If it was a culture and not typed then it could be HSV-1.
• Hence exactly what was the test result your wife has on the swab? If it says something like PCR test and HSV-2 detected then that is definitive. However if it doesn't say this, then HSV-1 is possible.
• Did she have the IgG antibody test type specific for HSV-1 and HSV-2? If not then it is useful to get it immediately. For example, if she tests very strongly for HSV-2, IgG antibodies then that is pretty well proof that she has had the virus a long time and suffering a recurrence.

For you:

• Exactly what test for HSV did you have and what were the specific results?
• There is only one test of credibility - and that is for IgG antibodies type specific for HSV-1 and HSV-2 with individual numeric results.
• Other tests, such as PCR on blood or an IgM antibody test do not have credibility.
• Even if you have had a credible test, this does not preclude a childhood oral HSV-1 infection for which IgG antibodies are sometimes not detected any longer.

[confused231]

So before I ask my wife for more details about her testing I have a few questions and some clarity. 

What I know about her testing is that it was a swab of the "rash" on genitals.  It was done at her ob, she was prescribed valtrex after the swab by the ob before getting results back.  2 days later she had results, I don't know specifically what test other than a swab, or numbers, but she was positive for HSV-2, and not HSV-1. 

I also do not know if she had a blood test.  When she first told me she got tested/I should get tested, she said something like her doctor said a blood test won't show anything for a new infection or something along those lines, but not really sure if she meant for me or her.  So I don't know if she had one or not, but would a doctor not advise her to get one?  To be able to determine whether or not it is a new initial outbreak or a recurrence? 

If she didn't get a blood test already, and her rash was first noticed about a month ago, would getting a blood test now be able to show whether or not this was an initial outbreak?  Or is it too late for that?

More about my testing, it was a blood sample from by doctors office.  I explained to the doc the situation, that I've never had symptoms but had recent contact with someone with hsv-2 and I asked for a blood test that tests specifically for hsv-1 and hsv-2.  Blood was drawn about 2 weeks after I was first told by my wife about her rash.  It took 2 weeks for me to get the results back, and it was verbally over the phone, negative for hsv-1 and 2.  I don't have the specific numbers or test type.  I have to call them today to gain access to my portal, I will provide that info when I can.

On your last note, Is it possible a childhood oral HSV-1 infection (I don't believe I had this) can cause HSV-2 in somebody else?

 

[WilsoInAus]

Hi @confused231 thanks for the additional questions, let's see if we can get some more clarity.

If your wife had a culture swab then the HSV-2 may be an assumption. Culture swabs are not typed. They need a secondary test performed using drops of HSV-1 and HSV-2 antibodies (separately) to see which one reacts. If it was a PCR swab test then the result is definitive as to type. The point is if all you know is that a swab was taken, then without additional information you do not know the type until you get that facts.

The doctor is correct in that a blood test straight after infection will be negative. But that is rather the point here isn't it! If your wife happened to be positive when the rash occurred then this would be proof of a recurrence. I still feel it is worthwhile her testing now to add information.

It would be very useful to understand which test you had and what the results were. As I mentioned, there are tests that lack credibility.

HSV-1 and HSV-2 are distinct viruses defined by their DNA. Both viruses can be oral or genital. Although oral HSV-2 is quite rare, genital HSV-1 infections run at 30-50% of all new genital infections.