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18 yr old daughter was just diagnosed with HSV2

My 18yr daughter was diagnosed with HSV2 today, Doctor said her level is 1.8. HSV1 is negative. About 3 1/2 wks ago she had a pretty intense oral surgery for removal of wisdom teeth, had to be treated for dry sockets twice. She was on several medications, including antibiotics, pain medicine and ibuprofen. During this time she started to get oral ulcers, Dentist said it was common after a oral surgery. A few days later she was having problems with urinating, dryness and itching. She had a urine sample done and had a bladder infection. Then came vaginal ulcers. Back to the doctors again and they say it may be acute reactive aphthous ulcers which is common after a surgery and long doses of medication. Now after a blood test they say it's HSV2. We are both devasted. She says she has had oral sexual recently but is still a virgin and is adement about it. Both the doctor and myself believe her. Could it be possible this test came back a false positive even with having symptoms of herpes. It's all so confusing. I don't know if this is all from her surgery or she really has HSV2. I am 100% behind my daughter, I am not mad or angry. My heart is broken for her, she thinks no one will ever want her now and that she's damaged. Please some one help me with advice

Comments

  • First of all that is a low enough value that it very could easily be a false positive. Second HSV2 is not likely to transmit through oral sex. Maybe someone with more experience can chime in about that. She should get a western blot HSV test done, it is rather reliable. Did they culture (or even better run PCR) on a swab from her genital lesions?

    Lastly, please don't let the stigma of HSV break your heart and do anything you can to let your daughter know many people will love her with or without HSV. It really isn't a big deal. It's super common and rather innocuous.
  • He didn't swab the lesions because the outbreak happened fast and they are healing quickly. She's still in pain and it's hard for her to walk. Waiting on another test, if that's positive than we will move forward. I just hate seeing her in pain and so upset
  • Your daughter can be HSV2 positive and also be a virgin. If a man has rubbed his penis in her genital area it easily could have spread that way. I dont know very much about false positives on blood work, but I would say that would be more of a possibility if she didnt have vaginal ulcers. If she had vaginal ulcers, she more than likely has HSV2 in my opinion. The only way to know for sure would be to swab the sores or go back more blood work again. If the number has increased she is positive
  • edited January 13
    @scaredmom18

    This is why I think you should get a second opinion.

    https://www.statnews.com/2017/01/26/herpes-testing-false-positives/

    "A 2005 study published in the journal BioMed Central Infectious Disease found that index values above 3.5 yielded over 90 percent accuracy — but scores between 1.1 and 3.5 had around a 50 percent chance of being wrong.

    What’s more, scores falling just above the 1.1 cutoff had an almost 90 percent chance of being wrong."

    Considering your daughter's lab results of 1.8 she has, at best, a 50/50 chance of having HSV. You might as well flip a coin.
  • edited January 14
    Getting genital HSV2 from oral sex is so unlikely I personally would rule it out. As @annalove said, skin-to-skin genital contact (without intercourse) is a common way that HSV2 is transmitted. That’s why condoms will never offer full protection from transmission, because they only cover some skin. You could order another IgG test in a couple of months to see if there’s any change, or you could seek out the western blot test, which is far more sensitive (and acccurate). It’s only done at the University of Washington, so you either need to work with them to have blood drawn and sent there, or you can work with the Westover Heights Clinic (online) to have them order it for her.
  • edited January 14
    That is true. Since oral HSV2 is not common, and it much prefers the genitals to the mouth, it’s just less likely to have been the means by which this young girl acquired genital HSV2.
  • @Neb2006 @HikingGirl Also, on average, oral HSV1 sheds 25% of the time while oral HSV2 sheds 1% of the time, so likelihood of exposure is 25x greater on average with oral HSV1 than oral HSV2.
  • Your brain is like a giant repository of statistics, @optimist. I don’t know how you do it! :)
  • @HikingGirl Haha. It's an area of interest for me. Terri Warren started quoting new shedding stats a while back that differed from how they were presented in the Handbook and I wanted to understand why. I think it was in some cases related to newer research and in other cases just about how the numbers were presented (like an average versus a range). The current average shedding rates she quotes are as follows:

    - HSV1 oral, 25%
    - HSV1 genital, 5 %
    - HSV2 oral, 1%
    - HSV2 genital, 14% (10% asymptomatic, 20% symptomatic)

  • Wow. Those numbers are really interesting. When you look at these, it’s no wonder genital HSV1 is being diagnosed so frequently. Thanks for sharing!
  • edited January 15
    Just want to say I caught it at 19 now 44 and my dating and sex life has been great/normal and hers will be too! :) She is not damaged, while it will take her time to see this, tell here we are here and living a great life just like a non H person.
  • So my daughters first blood test came back within 24 hrs positive and after 8 days her PCR blood test came back negative. Now we've had 2 different results and don't know which one to go by.
  • edited January 21
    Have your daughter request copies of her lab work so you can look at the results with your own eyes to confirm exactly which tests were done and what the index values were. I’ve only heard PCR referred to as a type of swab test, but I’m no medical professional either. The most common blood tests are the IgM (older and notoriously inaccurate) and the IgG (pretty accurate with HSV2 but produces a lot of false negatives with HSV1).

    Here’s what you’re looking for: If she had a PCR swab test done and it was positive, that test is definitive and it will also tell her the type.

    If she had an IgM blood test done, ignore those results entirely and ask for an IgG.

    If she had an IgG and the index value for each type was below 0.9, she does not have herpes. If it was between 0.9 and 1.1, that’s a gray area and would warrant another test in a few months.

    Index values above 1.1 are often diagnosed as positive, but as others have mentioned, there are a fair number of false positives for index values between 1.1 and 3.5. If your daughter’s IgG index value was between 1.1 and 3.5, there are two possibilities. First, it could be a false positive and you’d need to have the western blot test done to know for sure (it’s a more sensitive blood test only done at the University of Washington—you don’t have to go there, you’d just need to send a blood sample there. My IgG index value for HSV2 was 3.27 and the western blot confirmed I do have HSV2. Others have had similar experiences and found out they really did not have HSV.). The second possibility is that it’s a new infection and her body hasn’t produced enough antibodies yet to test positive on a blood test. If that’s the case, you could retest at 16 weeks post-exposure and see if the numbers change.
  • The above treatment and management of your daughter is incorrect. PCR on a blood test is worthless; herpes is not present in the blood stream. Your doctor should not have ordered the test as it is a waste of money. PCR can be ordered on bleeding lesions, but not from the blood. A low positive IgG HSV-2 (or for that matter, even a high positive IgG is not conclusive that herpes is causing the sores as you mentioned that acute reactive apthous ulcers are quite common after treatment). A swab of the lesion would have had to been taken.

    You need to have a western blot performed 12-16 weeks after her last sexual activity (oral, anal, vaginal) for a definitive diagnosis. The IgG test should not be positive in an initial outbreak. If she has HSV-2 she has likely had it for a while and the procedure lowered her immune response. However, HSV-2 from oral sex is extremely rare.

    As of now, it is unknown, whether your daughter has HSV-2 or not. Given her history of only oral sex, it is likely she does not have HSV-2 and this was reactive apthous ulcers after a procedure with a false positive HSV-2. She will need a western blot to determination the final diagnosis.
  • @hikinggirl: The likely reason in the uptick of GHSV-1 is the decreasing prevalence of oral HSV-1 in the young adolesent population and the decreased courtship seen today. If an individual that is negative for HSV-1/2 is dating a individual positive for HSV-1 orally and they wait for a few weeks or months before engaging in oral sex, the HSV-1 negative individual would have likely aquired HSV-1 orally with the production of antibodies to prevent genital infection .
  • That makes a lot of sense, @Jack101. Any thoughts on why the prevalence of oral HSV1 among younger individuals is going down?
  • edited January 31
    The prevalence of oral HSV-1 is not decreasing uniformly. This decrease is predominately seen in the developed countries with differences associated with ethic groups and socioeconomic status. The decrease is attributed to an increase in sanitation and changing childcare habits.

    For example, my caretakers would often feed me adult food before I was of age to chew the food. As such, they would often soften the food in there mouths before transferring it to me. In addition, multiple children were often fed with utensils directly from our caretakers.

    I then would be placed with other children. As you know, children are constantly putting things in their mouths and sharing with each other (i.e. all the children would be affected and then go on to pass it to other children they interact with). As such, the vast majority of children affected are probably not infected by adults, but by other children sharing items covered by saliva.

    As you can see, all that needs to be broken in the above chain are caretakers not sharing food that has touched their mouths or keeping children isolated from other children. This explains the ethnic distribution and socioeconomic factors involved.

    Unfortunately, this illustrates a byproduct of our society. While decreasing childhood HSV-1, we leave our children open to genital HSV-1 in adulthood and the prevalence of HSV-1 will likely remain the same in older adults.

    As a medical professional, the irony is not missed on me concerning the stigma of genital HSV-1 or HSV-2. I understand the general public is concerned about herpes, but as 70-90% of population has some form of herpes (HSV1/2) i feel that the stigma could be dispelled if herpes was included as part of the standard STD panel (and all the carriers of HSV-1/2 were revealed) and I am currently advocating for this.

    In fact, those negative for HSV1/2 would be in the minority and have such a limited dating pool, they likely would have no problems being infected ( at least orally to minimize symptoms) to join the majority of the population.

  • I thought transferring HSV through utensils was a myth? I thought HSV is not present in body fluids like saliva but requires actual skin to skin contact for transmission to occur. Is that not right? Always a learning process for me.
  • edited January 31
    @username. You are correct. HSV is not a normal secreted component of saliva in individuals infected with HSV; however, if you have a sore in the mouth or lip or the virus is shedding from a mucosal lining saliva can carry HSV virus.

    You are also correct that sharing utensils with adults is generally a minimal risk for HSV infection as HSV can not usually survive outside the body greater than 10 seconds in low saliva environments.

    However, in general, the sharing of utensils which young children and with masticated food are hardly low saliva environments. Would you really eat after a friend if they produced a utensil covered in drool or partially chewed food? Would you brush your teeth with a toothbrush from a friend with a HSV blister after they just finished brushing?

    Children also are infected by skin to skin contact as well.

    The virus is highly contagious, as in some African countries the prevalence of HSV-1 nears 100% and in developed countries is around 70% in adults.

    Studies documenting transmission risks of HSV-1 are also difficult to determine. This is due to the fact that the majority of oral HSV-1 infections are asymptomatic, the virus is widespread, and the most popular IgG test for HSV-1 misses approximately 30% of positives. So it is difficult to say if a person is truly HSV-1 negative, unless they take a western blot test. Even this test cannot be truly validated with asymptomatic individuals, as it is looking for antibodies, not the virus. If someone were to make a variant antibody to HSV-1 the test may show negativity, even if the person is infected. Conversely, if a new antibody similar to HSV-1 were to develop this could create the potential for false positives. This appears to be the case with the current Herpes Select test, as there has been a recent uptick in high false positives (greater than 3.5) for HSV-2. This is less of a problem with the western blot test as several antigens on the antibody are examined. This is the drawback of using an antibody test to evaluate the disease. Daily oral/genital swabs over months would be more accurate to detect shedding, but impractical on a population based scale.

    In addition, many individuals only think you have oral herpes if you have cold sores and don't remember they can be asymptomatic carriers and even those who have taken the IgG test and are negative may actually be truly positive.

  • optimist said:

    @HikingGirl Haha. It's an area of interest for me. Terri Warren started quoting new shedding stats a while back that differed from how they were presented in the Handbook and I wanted to understand why. I think it was in some cases related to newer research and in other cases just about how the numbers were presented (like an average versus a range). The current average shedding rates she quotes are as follows:

    - HSV1 oral, 25%
    - HSV1 genital, 5 %
    - HSV2 oral, 1%
    - HSV2 genital, 14% (10% asymptomatic, 20% symptomatic)

    Hey any source from this? Are you sure those are new stats for HSV2 though? I mean 10% asymptomatic and 20% symptomatic sounds like the older stats. 25% HSV1 oral and HSV1 genital being 5% might be new though.
    Anyway, would be great to see a link to this, cant find it googling.
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