Hsv2 false negative?

[BackAgain]

Dear Terri,
I have a bit of a long story that I will try to make short and clear. Back in 2014 I reached out to you online about a hsv2 test result. My tests were:
Hsv1:
September 30 – 0.23 negative
November 25 – 0.26 negative

Hsv2
September 30 – 1.05 – equivocal
November 25 – 0.69 negative

You told me that you thought it is likely that I have some protein within my own body, unrelated to herpes, that is causing the HSV 2 test to be a little more reactive than the typical negative. You also urged that if I tested again, this could happen again and that Unless the numbers are really higher, not worry about it.

Fast forward to now. I am in a monogamous relationship with the most wonderful man. We have been having sex for about 2 1/2 months, usually unprotected as we are in the mindset that we will become pregnant when the time is right and are welcoming to the idea of parent hood. We are letting nature take its course. My boyfriend is uncircumcised and has had two instances when he has woke up with irritation on his penis after a night of sex. I admit that we have been lazy and not getting up to shower after intercourse. When this happened about two weeks ago, we went to an urgent care center for std testing and to speak with a doctor. The doc felt that he was experiencing symptoms of being uncircumcised and told him that the moisture under his foreskin could cause problems and that he could have had a bacteria, urged him to have better hygiene, gave him a cream and that was it. She said that it didn’t look like it was caused by any std. The next day, his irritation was gone completely. It looked like small red flat irritated skin, no fluid, no bumps. I was tested as well and found out that I had candida and BV. I opted to not have the herpes test because of the headache from last time with results. I was treated. His results all came back negative except for hsv2.

Herpeselct IGG 1&2 ELISA

Hsv1: .2

Hsv2: 3.83

He then had an hsv2 Inhibition ELISA with the same sample that came back:

Hsv2 IGG Screening index: 2.65

Inhibition % 87

Based on my experience and the fact that he hasn’t had an outbreak or what is typical for herpes, I wonder if he has false positive. My questions are:

1) Could this be a false positive? I know the false positive range is considered up to 3.5 which numbers should we consider? The original ELISA or the inhibition? Why are the numbers different?

2) What is the percentage number from the inhibition mean?

3) my boyfriend was taking antibiotics for an unrelated dental issue at the time of his test and had chicken pox within the last two years, could those things trigger a false positive?

4) What should we do next? We live in New York. I have read on a post that you now have. A research study where NY samples can be sent for Western Blot . Is that still true?

5) should I get tested again?

I love this man dearly and will stay with him no matter what. I know that the antibody tests are faulty. We need clarity. Also, considering that I could be expecting I really want clarity.

Thank you for taking the time to read this!

[Terri Warren]

1) Could this be a false positive? I know the false positive range is considered up to 3.5 which numbers should we consider? The original ELISA or the inhibition? Why are the numbers different?

The numbers vary normally – not a big deal. He is in the low positive range and needs confirmation. I’m not a huge fan of the inhibition assay, honestly, I think the western blot has a far better track record of accuracy.

2) What is the percentage number from the inhibition mean?
Here is a link to an explanation about how the inhibition assay works: http://education.questdiagnostics.com/faq/FAQ73

3) my boyfriend was taking antibiotics for an unrelated dental issue at the time of his test and had chicken pox within the last two years, could those things trigger a false positive?

No

4) What should we do next? We live in New York. I have read on a post that you now have. A research study where NY samples can be sent for Western Blot . Is that still true?

Yes, that is true We can help you with that.

5) should I get tested again?

Good question. If you test positive now and he confirms as positive, then that would actually be a relatively good situation. I think you might consider getting his western blot results back before you do anything. If he tests positive by WB then you may wish to test, yes.

Terri

[BackAgain]

Thank you for your response Terri. How do we go about getting the WB testing done from New York?

Also, in the 2 1/2 months that we have been intimate, do you believe that I would have caught the virus if he is indeed positive? I have had no symptoms how long would it take to cause a initial outbreak? What is the likelyhood of someone catching hsv2 from someone asymptomatic?
I am concerned about what he and I should do now sexually, should we abstain? Use protection? Or should we assume that I have already been exposed, if he’s positive and just continue with our sexual activity while we pursue the WB? I understand taut condone do not fully protect from hsv

How many people in the low positive range with his numbers turn out to actually be confirmed negative with WB?

I really appreciate your time and look forward to guidance with the further testing. I will probably wait if he does the WB and see what happens because it hasn’t been the recommended 4 months since possible exposure for either of us. Is that correct?

[Terri Warren]

You can participate in a study we are doing at the clinic that looks at the rate of false positives in five different states – New York, Pennsylvania, Florida, Rhode Island and Maryland. He would set up a phone consultation with me and then we would send you a kit to take to a lab in your area for a blood draw. There is a charge for the western blot – the study is just looking at the results of your testing.

If you were my patient, I would recommend that you consider this positive until proven otherwise. What would your behavior be if you knew he was positive? That’s what I think might be best for you, whatever that is, until proven otherwise.

If I had to guess, with the value in the 3.something range I think there is a good chance he is actually positive, but I have also seen values that high NOT confirm.

Terri

[BackAgain]

Thank you Terri. He will call and set up a phone consultation and will get the western blot. Do you think I should get one now as well? We started being intimate around May 15. Would the test show me results from being exposed by him at this point? I imagine it may take at least two weeks to have to have the consult and recieve the kit by mail so that would add some time.

We have decided to abstain until we get the WB. He is very worried about infecting me. We are both actually struggling with this a lot. We are also considering counseling to get us through this but I’m afraid of going to someone that is not very knowledgable about the virus and the tests. Do you have any suggestions in NY?

You said that your guess was that he may actually be positive with the number over 3. Did you consider the Inhibition ELISA he had with the same sample that came back:

Hsv2 IGG Screening index: 2.65
Do you think he may actually be positive with this number as well? What’s the probability of false positive at 2.65?

Thank you again Terri.

[Terri Warren]

I’m not clear that getting a western blot for you at this point is a good idea. It’s a bit earlier .
The false positive rate is about 40% I believe with that 2.65. I am not at my office today so I don’t have my little chart with those numbers with me, but I’m pretty sure that’s right. The inhibition assay has been off and on correct vs. the western blot. And I do prefer the western blot.

Probably not a bad idea to abstain for now. But I think you need to be thinking ahead to a possible positive and how it will impact your relationship. I don’t have any suggestions for counseling in New York. But summarizing what I think it will come down to is this:

Would you rather be with this man and risk acquiring herpes or be without him? Not that being without him means that you’ll never be at risk again because you may find yourself in this situation again. Sometimes I think people get swept up in the WORD herpes and all of its accompanying stigma. Genital herpes can be managed successfully with medicine. Women with herpes have healthy babies all the time People live completely full and rewarding lives with herpes every day. But how often do you find someone you really really love? Maybe you aren’t there in this relationship right now. But I’ve been in your position and I’ve had to make this decision and for me, I really loved this person and the decision was a slam dunk to take the risk. Let’s face it – everybody brings negative stuff to a relationship. Some is really obvious, like herpes. Other things take time to reveal themselves. Things like over attachment to parents or cheapness or excess use of drugs or alcohol or OCD or laziness, a whole lot of things are possible! But herpes is one that’s pretty easy to deal with over time while the others? Not so much.

Here’s another little thing: Your negative .69 is higher than most negatives. We do see true negatives at this value, but not all that often. Sometimes a negative at this value suggests seroconversion happening but certainly not always. It might not hurt for you to get another ELISA test at some point. Just to see where you stand.
This is your final post on this subscription. If you have more questions, feel free to renew.

terri

[Author]

Posts