Herpes antibodies = infection always??

General Questions
#1

Howdo.

I’ve been doing some reading on herpes, here and on other sites.

Here’s my question: If the blood test for herpes confirms you have antibodies to HSV-2, does that always mean that you have been infected and can pass the virus on to others?

Or, could you have been exposed, but not become a carrier?

#2

Herpes is forever. Once infected, the viral genome lives in the body for good, usually in one of the nerve roots. Under times of stress, and for other poorly understood reasons, the viral genome gets activated and causes an outbreak of herpetic lesions.

The only time you can pass on the infection however, is when you have an outbreak, ie right around the time the sores appear.

Whether one has outbreaks monthly or next to never is very individual and not well understood.

Check out this link for more info
http://familydoctor.org/healthfacts/091/index.html

QtM, MD

#3

If you carry the virus you can infect others if you pass it on but this requires an outbreak. In other words, if you have the virus but it is contained then you would not infect others but if you are suffering an outbreak then you could transmit the virus.

#4

Qag, this is a commonly held misconception. The truth about HSV is that most transmission occurs between outbreaks or during subclinical outbreaks when individuals shed virus but believe they needn’t take precautions. Chronic acyclovir supression reduces viral shedding in infected, asymptomatic individuals

See Below:

#5

I am reading the OP a little differently. I’m understanding the question as “Does a positive antibody test = EXPOSURE or INFECTION, and if EXPOSURE, do you have herpes and therefore can transmit it?”

I was told by my doctor years ago that I was positive for herpes-1 antibodies, “Like everyone else,” as he put it, but he stated that since I’d never had any evidence of infection I was probably exposed but not infected.

Someone I’m close to recently was infected with herpes-2. She had a new sexual partner and had had a previous negative herpes antibody test in the recent past. In fact, even with the outbreak, she was still testing negative, causing her doctor to say “Come back for another antibody test that will be positive in about 6 weeks.” This seems like pretty good reason for her gentleman friend to be tested. However, several doctors and the state board of health refused to test him if he wasn’t having an outbreak, even when his girlfriend called the state to explain the situation. This blows me away.

#6

I am reading the OP a little differently. I’m understanding the question as “Does a positive antibody test = EXPOSURE or INFECTION, and if EXPOSURE, do you have herpes and therefore can transmit it?”

I was told by my doctor years ago that I was positive for herpes-1 antibodies, “Like everyone else,” as he put it, but he stated that since I’d never had any evidence of infection I was probably exposed but not infected.

Someone I’m close to recently was infected with herpes-2. She had a new sexual partner and had had a previous negative herpes antibody test in the recent past. In fact, even with the outbreak, she was still testing negative, causing her doctor to say “Come back for another antibody test that will be positive in about 6 weeks.” This seems like pretty good reason for her gentleman friend to be tested. However, several doctors and the state board of health refused to test him if he wasn’t having an outbreak, even when his girlfriend called the state to explain the situation. This blows me away.

#7

Shoshana:

Yes, you are reading the OP correctly. And that really is my question. Is it true that just because you’ve been exposed to the virus - and thus have produced its antibody - that you are infected and can transmit it to others?

#8

Good point, choosybeggar. I do put a few patients on chronic viral suppression for that reason alone. Even more problematic is that even for symptomatic people, viral shedding reaches its peak just before lesions appear.

That’s why weekly viral cultures in pregnant women near term may be needed.

Thanks.

QtM

#9

QtM:

If you are asymptomatic, then would you advise using daily antivirals?

#10

Nope. Not in ordinary circumstances.

#11

Thanks, QtM. It seems like the case I know of is going to be very tricky, because the carrier has never had any symptoms, and only went in for the blood test after his partner showed up with symptoms.

So, no idea where on the skin the virus may be shedding from, nor when. Not ever having sex again in an attempt to not transmit the virus is not really an option… let’s be realistic here. But at the same time, how does he protect his partner when there are not indications of when he’s prodromal or shedding??