Hi, I was recently diagnosed with genital herpes. I’m in

(20)

Hi,
I was recently diagnosed with genital herpes. I’m in a long term relationship, and this journey after being diagnosed has been tough on both of us. He has tested negative and believes I have cheated on him. I have been faithful the entire relationship, and contacted my exes and they have tested negative as well. I feel really stuck, lost, and misunderstood. I’m unsure on how to navigate this situation. I would appreciate any support or advice that anyone has to share.

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a_survivor's picture
(79295)
Nov 22

@Mo22
here is a little reading about testing properly:
The test you want your clinician to order when screening blood for HSV antibodies is the:
******* HSV Type-Specific IgG Antibody ******* blood test.

Antibodies = the immune system's response to the presence of HSV (or any foreign organism) in the body. You won't have antibodies to HSV if there is no HSV in your body. Antibodies are in your blood; the actual virus is NOT.
Viral DNA = the actual virus which can be found at the location of an outbreak lesion. The virus lives in the nerves at the base of the skull or the base of the spine, NOT in bodily fluids like blood, saliva, semen or vaginal fluids.

Common Test Types:
IgM (blood) – measures the "initial" antibodies found in the blood just after acquiring the HSV. Positive results may also reflect infection of chickenpox, mono or other human herpesviruses besides HSV, so this test is not recommended as a confirmed diagnosis without other testing to confirm.
IgG type-specific (blood) - measures the "long term" antibodies found in the blood, most commonly 4-6 MONTHS AFTER ACQUIRING HSV. ****False negatives results are common if tested less than 4 months after acquiring the virus****, as there has not been time for the body to recognize the virus and produce sufficient antibodies. If you want to know if it is type 1 or 2, then you MUST ASK for the type-specific test.

PCR (swab) - the test that identifies the actual DNA of the HSV. This test is commonly referred to as a culture swab of an outbreak lesion. The most reliable "positive" result for HSV. A false negative is possible if you wait too long to swab the lesion after it first appears.
PCR (blood) – tests for the virus in the bloodstream which is a rare and serious occurrence. Healthcare providers may accidentally order this test. It is the WRONG TEST to screen for HSV and will give a misleading negative result.

Understanding Blood Tests:
The IgG type-specific test is the more accurate blood test for an HSV diagnosis. The IgG antibodies are the body's more specific immune response after acquiring HSV. They are the immune system's long term sparring partner and show up to "greet" the virus after the IgM antibodies have dissipated. IgG type-specific tests for antibodies in the blood. There should be a minimum 4-6 month wait from the initial exposure of HSV before you can rely on an accurate test result. This test looks for the "long term" antibodies the immune system creates to deal with HSV. Early testing can result in false negative results.

The IgM test will show up positive shortly after acquiring HSV. These are the body's "meet-er" antibodies. The problem is they may "meet" other viruses in the herpes family (chickenpox; EBV, which can cause mono; shingles, etc.) and those can also trigger a false positive result for HSV. The presence of IgM antibodies will diminish after the initial acquisition of HSV. A negative result can occur if the person has had HSV for a long time or is tested immediately after exposure (it takes at least a few days for IgM to show up). If the person has had HSV for a long time, an IgM antibody test will typically result negative as IgM antibodies have subsided and the IgG antibodies more specific to HSV are being made by the immune system. It produces unreliable results and should be followed up in 4-6 months with an IgG antibody blood test for a definitive diagnosis.

Do NOT accept an order for a PCR blood test for routine screening. Unless you are very sick with viremia (the virus IN the bloodstream), this test will come back NEGATIVE.
===>> Western Blot is a specialized IgG test done ONLY through the University of Washington Virology Department in Seattle, WA. To order the test, you must contact their lab.

Understanding Culture Swabs
Culture swab PCR detects the VIRUS found at the site of the outbreak so should be done only in the presence of an outbreak.
If the lesion is old and has started to crust over, there may not be enough viral DNA to trigger a positive test result.
A positive culture swab is the MOST DEFINITIVE positive HSV test result, as it detects the presence of the actual virus. On the flip side, waiting even one day too long can result in a negative test result, even though the person has HSV and an active herpes outbreak. Unlike with an IgG blood test, there is no waiting period when testing a lesion for an accurate result.

Ideally, have your partner tested BEFORE you knowingly expose him/her to the virus through oral, vaginal or anal contact. If that didn't happen, the next best thing is to have them get an IgG type-specific blood test as soon as possible (within a week) after contact. If they have an outbreak, have them get the IgG blood test and a PCR swab. A positive swab along with a negative IgG would indicate a new infection.

In the absence of an outbreak, if they test positive on an IgG type-specific test, this indicates that they had HSV prior to sexual contact with you. If the IgG test is negative, a follow-up test 4-6 months after initial exposure is necessary to confirm the person indeed did or did not acquire HSV at the suspect time.
Should a relationship with a confirmed non-H person not work out, they should get the IgG type-specific blood test 16 weeks out of the relationship to recheck their status. Even though they may not have had an outbreak, it does not mean they did not contract HSV from you. Only about 20% (1 in 5) of people with HSV have any recognizable symptoms. The other 80% have no clue they have HSV because they don’t get symptoms
FINALLY....
It is possible to be IgM negative, IgG negative and PCR negative, and still have HSV - with or without symptoms. Knowing the testing dynamics and timelines is important in understanding when follow-up testing is a good idea.

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(20)
Nov 23

I really appreciate your response! Thank you for all of this information. This is definitely helpful and I’m going to look into these tests.

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a_survivor's picture
(79295)
Nov 23
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