HSV2 low positive

[HSVquestioner]

Hi, thanks so much for creating this resource!

I am male, and a previous sexual partner thought she had HSV2 so asked me to get a test (she later turned out to be negative, so <shrug>)

My HerpSelect (Quest) IgG results:
Initial: 1.47
1 month later: 1.52

At 3 months, I got the Labcorp IgG w/ refelx test . Results were:
IgG: 1.17, HSV2 reflex test negative.

From labcorp’s website, the methodology for this test is: “Chemiluminescent immunoassay (CLIA). Reflex of specimens equivocal and low positive for HSV-2 type specific IgG to a membrane based immunoassay.”

My doctor thinks that this means I have some level of antibody proteins, but I most likely don’t have the virus and probably never had any actual infection. In other words, I am not a carrier and cannot transmit HSV2 to anyone else.

Some additional info: I’ve never had any symptoms. Also, 2 years ago for various reasons I got an HSV2 test which was negative. In between, I did have other sexual partners, so it’s possible I was exposed, but unclear.

Would appreciate your thoughts on whether my doctor’s interpretation is correct. In particular, my current sexual partner either wants some confidence that I am not contagious or else would like me to start suppressive therapy. These lab results make it hard to figure out what I should do.

Thanks again!

[Terri Warren]

I would suspect that you are not infected with HSV 2, given your test results, but I have seen people actually be positive at this level, but rarely. The CDC recommends a good confirmatory test, like the herpes western blot. But your call.

Terri

[HSVquestioner]

Hah, I was hoping you’d say “yeah definitely a false positive!”

So a few follow-up questions:

When you say “a good confirmatory test,” does that imply the Labcorp reflex test (membrane based immunoassay) is not a good confirmatory test? I realize the Western blot is the gold standard, but for an ambiguous case like this, is that the only method you’d recommend?

Do you have any suggestions for how to get a Western blot in the San Francisco area?

My doctor seems to imply that “less IgG antibodies” => “less active (or inactive) viral infection” => “less chance of being contagious” which doesn’t entirely make sense to me based on my understanding of how antibodies works. Is he correct here?

Thanks again.

[Terri Warren]

I have now had 16 people who tested positive on the LabCorp membrane test who were negative by western blot, so no, I have no confidence in this test. I suspect that they are over-reading it. We stopped doing it in our office because it is easy to over-read as positive. That’s my opinion – I’m not even positive it is the same test but I think it is.

The only place that does the western blot is the Universit of Washington. You can have blood drawn in San Francisco and have the blood shipped to UW. You’ll need the kit from UW and a provider to order it for you.

Less antibody does NOT mean less infectious. I don’t know why on earth he would say that, no.

Terri

[HSVquestioner]

Thanks, but it’s the opposite of what you say.

The initial IgG test was (low) positive (using a CLIA assay), then the follow-up confirmatory test (Labcorp membrane assay) was negative. From my original post:

At 3 months, I got the Labcorp IgG w/ reflex test. Results were:
IgG: 1.17, HSV2 reflex test negative.

You’re saying that the membrane test has a high false positive rate, but in my case the question is what is its false negative rate, which presumably would be different. Does that change your opinion at all?

In any case, I’ll look into getting a western blot ordered since it would be nice to have an unambiguous answer. Thanks again.

• This reply was modified 1 week ago by HSVquestioner.
• This reply was modified 1 week ago by HSVquestioner.

[Terri Warren]

I was referring to the quality of the membrane test. If your confirmatory test is negative, then I think that is a very good sign, yes.

Terri

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