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How Is HSV2 Transmitted?

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Posted on Thu, 28 Aug 2014
Question: Dear doctor XXXXXXX
Reference to our old conversation regarding HSV linked :
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=106439

I would like to continue :
- After 60 days :
No symptoms
HSV-2 IgM = Negative / HSV-2 IgG = Negative
- After 90 days :
No symptoms
HSV-2 IgG = Negative
- After 105 days :
No symptoms
HSV-2 IgG = Negative

Can we say that man HSV-2 free ? or he has to test more ?
Is it possible for man to get HSV-2 from being sucked ?
Is it possible for man to conttract new infection of HSV-2 and not facing any symptoms at least for first time ?

Thanks in advance






doctor
Answered by Dr. Sanjay Kumar Kanodia (10 hours later)
Brief Answer:
Your friend is completely free from HSV2

Detailed Answer:
Hello young fellow,

Welcome again to the forum and thanks for your follow up regarding HSV2.

Let me first reassure you that your friend is completely free from HSV2. There is no further necessity of testing.

Though one can get HSV 2 by oral sex but your friend is not the one to get it. In herpes or any other viral infections, IgM appears within 2 weeks and IgG can appear in 6 weeks which may be persistently present life long.

In your friend the negative test results at 60 days is more than enough to designate negative status.

So just relax about your friend and ask him to relax too as he is completely free from the infection.

I hope this information will help you. I will be glad to guide you any further.

With best regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (17 hours later)
Dear doctor,
- I informed by yourself that after 4 weeks if no symptoms, we should forget HSV-2. Is it possible for man to contract the virus and not showing any symptoms with considering that on 105 days he is non-reactive for IgG.
- Can we consider non-reactive test for ( HBs.AG ) & (HCV AB ) on 90 days conclusive to rule out both HBV & HCV with considering that PCR test foe both on 3 weeks was negative also.
- Prednisone course for 16 days started after 36 days of the proposed infection ( 4 days : 20 mg + 4 days : 15 mg + 4 days : 10 mg + 4 days: 5 mg )
As you note this course limited in time and quantity, so is it possible that affect anti-bodies production then affect the conclusively of virus tests ( HIV, HCV )for anti-bodies done on 90 days.
doctor
Answered by Dr. Sanjay Kumar Kanodia (1 hour later)
Brief Answer:
Your friend is completely free of any of STDs

Detailed Answer:
Hello young fellow,

Welcome again to the forum and thanks for your follow up. I can understand the concern for various issues related to sexually transmitted infections. Let me guide you for all the points of concern:

Q. I informed by you that after 4 weeks if no symptoms, we should forget HSV-2. Is it possible for man to contract the virus and not showing any symptoms with considering that on 105 days he is non-reactive for IgG.

@ I already guided you that in my clinical experience (practically) as well as theoretically speaking if a person is infected then the symptoms generally comes within 2 weeks and maximum of 4 weeks. So I take 4 weeks as simple practical or clinical reference point for herpes infection. If a person is suspecting of herpes then 4 weeks is enough of time when the clinical symptoms and therefore the antibodies must show up in blood.

It is possible to contract the virus in many a person and not show any infection. In these cases we consider that the immunity is so good in the sense that the virus is not able to produce the clinical manifestations. So it is a very much positive side to have virus but not show symptoms at 105 dyas. It’s a good thing if in your mind that the virus might be present- so be positive in this aspect too!!!



Q. Can we consider non-reactive test for ( HBs.AG ) & (HCV AB ) on 90 days conclusive to rule out both HBV & HCV with considering that PCR test foe both on 3 weeks was negative also.

@ Great news with PCR my dear buddy. For PCR 3 weeks is more than enough to declare clear status. For antibody test in the same we take it around 60 days. But PCR is latest and most advanced test which detects the virus itself so non-detectability at 3 weeks is more than enough !!!


Q. Prednisone course for 16 days started after 36 days of the proposed infection ( 4 days : 20 mg + 4 days : 15 mg + 4 days : 10 mg + 4 days: 5 mg )
As you note this course limited in time and quantity, so is it possible that affect anti-bodies production then affect the conclusively of virus tests ( HIV, HCV )for anti-bodies done on 90 days.

@ For the above concern let me guide you that it is not having any effect on the virus detection. So there is no effect on PCR results by steroid therapy. For antibodies- there are two type of test- one is qualitative (which detects the presence or absence) and the other is quantitative (which detects the titer). Course of steroid may have effect on the level of antibody production (titers) but not on positive or negative status of the test.

So considering all these facts I firmly declare that provided your friend have not had any other exposure, presently is completely free from any of sexually transmitted infections.

My all best wishes for you and your friend.

I hope this information will help you. I will be glad to guide you any further.

With best regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (20 hours later)
Dear doctor,
Sorry for repeat same question, but still not understand so please simple the answer for me :
- HSV-2 no symptoms + ( non-reactive IgG test on 105 day ) + ( 16 Days of Prednisone course ) = possible infection and more test required ? or = Free from viruse infection .

- What the meaning of test : HEPATITIS B SURFACE ANTIGEN QUALITATIVE (HBS AG QUALI) = 0.1 s/co ( Viruse there or not ) ? what the reference of this type of tests ?

- PCR for both B & C final and comclusive at 3 weeks ?
doctor
Answered by Dr. Sanjay Kumar Kanodia (9 hours later)
Brief Answer:
There is no need to go for any further tests

Detailed Answer:
Hello young fellow,

Welcome again to the forum and thanks for your follow up. Let em again reassure you that your friend is completely free of the infections.

Regarding your further queries:


Q. HSV-2 no symptoms + (non-reactive IgG test on 105 day ) + ( 16 Days of Prednisone course ) =

@ There is no need to go for any further tests and your friend is free from HSV-2 virus infection. As I said the time period is more than enough to declare the negative status. A course of 16 days of Prednisone has no effect on test values.


Q. For the query regarding Hepatitis B& C: PCR is conclusive at 3 weeks and no further tests required for the same.

For the HEPATITIS B SURFACE ANTIGEN QUALITATIVE (HBS AG QUALI) = 0.1 s/co and its reference value - As there are different kits used in different tests so interpretation is also according to the test kits. Therefore kindly upload the reports HEPATITIS B SURFACE ANTIGEN QUALITATIVE test so that I can see it and give its interpretation.

I hope this information will help you. I will be glad to guide you any further.

With best regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (15 hours later)
Dear Doctor,
One more question regarding HIV
My friend performed HIV1&2 combo test at 90 days and 105 days = non-reactive
in addition to HIV1 RNA PCR on 118 days = no indication for HIV1

Can we consider those tests conclusive ?
As you know PCR is the best type of tests, but only following HIV1, So is the combo test above conclusive for HIV2 with considration same course of Prednison if will affect ?
Is HIV2 rare ?
doctor
Answered by Dr. Sanjay Kumar Kanodia (5 hours later)
Brief Answer:
Your friend is completely free from HIV infection

Detailed Answer:
Hello young fellow,

Welcome again to the forum and thanks your follow up.

Regarding your further query: Let you know first that your friend is completely free from HIV infection.

Let me simplify the things and give you medical and scientific facts behind my firm declaration- Let you know about HIV infection:

In an unprotected intercourse with a HIV positive person the HIV viruses gets entered into the body and divides in innumerous numbers(millions of viruses per ml).

After a period of 2-6 week there is mounting of antibodies against the viruses. These antibodies can take at the maximum of 8-10 weeks of the period to get expressed.

There fore the infection can be analyzed by two ways -

-A): By HIV virus detection: done by RNA- PCR. It tells us the number of copies of virus present in per ml of blood. By this latest of method the viruses can be detected within 2 weeks of period.

B): By HIV antibody Detection: The antibodies appear within minimum of 4-6 weeks to maximum of 8-10 weeks then these antibodies to HIV virus persist throughout life.

The protocol of the antibody tests done for HIV is as follows: One HIV antibody test at 6-8 weeks and then a follow up final test at 3 months (84 days or 12 weeks).

Antibodies once formed to HIV can never disappear. So if a person has HIV infection, 3 months of period is the time when we say to be fully sure of whether HIV is present or not. Now correlating all the facts and interpreting with your situation:

So we consider HIV 1 & 2 combo test after 84 days (or 12 weeks) as most definite and conclusive. So at 90 days or 105 days the test doesn't need any further clarification or testing. It is more than enough for declaring clear negative status.

For HIV1 RNA PCR on 118 days: There was no need of performing the test. Even then we can see that the test is negative with no indication of HIV1. Beyond 15 days PCR gives a clear indication for presence or absence of HIV.

There is no effect of Prednisone on any of these tests. So there is no issue for steroids in your friend's case.

For HIV 2: It is very rare to find HIV2. Mainly we see cases of HIV1 only. Even in my own clinical practice I have few often observed cases of HIV2. But even then for the best of test profile both HIV1 and 2 are tested. You can see in your friend's case too both HIV1 and 2 are non reactive (negative).

I hope you got the knowledge more than my medical students have got ever!!!

Enjoy the weekend and cheers to healthy life of both you and your friend!!!

I hope this information will help you. I will be glad to guide you any further.

With best regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (22 hours later)
Dear Doctor,
We received the negative report of HIV-RNA PCR with a note that due to 0.7 ml plasma sample, we will have a loss of sensitivity which the recommended volume is 1 ml. ( The lab does not know how many days after exposure the test was requsted )
Kindly correct me if I am wrong :
The sensitivity mean that test has ability to discover the minimum copies of viruse in 1 ml plasma sampl, accordingly the test will be applicable on 14 days period which the viruse replication almost start.
The viruse replication after ( 118 ) should be in millions, so the test can found the viruse even in 0.7 ml plasma sample.
Please let me know the FACTS even if not good.
Thanks a lot from all my heart.
doctor
Answered by Dr. Sanjay Kumar Kanodia (3 hours later)
Brief Answer:
Great understand of facts- good knowledge!!!

Detailed Answer:
Dear young buddy,

Welcome again to the forum and thanks for your further follow up.

You are perfectly correct in your interpretation and I do agree with you for the same. I do appreciate your knowledge and thanks to you that because of this you will understand the facts properly.

RNA PCR test in general requires 1 ml blood. All the test reports interprets reports according to the same. You must have seen various reports or atleast any of the report and it tell the number of viral copies per ml of blood- This is per ml of blood means 1 ml of blood.

So if the amount of blood is less than that of 1 ml then accordingly the number of copies (if the person is HIV positive) would also be less and therefore less sensitivity.

As you gave 0.7 ml of blood so the number of copies according to lab would be less and therefore less sensitivity if the person is positive.

Therefore neither the lab is wrong in its reporting nor you are wrong in your interpretation.

But overall to say if a person is positive then even 0.1 ml of blood contains millions of copies or so many of copies which are easily detectable.

So not the good...... but the best news is that your friend is clear and HIV negative.

I really appreciate your caring nature. I hope I was able to clear all your doubts.

"May God bless you"

My all good wishes to you.

With regards,

Dr Sanjay Kumar Kanodia
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (1 hour later)
Dear doctor, please consider this submittal is the last one for current subject with highly appriciation for your humane support.

Did you mean in last answer :

But overall to say if a person is positive then after (( 118 days )) even (( 0.7 ))ml of blood contains millions of copies or so many of copies which are easily detectable.

May God bless you

Thanks a lot, Your family should be proud with you as great human.
doctor
Answered by Dr. Sanjay Kumar Kanodia (10 hours later)
Brief Answer:
Completely negative status and a healthy body.

Detailed Answer:
Hello young fellow,

Good morning from XXXXXXX May this rising sun bring all the good thing & shine in your life.
You got it completely right that even 0.7 ml of blood is sufficient to detect HIV viruses. These are so numerous within few months (118 days) of infection that even a least of 0.1 ml of blood would also show millions copies of viruses.

So if we assume that your friend had positive status (which is actually not) then even 0.7 ml of blood would have shown so many copies.......that had actually shown within few days!!!

So at 118 days if it shows no copies then it means completely negative status and a healthy body.

So give this good news to your friend and explain the complete logical and medical facts.

I also suggest to have safer sex by use protection in form of condoms for any kind of sexual act which is the best method of prevention of all types of STDs.

I hope this information will relax you and your friend completely. I will be glad to guide you any further or if not then can close the discussion.

"My all best wishes for your family"

With best regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology & Sexually transmitted diseases
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sanjay Kumar Kanodia

Dermatologist

Practicing since :2002

Answered : 4165 Questions

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How Is HSV2 Transmitted?

Brief Answer: Your friend is completely free from HSV2 Detailed Answer: Hello young fellow, Welcome again to the forum and thanks for your follow up regarding HSV2. Let me first reassure you that your friend is completely free from HSV2. There is no further necessity of testing. Though one can get HSV 2 by oral sex but your friend is not the one to get it. In herpes or any other viral infections, IgM appears within 2 weeks and IgG can appear in 6 weeks which may be persistently present life long. In your friend the negative test results at 60 days is more than enough to designate negative status. So just relax about your friend and ask him to relax too as he is completely free from the infection. I hope this information will help you. I will be glad to guide you any further. With best regards, Dr Sanjay Kumar Kanodia MD- Dermatology & Sexually transmitted diseases