Herpes Testing Confusion

[gdherpesconfusion]

Male in late 30’s. Was in long term relationship, 10 years. Broke up couple of times. Had sexual encounter Feb 2011, no symptoms or lesions, tested for HSV at 13 weeks igg HSV 1/2 low negative, HSV 2 was .20. Back together with GF 3 months later. Broke up again 12 months ago. protected vaginal sexual encounter with 21 Y/O female 21 days ago, but condom broke. Not sure how long. Did full 8 panel STD test 8 days past encounter. Mainly for chly/Gon. All tests negative except for HSV 2 which was igg 2.6. HSV 1 negative. Could this possibly be from this encounter? Now 21 days post encounter no lesions or other herpes symptoms. Only issues, diarrhea, and tingling around penis and scrotum and sensitive meatus. These come and go based on how focused and worried I am. Checked multiple times a day. No bumps of any kind or soreness. No other pain, no fever, no swollen lymph nodes. Is it possible to have 2.6 at 8 days? With no symptoms or lesions? Would another igg test mean anything now? Would I expect numbers to change? Is this a false positive? If something in my body is causing false positive would it be gone 2 weeks later? I am fairly certain long term girlfriend was did not have any STD’s. Want to order a WB now to verify results, I know would have to do it again. But from everything I have read, does not seem possible to seroconvert that fast, especially with no symptoms or lesions. Read on medhelp where Terri had seen one case at 10 days with very low positive and significant symptoms. Please help, need to understand what is going on. Have always been very vigilant about paying attention to my body. Never had any outbreaks, lesions of any kind, rashes or infections in genital area. Thank you!

[Terri Warren]

So the 2.6 IgG index value is in what we call the low positive range. In this range, half of the positives are false positives, so your test definitely needs confirmation. I seriously doubt that if you have new herpes that you acquired it eight days before testing. I just think the value is too high.
Having said that, you waited 13 weeks for your antibody test the first time and it’s possible, if the 2.6 is a true positive, that you were in the process of serconverting then and just didn’t wait quite long enough for a final test.

In the end, I think you are going to need to get a western blot antibody test from the University of WAshington because I suspect if you do the ELIsA again, it will be in approximately in the same range. But you sure can try it again. If you do the western blot, you should wait 16 weeks from the encounter to do it.

Is that helpful

Terri

[gdherpesconfusion]

Thank you Terri, that is helpful and what I thought regarding too high at 8 days especially with no outbreak and being a primary outbreak. I know that some people at asymptomatic, but I am vigilant about checking and I was during the prior period back in 2011. From the information I read on medhelp, to have a single encounter, have NO symptoms or lesions and test low negative at 13 weeks seems statistically almost impossible to have gotten it from that encounter. And to have no symptoms or outbreaks of any kind while being vigilant for the past almost 4 years. I don’t want to get my hopes up, but statistically seems a lot more probable of a false positive. I did the blood work today for the WB. I know this will only confirm I did not have it previously and will not mean I didn’t get it from this most recent encounter. If it is negative I will test again. From what I have read, 13 weeks with no symptoms from a single exposure is pretty definitive negative on the igg. especially low negative. Would you expect the number to be higher if it was from a previous infection???? I talked to a clinician at the virology lab today and they said they had never heard of someone having seroconversion is 8 days especially with NO symptoms or lesions with a primary and would never have a 2.6. They also said I would have to wait at least 8 weeks for another igg if there was something causing a false positive to clear my system. I know people are asymptomatic, but wouldn’t you expect someone with a true primary infection to have some symptoms or lesions??? Even if they are mild. Your thoughts and comments are truly appreciated. Thank you for all you do to help people dealing with these kinds of situations.

[gdherpesconfusion]

Sorry, meant to add this as part of the question. If this was a new outbreak, what would you expect the igg value to do in the 2 weeks from 8 days at 2.6 to what today 22 days post exposure? I am thinking of getting another igg elisa test and wanted to know your thoughts. If my body is fighting a new infection would the igg number now be very positive after an additional 2 weeks? Also, is a low positive unusual for an old infection? Wouldn’t you normally expect to just be strong positive if you have had the virus for a couple of years?

Thank you Terri!

[Terri Warren]

The 2.6 is in the low positive range. Half of the positives in this range (1.1 to 3.5) are false positives, so that means that half are real positives, so yes, people with long term infection can have a true low positive index value. You could get another ELISA if you want to. If your western blot is negative (which would reflect the past, not the current situation), then I think it is extremely unlikely that any further test would be positive from this very brief encounter. again, I do not believe that the situation you described presents a significant risk.

Terri

[gdherpesconfusion]

Terri,

Thank you again. Sorry, there were a few questions from my last post that I would really like to get your opinion on. 2.6 igg with no symptoms at 8 days past encounter. I know you can’t give absolutes, but I am assuming that is almost impossible. I read on one of your medhelp threads one of the earliest you have ever seen was 10 days with very low positive index and very visible symptoms. To figure out if it would make any sense to get an igg test I would like to get an idea what to expect. If it is a long term infection would the number stay close to the same? If it is something cross reacting and causing a false positive would the number stay close to the same? If it is a new infection that caused a 2.6 at 8 days, would you expect a significantly higher positive 2 weeks later? over 3.5? I would also like to get your opinion from the past. Again, no absolutes, but one encounter, no symptoms and a very low igg at 13 weeks is very conclusive. I know there are always exceptions and it could be a late seroconversion, but very very low possibility. I have seen many posts where they say that is conclusive from medhelp experts.

Thank you again for all of your help. I really appreciate your answers guidance on this matter.

[Terri Warren]

I feel like I have answered all of this earlier. If it is a false positive, you will know that from the western blot. If you have more new questions you would like to ask, please go back and sign up for more questions, but honestly, I don’t think I can help you know. I am not going to take a guess about the result of a western blot with a 2.6 index value – its 50-50 at this point, statistically.

Terri

[gdherpesconfusion]

Hi Terri, Thank you for all of your answers. Can I just get a little clarification for piece of mind? I will go back and pay for additional questions. In your first response you say you doubt from the exposure 8 days prior because the number is too high. From some of what I read on medhelp, I saw one post where you said the earliest you had seen seroconversion was 10 days and that person had strong symptoms and a very low index. Is that true? Just clearing some things up in my head. I had 2.6, 8 days from exposure and have had no symptoms at all. I am thinking it is basically impossible the recent positive test is from this exposure and it has to be from some previous exposure. I guess I am looking for a little stronger statement that it can’t be from recent exposure. I know the internet is dangerous from too much information and bad information. But I can’t find anything that talks about someone seroconverting in 8 days, especially with no lesions or symptoms. Sorry in advance, and thank you for helping my anxiety. I promise to pay for additional questions and I will report back with test results.

[Terri Warren]

Yes, please pay for two more questions.

I think it is extremely unlikely that you would have a 2.6 index value from an exposure 8 days prior, yes. Extremely unlikely. I never say never – STI’s are not like that. The earliest I have seen serconversion is a 1.2 (as I recall) 10 days later.

You are looking for absolutely, I think, and I can’t give you that – only that it is highly unlikely. And there is also a reasonable chance that the 2.6 is a false positive as we have discussed. That issue should be cleared up by the western blot.

Terri

[gdherpesconfusion]

Hi Terri,

First, thank you for all of your help!!! You provide a great service. I went and paid for additional questions. Wanted to give an update. First igg test positive for hsv2 at 2.6 8 days after sexual encounter. Took another igg test 11 days after encounter positive hsv2 at 2.9. Took another igg test at 21 days positive at 2.8. Took Western Blot at 17 days post encounter negative for HSV 1/2!!! Got the results today 35 days post encounter. No symptoms or lesions 35 days post encounter. I will do some more testing in a couple of months, but feeling very good about the WB results. Since it is extremely unlikely to serconvert with NO symptoms or lesions in 8 days post exposure and still have had no symptoms or lesions think it was just a false positive in the low range. Please let me know your thoughts, but feeling much better after the results today. If had already seroconverted in the 2.6 range 8 days and 2.9 range 11 days after exposure, most likely WB would have detected at 17 days. That is a fairly high reading even if still in the low positive range.

Thank you!!!

[Terri Warren]

I agree that it is good news for any past infection, but as you know, not definitive for the new encounter. But as I recall the new encounter was very brief and mostly protected so I think the chances that you will stay negative are very high indeed. I would say certainly better than 90%. Not to be a wet blanket but 17 days is very early for the new infection possibility, you know. To be comforted and reassured there, I think it is best to look at the nature of the encounter rather than the western blot results. I think it is also very important that you’ve had no symptoms at all and I know you’ve got your focus down there. I think it is also worth noting that you likely have some cellular protein that is giving you that high false positive that is not confirming with western blot. The ELISA test may never be very clear and useful for you, right?

Terri

[gdherpesconfusion]

Hi Terri,

Thank you for getting back to me and your response. I agree that something I have is setting off the ELISA. Do you think it will always be that way or at some point will it go back to normal? I have had negative HSV2 igg ELISA tests in the past. I am looking at the nature of the encounter now and the fact I have had NO symptoms or lesions. From everything I read I know 8 days is too soon to test. I was very confused by the positive test at 8 days. I really just did a package deal but got the original test to eliminate ghon & chlym. Thank you for the information and the service you provide. I feel good I can move on, but it has been a very difficult 3-4 weeks since the original ELISA test.

[gdherpesconfusion]

Hi Terri,

It has been 9 weeks since my sexual encounter. I have had no lesions, sore throat or muscle/joint aches. Some general tingling that comes and goes and moves around, but nothing specific and no bumps or lesions of any kind. Lots of anxiety due to the previous false positive and constant examination looking for signs of anything. What do you think next steps should be? Do you think I would still register a false positive if I took another IGG test? Do you recommend another WB? How accurate is that at 12 weeks? Do you recommend any additional testing? Anxiety has lessened and I am doing much better, but still vigilant and trying to make sure.

Thanks! You have really helped during this difficult time.

[gdherpesconfusion]

HI Terri,

I posted the above question a couple of days ago and did not get a response. I went and purchased additional questions assuming that may be why you did not respond. I really appreciate your help. At 9 weeks is there anything to be looking for? I did not have any lesions and I have been looking. Still dealing with stress and anxiety. Do you think I should do additional testing? You stated IGG may never be useful for me. I was negative a couple of years ago, do you think I will be neg again at some point? Or am I always going to have an issue? Not sure how the false positive thing works. I have read quite a bit about asymptomatic infection. Is this less likely when it is a true PRIMARY HSV infection? The WB came back neg for both. I talked to the people at the UW virology clinic and they said there would almost always be symptoms with a primary and it would almost always include lesions on the penis.

Thank you in advance.

[Terri Warren]

Sorry, I didn’t see the additional question renewal. You are assuming the IgG is a false positive but we have no idea if it is a false positive. The western blot definitely takes more time to become positive than the ELISA. Also, I am a little confused about your western blot. I looked at the timing of the western blot and I’m a little confused because normally it takes way more time for a western blot to come back. Are you sure it is a herpes western blot from the University of Washington? How was that arranged? It’s hard to know exactly what is going on with testing from this forum so it might be just fine and exactly what it should be. Again, if you had the western blot drawn at 17 days, it is not a reliable test. UW would be the first to tell you that. I am really confused about UW saying that to you about most people having symptoms with primary infections. We know that 80% of those infected with HSV 2 don’t know they are infected so it really isn’t true that everyone with a primary would have symptoms. While many people with a true primary will have symptoms, many will not. However, with you, you are watching so closely, IF you did have symptoms, you would like notice. Yes, the primary location of lesions in the male, if they have them, is the penis.

I know you are anxious about these results and want a truly negative result. I get that. But your expectations just can’t be met right now, you’ve got to wait longer.

Is there a reason in particular that you are in such a rush for these results?

Terri

[gdherpesconfusion]

Hi Terri,

I went directly to the harbor view clinic in Seattle to have the Western Blot done. It was definitely the western blot done through the UW. Sorry if there is any confusion, but I went to the STD clinic as a walk in and did the test. I am not assuming that I don’t have herpes. I am assuming that a 2.6 IGG at 8 days is a false positive based on the high number and seroconversion not happening that quickly. From the medhelp site and other resources I was under the assumption testing at 8 days would be testing what happened prior to the encounter, seroconversion would not happen that quickly and have that high of a number. From other information I have read I also thought if herpes was attacking the body to the point of building anitbodies that fast there would be symptoms especially since it would be a primary. Based on those assumptions I was comfortable that the WB was confirming that test was a false positive. I am in the process of reconciling with my significant other and really want to put this behind me, that is one of the reasons this is causing me so much stress. When I talked to the clinician at the UW they did bring up asymptomatic infection and said that is definitely a possibility. They said it does happen, but they thought it was more likely with someone who already has HSV-1. Other people dismiss or ignore their symptoms as something else or do not notice them because they are not paying close attention. The same people at the virology clinic did not think it was possible to have a 2.6 IGG after 8 days, and that result would be from an exposure prior to the sexual encounter 8 days earlier. They told me to come back in at 12 weeks to have additional testing and that would be 95% accurate at that time.

Regarding the timing, I did go and do the WB blood test about a week before my first post on your site. I was dealing with a lot of stress and anxiety and really wanted to get your expert opinion on my situation to help calm my nerves. All of the other information I gave you is accurate, especially with regards to timing. I was concerned if I told you I already had ordered the Western Blot you would just tell me to wait for the results. I apologize, but I was not thinking straight. I have paid again and I will again if appropriate, but can you please address my statements above. You really have me concerned now that you are saying the WB did not confirm the false positive. From websites, other resources and the clinicians at the UW I thought it was a false positive based on the number and short period of time. You also stated above you thought it was now better than 90% that it would remain negative and there was problem a cellular protein causing the numbers. I am not sure how the testing works and what they are testing for, but if the IGG was that high that soon, wouldn’t the same antibodies be present for the WB test and stronger 9 days later so that test would be positive too??? Is a biokit something I should look into at 9 weeks while waiting to do another WB??

Sorry for the long post, I really do appreciate the service you provide and how much you help people. It truly was a 1 time encounter and something I regret. I also wish I knew more about the false testing risk. I would never have tested when I did with no symptoms. This has really messed with my head and affected my life.

[gdherpesconfusion]

Hi Terri,

One follow up, I just read the thread you having going tonight with very paranoid. You told him that “most likely” he would have symptoms if he contracted genital HSV-1. Thinking back I probably heard what I wanted to hear when I said the UW person “almost always”. They probably said something closer to most likely, but wouldn’t it be a similar situation whether acquiring HSV 1 or HSV 2 if it is a true PRIMARY infection with no antibodies in the system? Wouldn’t the likely hood of symptoms be the same?

Thank you again. I am really sorry for any confusion I caused with my previous post. I just want to put this behind me.

Thanks Terri!

[Terri Warren]

Yes I think almost always is different. Anyway, there are no certainties. I actually see pretty dramatic infections with HSV 1 genitally in the adult with no previous infection. There are no absolutes here but I think things are looking good for you. I will post more when I read backwards.

Terri

• This reply was modified 8 years, 10 months ago by Terri Warren.
• This reply was modified 8 years, 10 months ago by Terri Warren.

[Terri Warren]

So now that you have explained about getting the western blot in person, it all makes more sense to me. Yes, I agree that having a 2.6 at 8 days is very unlikely and now that I know you actually did get the western blot for certain, in person, I feel more measured about your situation. People often call other tests the western blot and when it comes right down to it, they have had an immunoblot (most often) or something else.

In summary of your situation, I think that if the real western blot is negative at this point, then the 2.6 is likely to be a false positive as you predict. I would agree that another western blot at 12 weeks would be 95% accurate.

Yours is a complicated case and I’m very glad you took the extra time to clarify all of these points for me. Again, I think this is looking very good for you.

Terri.

[gdherpesconfusion]

Hi Terri,

Thank you for your responses, I really appreciate it. Sorry for any confusion and I am glad I was able to explain. I am definitely going to do the WB retest at 12 weeks. I am now at 10 weeks so 2 more weeks to go. Would another IGG test do anything at this point? I was 2.6 at 8 days, 2.9 at 11 days and 2.8 at 21 days when I took the test previously. If I took it now and the numbers were the same or went down would this help or shed any light on the situation? If they have gone up would that give more clarity? Previously you said there might be a cellular protein setting it off. Didn’t know if the 7 weeks since the last test would be enough time to clear anything up or help.

Before starting the thread with you and before getting the neg WB everyone on the medhelp page said that a test at 8 days would only be dealing with a past situation and not the encounter from 8 days before the test, especially with no lesions or flu like symptoms. I know you don’t say “always”, but would really like to put the positive IGG test out of my mind and focus on moving forward just dealing with the low risk one time encounter with some who statistically probably doesn’t have HSV and if they did the chance of transmitting from one time would be very low with no lesions.

I really want to get this behind me. I know you said the situation looks good, but this is still messing with me. Would really like to be able to enjoy the holidays without this hanging over my head.

Thanks, sorry for all of my insecurity and insanity….

[Terri Warren]

I have never in 32 years of practice seen someone who was exposed 8 days ago have a value this high. I think that’s all I can really say about this. If UW says they have never seen it either, then I think the chances are excellent that this does not reflect the most recent encounter. I doubt that you framing the question is a different way will make a difference in my response. I really want to be helpful to you but as you know, I will never say never or always when it comes to herpes. I don’t think doing another ELISA test would be helpful, no. I think your ELISA values will likely stay about the same. They will vary a little, based on the control that they are run against, but that won’t really mean anything at this point, I don’t believe.

Terri

[gdherpesconfusion]

Thank you!!!! Anything to look for/watch out for between now and getting the next WB results? Probably about a month. 2 weeks to test at 12 weeks and 2 weeks for results. Would a biokit be of any use to me, or best to just wait? I will not post anymore unless something changes. I will make sure to come back and post the results of the WB test.

[Terri Warren]

You have paid for 7 posts and you’ve done 12 posts now. I would appreciate you paying for the last posts. Until now, I had no way to really see that but now I do (this is a relatively new service). Only one of these 12 posts does not contain a question. So at a minimum, you owe for four more questions. Please take care of this. This is a paid service and the only way it can continue is it people pay their fare share of this experience.

[Terri Warren]

Whoops, that is another question. Now you owe for 5 more posts, definitely.

Terri

[gdherpesconfusion]

Hi Terri,

Thank you for the service you provide. I just went and purchased 5 additional questions as you asked. Very happy to support what you do! If you could answer the last question I posted that would be great.

[Terri Warren]

Well, you certainly want to look out for any genital lesions, but I think you know that already. I used to like the Biokit but we got stumped with several patients who had very very light colored dots that we could not interpret. It might help to reassure you however, if it was completely negative.

terri

[gdherpesconfusion]

Hi Terri,

A follow up. I did another IGG test at 10 weeks and the value went from 2.6 at 8 days to 2.8 at 3 weeks to 2.01 at 10 weeks. HSV -1 still negative. Would you expect the igg level to be increasing rather than a significant decrease at 10 weeks? Like you said previously, probably a cellular protein if false positive so not a valid test for me, but hoping this is a good sign that igg levels decreasing rather than increasing. Again, had the negative WB at 17 days so we know it is not an existing infection prior to encounter, no other possible exposures 6-8 months before WB. If producing antibodies that soon after, 8 days, wouldn’t you expect a much stronger reading by 10 weeks? Thanks!

[Terri Warren]

The ELISA at 10 weeks at a slightly lower number is not significant. The index value varies from test to test, depending upon the index value of the control your sample was run against. I don’t have any particular expectation of your lab values at this point. Either that is a true positive or a false positive, we cannot know at this point. Some people simply have lower index values and some have higher. This does not add anything, in my opinion.

Terri

[gdherpesconfusion]

HI Terri,

Thank you for all of your help and guidance during this time. I was having a very difficult time dealing with the low positive IGG test I received. I just wanted to follow up and give you and update. As you predicted I had another WB done at 3 months and was negative for HSV 1 & 2!!!! Thank you for the work you do! You are doing such a great service educating and letting people know the facts. Especially when they have a situation like mine with a low positive or atypical results. You are an ANGEL!

[Terri Warren]

awwww, that’s very nice and I am really happy for you. You did all the things you should to take control of your own health, congrats to you.

Terri

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