From the Guidelines
A positive HSV-1 test with elevated antibodies in a patient without symptoms indicates a past infection with the herpes simplex virus type 1, even though the person has never experienced visible outbreaks. This is actually quite common, as many HSV-1 infections are asymptomatic, as noted in the guidelines for laboratory diagnosis of genital herpes 1. The elevated antibodies are the immune system's response to the virus, which remains dormant in nerve cells after initial infection. According to the 2022 review of the evidence for the Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines, type-specific HSV serologic assays can differentiate between HSV-1 and HSV-2 infection, providing patients with information regarding the expected natural history of genital herpes 1.
Some key points to consider when explaining this to a patient include:
- The patient can potentially transmit the virus to others, particularly during periods of viral shedding, which can occur even in the absence of symptoms 1.
- The transmission risk is higher during intimate contact like kissing or oral sex.
- While many people with HSV-1 never develop symptoms, some may experience outbreaks later in life triggered by factors such as stress, illness, sun exposure, or hormonal changes.
- No treatment is necessary for asymptomatic HSV-1 infection, as antiviral medications like acyclovir, valacyclovir, or famciclovir are typically only prescribed for active outbreaks or for suppressive therapy in those with frequent recurrences.
It's essential to note that the sensitivity and specificity of HSV serologic tests can vary, and false-negative or false-positive results can occur, as discussed in the 2022 review 1. However, the presence of elevated antibodies in a patient without symptoms is a clear indication of a past HSV-1 infection, and this information can be used to inform patients about their risk of transmission and the potential for future outbreaks.
From the Research
Understanding Positive Herpes Simplex 1 (HSV-1) Test Results
A positive Herpes Simplex 1 (HSV-1) test with elevated antibodies indicates that the patient has been infected with the HSV-1 virus at some point in their life. This infection can occur even if the patient has never experienced a cold sore or herpes outbreak.
What Do Elevated Antibodies Mean?
- Elevated antibodies against HSV-1 suggest that the patient's immune system has responded to the virus, producing antibodies to fight the infection 2.
- The presence of these antibodies does not necessarily mean that the patient is currently infected or will experience symptoms, but rather that they have been exposed to the virus in the past.
Asymptomatic Infection
- It is possible for individuals to be infected with HSV-1 without ever showing symptoms, a condition known as asymptomatic infection 3, 4.
- In such cases, the virus may still be present in the body, and the individual may still be able to transmit the virus to others, even if they do not exhibit any symptoms themselves.
Diagnosis and Testing
- The diagnosis of HSV-1 infection is typically made through laboratory tests, such as blood tests that detect the presence of antibodies against the virus 5, 6.
- These tests can help determine whether an individual has been infected with HSV-1, but they may not always be able to distinguish between current and past infections.
Implications for Patients
- Patients with positive HSV-1 test results and elevated antibodies should be aware that they may still be able to transmit the virus to others, even if they do not experience symptoms themselves.
- It is essential for patients to discuss their test results with their healthcare provider to understand the implications of their diagnosis and to determine the best course of action for their individual situation.