HERPES

If I’ve got Antibodies, I’ve got Herpes, right?

Dear Dr. Tom:

Your opinion, please. I recently was diagnosed (via a Western Blot Test) with HSV2. In other words, I have antibodies in my blood to the HSV2 virus. I have never had any symptoms of herpes-no outbreaks, blisters, anything, anywhere on my body. I have talked to four doctors since then two of whom have told me that if I don’t have outbreaks, it means I don’t really have herpes, and that I don’t need to tell future sex partners about it. I tend to disagree with that, if I’ve got antibodies, I’ve got herpes, right? Can herpes stay dormant? Thank you!

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Dr. Tom’s Response:

Dear Anonymous Who Is Sero-positive for HSV2:

The Western Blot procedure is a reliable serologic test. However, we know virtually no serologic procedure that is 100% specific or 100% sensitive. The most reliable indicator for herpetic infection would be actual isolation of HSV2, and if you have never had an outbreak, the likelihood of a suitable test sample such as blister fluid is nil. I agree: if you have antibody against HSV2 then the antigen (HSV2) must be present to have stimulated the antibody formation. Yes, HSV can remain dormant, but for how long does not seem clear. One study published more than 20 years ago suggested that 70% of HSV2 infections can remain asymptomatic. A high antibody level in the body would tend to help keep the virus from becoming clinically active. Some alternatives to think about: A virus isolation might be attempted from saliva, semen, or urethral swabbings on the premise that you might be an asymptomatic shedder; another serologic test might be performed, or the Western Blot procedure might be repeated. How much do you want to spend for an answer? Other than the presence of antibody, you have nothing to suggest that you might be infective to a sex partner, but I admire your position of caution toward the physicians who suggest you are not potentially infectious. I too disagree, because all the information isn?t in.

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