What Does a High HSV-2 IgG Level Indicate?
A high HSV-2 IgG antibody level indicates past exposure and ongoing lifelong latent infection with herpes simplex virus type 2, which persists indefinitely in the sacral ganglia and can reactivate to cause recurrent genital herpes outbreaks or asymptomatic viral shedding. 1, 2
Understanding the Test Result
The presence of HSV-2 IgG antibodies means you have been infected with HSV-2 at some point in your life, and the virus remains dormant in your nervous system permanently. 2 The antibodies develop within several weeks after initial infection and persist for life, regardless of whether you have symptoms. 1, 2
Key Clinical Implications:
The test cannot distinguish between recent and long-standing infections - whether you acquired HSV-2 recently or years ago, the IgG result will be positive. 1, 2
HSV-2 is primarily associated with genital herpes and is almost always acquired through sexual contact. 3
Most HSV-2 infections (80-90%) progress subclinically - you may have never had noticeable symptoms despite being infected. 3
You can transmit the virus to sexual partners even without visible lesions through asymptomatic viral shedding. 4
Important Caveats About "High" Levels
Test Accuracy Concerns:
If your index value is between 1.1-3.0, the result has only 39.8% specificity and should be confirmed with a second test using a different method. 2
Index values ≥3.0 have improved specificity of 78.6% but confirmatory testing may still be warranted. 2
False positives are more common if you also have HSV-1 infection, especially with lower index values. 1, 2
Western blot/immunoblot is the gold standard for confirmation but has limited availability. 1, 2
The "Window Period" Pitfall:
If you were potentially exposed within the past 12 weeks, a negative result may be falsely reassuring - antibodies may not have developed yet. 1
Repeat testing after 12 weeks from potential exposure if recent acquisition is suspected. 1
What This Means for Your Health
Natural History:
HSV-2 causes recurrent genital herpes with varying frequency - from once every few years to several times per month. 3
Recurrences result from viral reactivation from the sacral ganglia where the virus remains latent between episodes. 3
Each recurrence typically presents as vesicles that burst and form shallow ulcers, healing spontaneously within 10 days. 3
HSV-2 has higher rates of symptomatic recurrences and subclinical viral shedding compared to HSV-1 genital infections. 2, 4
Clinical Management:
You should receive counseling about transmission risk, asymptomatic shedding, and the lifelong nature of infection. 1, 4
Treatment options include episodic therapy for outbreaks or daily suppressive therapy to reduce recurrence frequency and transmission risk. 1, 2
Abstain from sexual activity when lesions are present, and use condoms during all sexual exposures to reduce (but not eliminate) transmission risk. 4