how should i follow up on an equivocal hsv-2 igg result?

[pseudoanonymous]

here are the pertinent details:

i am a female. i have never experienced any genitourinary symptoms of any sort, including any that would indicate sti. i’ve never even had so much as a yeast infection or a uti. i’ve also never had a cold sore on my mouth, nose or face.

i was for sure sti-free until june 2014. in june 2014, i performed unprotected oral sex once, received unprotected oral sex once, and had unprotected vaginal intercourse once with a new male partner who stated that he had been tested recently and was sti-free. i had no further sexual contact with this partner. i did not develop any symptoms of any sort after my contact with this partner and did not seek sti testing after our encounter. i was not sexually active again until october of 2014.

in october of 2014, i performed and received unprotected oral sex on a new male partner, twice. i also had protected (male condom) vaginal intercourse with this same partner, twice. this partner also stated he was sti-free, and i trust that he truly believed that at the time. after this, i had no further sexual contact with this partner, and i did not develop any symptoms of any sort. i have not been sexually active since.

this week, the partner from october 2014 contacted me to inform me that he has “extremely symptomatic” genital herpes – both hsv-1 and hsv-2 – and that he “most likely” had it at the time of our encounter in october of 2014. while i remain nothing but symptom free and comfortable, this prompted me to go for a 10 panel sti rule out. today, i learned that my hsv-2 serology igg value is 1.61… slightly above the >0.90 index for a negative result, but also slightly below the >3.5 index for a positive result.

how should i best interpret this result, and what follow up testing would be appropriate to confirm/deny the presence of a genital and/or oral hsv-2 infection in my case, based on my exposure?

thank you!

[Terri Warren]

There is about an 80% chance that your 1.6 index value is a false positive. You most definitely need a confirmatory test and I strongly suggest a herpes western blot for this purpose. Our clinic can order that test for you at lab near you to be sent to the University of Washington. It is my opinion that you will likely test negative but you’ll never know for sure unless you do the test.

I’m also wondering what he means by extremely symptomatic? If he is extremely symptomatic now and thought he had it at the time he had sex with you, why wasn’t he extremely symptomatic then? It is very unlikely that he would have had it in 2014 and then all of a sudden be extremely symptomatic now. Just doesn’t make sense. Could he be messing with your head?

Was he your most recent sex partner?

Terri

[pseudoanonymous]

good morning, terri. thank you so much for your prompt reply, and for your recommendation. it is important to me to know, one way or the other, symptomatic of not, my true hsv-2 status. there seem to be so many testing options out there… thank you for pointing me in the right direction in that regard.

will the western blot test through your guys’ lab indicate location – oral or genital – of infection, if indeed there is an infection at all? or will it simply confirm or deny the presence of hsv-2 antibodies and therefore hsv-2 infection? my understanding is that hsv-2 is more often than not a genital infection, however it can also be oral and facial in a minority of instances. is my understanding correct?

the partner from october 2014 was my most recent sexual partner, and my exposure was limited to a total of 2 encounters with him in a 1-week span. i spoke with him on the phone again last night to clarify some details, and i now believe that he knew that he was hsv-1 and hsv-2 positive in october 2014 when we were together, but that his symptoms were well-managed with antiretroviral medications such that he didn’t think it would be risky for me, and therefore didn’t think it was his responsibility to inform me beforehand of his hsv status. i respectfully disagree, but of course that changes nothing at this point.

[Terri Warren]

The western blot will only confirm if you have HSV 2 or not – it cannot identify location, no, but I think you can assume, with 95% certainty, that it is genital.
I also think that is just crap that he knew and didn’t tell you, but it is possible that someone misinformed about about their effectiveness, I suppose. You mentioned antiretroviral medicnes, which are for HIV, but I think you mean antivirals which are for herpes. Yes?

I hope you will pursue the western blot to get clear about this – I really do. If you decide you want to do it, just call and make a phone consultation appointment with me and we will get it all set up.

terri

[pseudoanonymous]

agreed! i too think it’s crap. thank you for voicing that sentiment. what bothers me most is that he specifically told me at the time he had been recently tested and had no known stis. so, basically, he lied. that’s frustrating. it wasn’t his place to decide if it would be risky to me or not. his role was to be honest and to equip me with accurate information so that i could decide for myself if it was an acceptable level of risk or not to me.

antiviral. not antiretroviral. important distinction. 🙂 typo on my part.

so, lesson learned for me, i suppose. as i have never experienced any symptom, and as i’m not currently sexually active, i’m going to hold off on the western blot for now. if i ever experience anything that is even remotely symptomatic, however, i will pursue western blot testing immediately. or if i decide at some point in the future to have a sexual relationship with anybody, i will require that we go together for testing before we start anything. in the meantime, i feel comfortable with my completely asymptomatic, 80% likelihood of a false positive hsv-2 status.

thank you, terri, for equipping me with accurate information to empower my informed choice about my sexual health. i very much appreciate you!

[Terri Warren]

Yup, he definitely blew it. And lied to you also about the STI testing.
Its fine to hold off on the western blot until you are in a situation where you need a clearer answer. I just don’t want you to worry about this forever and not really know or 2) put someone else at risk based on the 80% chance things. When you’re ready, you’ll do it.

Terri

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