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Do I have herpes infection?

Q: Please explain this report. AntiHSV - IgM titre (HSV1 & 2): 1.55 A.I. POSITIVE. Interpretation less than A.I. 0.9 : Negative; A.I. 0.91 - 1.10 : Equivocal; Greater than A.I. 1.10: Positive. A positive result indicates there is a recent infection of the HSV2 serotype. Does it mean that I have herpes simplex virus (HSV) 1 and HSV 2 or just HSV 2? Is the herpes of the skin (body) different from HSV 2? I had blisters on my penis during my recent trip to the US and went to the doctor who prescribed Acyclovir 200 mg to treat them. I took a test, which came out positive. What are the ways of getting HSV 2 in absence of multiple sexual partners? If I kiss my son on his cheeks would he be prone to acquiring this virus from me? Does one instance of sex (unprotected) with my wife make her a 100% recipient of this virus?

A:Herpes simplex viruses (HSVs) are ubiquitous pathogens that cause a wide variety of illnesses. There are two types - type 1 (HSV-1) and type 2 (HSV-2). Both are closely related but differ in epidemiology. HSV-1 is transmitted chiefly by contact with infected saliva, whereas HSV-2 is transmitted sexually or from a mother's genital tract infection to her newborn. Herpes simplex infections are asymptomatic in as many as 80% of patients, but symptomatic infections may be characterised by significant illness and recurrence. These infections can cause life-threatening complications in immunocompromised hosts. HSV infection appears to have increased in prevalence worldwide in the last 2 decades, making it a major public health concern. The availability of effective chemotherapy underscores that the prompt recognition of the infection and early initiation of therapy are of utmost importance in the management of the disease. Blood tests are often used when a person has concerns about herpes, but does not have any visible symptoms. In the past, type-specific blood tests were not always accurate because they confused other herpes virus antibodies such as varicella zoster (chicken pox), Epstein Barr, or mononucleosis for herpes simplex (Types 1 and 2) antibodies. The presence of HSV-1 or HSV-2 IgM antibodies indicates an active or recent infection. HSV-1 or HSV-2 IgG antibodies indicate a previous infection. A significant increase in HSV IgG antibodies, measured by comparing acute and convalescent samples, indicates an active or recent infection. Negative HSV antibody results mean that it is unlikely that the patient has been exposed to HSV, or that the body has not had time to begin HSV antibody production. Antibody testing may also be used to screen certain populations, such as sexually active people, potential organ transplant recipients, and those with HIV/AIDS, for a previously contracted HSV infection. Because of serological cross-reactivity, HSV-1 and HSV-2 are not generally distinguishable unless a glycoprotein G antibody assay is available. Antibody titre increases generally do not occur during recurrences of HSV, which is in contradistinction to the situation in varicella-zoster virus recurrence. Therefore, the test generally is not used for the diagnosis of mucocutaneous HSV relapse. The Western Blot can also be done, and has long been the standard test for diagnosis; it was designed to test for antibodies, but is costly, time consuming and not available at most labs. HSV infection is best confirmed by isolation of virus in tissue culture (the standard criterion for diagnosis). A herpes culture or HSV DNA testing may be ordered when a patient has a blister or vesicle on their genitals or mouth. They may be ordered when a patient has encephalitis that the doctor suspects may be caused by a virus. HSV testing may be ordered regularly when a pregnant woman has herpes. A mother and newborn may be tested for HSV when a baby shows signs of HSV infection (such as meningitis or skin lesions). A positive herpes simplex culture or HSV DNA test from a vesicle scraping indicates an active HSV-1 or HSV-2 infection. Immunofluorescent staining of the tissue culture cells can quickly identify HSV and can distinguish between types 1 and 2. A negative test result indicates that the herpes simplex virus was not isolated but does not definitely rule out the presence of virus. This is because if the specimen taken does not contain actively replicating virus or if the sample was not transported under optimum conditions, no viable virus may be detectable, resulting in a false negative result. For example, viruses can be readily inactivated and if the sample was taken from an older lesion, not a fresh blister, or if transport of the sample was delayed, there may not be sufficient virus to detect even though the patient is infected. Rapid detection of HSV DNA in clinical specimens is now possible with polymerase chain reaction (PCR) techniques. In HSV encephalitis, PCR using cerebrospinal fluid (CSF) provides a rapid, noninvasive diagnostic technique that is as sensitive as brain biopsy. PCR has detected HSV-2 as the cause of recurrent meningitis and has shown a strong association of HSV-1 with Bells palsy. PCR can also detect asymptomatic viral shedding. To answer the specific questions: a) The ELISA test done probably cannot accurately differentiate between HSV 1 and HSV2, or the other herpes group of viruses. b) Yes, HSV1 is different from HSV2 though they are closely related. c) Rarely HSV1 can also cause genital infections. d) Your HSV status requires to be determined using a conjunction of clinical and lab tests. e) There are reports of discordance between husbands and wives status for HSV, and the impact of a single unprotected intercourse depends on a number of factors, including the test results, and the stage of the infection.


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