IgG tests with no index values

[ConfusedBacon]

Hi Terri,

I hope that you are well. I am from Australia and I was diagnosed with genital herpes back in 2015 from a swab test. My record does not state which strain and I just assumed it was GHSV2. I did not learn that until last year it could be HSV1 or HSV2. I have been on Valtrex since 2017 and then stopped in 2021. I recommended Valtrex in October 2022 (one daily dosage). I have barely gotten any outbreaks over the years.

When I first had my initial outbreak it was very mild and ever since, my recurrent outbreaks have been infrequent and mild. I took an IgG test in Australia to help identify what I could have.

I tested positive for HSV1 but equivocal for HSV2 on 4 March 2023. However, Australia does not provide index values as I have been advised that the values will not change anything. I stopped taking my Valtrex for 10 days and re-took a test today, and now it states positive for HSV2.

I have never experienced an oral outbreak growing up. The only outbreaks I have ever had has always been on my genitals.

1. Do antibodies cross react?
2. What should I make of the results?
3. Should I go for another IgG test?

Thank you kindly.

[Terri Warren]

1. Do antibodies cross react?
Sometimes but I don’t really know what to make of your testing. Are you sure there aren’t any labs in Australia that give index values on the herpes antibody test?
2. What should I make of the results?
I’m sorry I just don’t know. It sounds like you are positive now for both HSV one and two but without index values, I cannot say how accurate this might be. I sure wish I could help more with that question.
3. Should I go for another IgG test?

You could do it again and see what you get. I would stay off the Valtrex for a while. Another approach to this would be to stay off the Valtrex and let an outbreak happen and get that swab tested and typed.

Terri

[ConfusedBacon]

Hi Terri,

1. I have asked around and no clinipathology in Australia provides for index values. This is actually quite upsetting that they do no do that.

2. What is the possibility of me having asymptomatic oral herpes but then having symptomatic genital herpes? I would have assumed that surely if I get outbreaks downstairs then I would have gotten an outbreak on my face by now.

3. The other option was to wait for a recurrent outbreak. However, it seems that I could be waiting for a long period as since I have had HSV, I have had only 5 outbreaks since 2015. I was thinking, wouldn’t valtrex also affect the detection of HSV1 if it was to affect the detection for HSV2?

Thank you. This is all so overwhelming. I have tried to contact my past doctor to see if there were more information regarding my PCR test. But no, they have nothing else on file except for genital herpes.

[Terri Warren]

1. I have asked around and no clinipathology in Australia provides for index values. This is actually quite upsetting that they do no do that.
Agree. I think they DO get an index value but they may not report it out.

2. What is the possibility of me having asymptomatic oral herpes but then having symptomatic genital herpes? I would have assumed that surely if I get outbreaks downstairs then I would have gotten an outbreak on my face by now.
I would agree with your last sentence

3. The other option was to wait for a recurrent outbreak. However, it seems that I could be waiting for a long period as since I have had HSV, I have had only 5 outbreaks since 2015. I was thinking, wouldn’t valtrex also affect the detection of HSV1 if it was to affect the detection for HSV2?
Not if the HSV 1 infection is long standing and the HSV 2 is new

Thank you. This is all so overwhelming. I have tried to contact my past doctor to see if there were more information regarding my PCR test. But no, they have nothing else on file except for genital herpes.

If you got HSV 2 in 2015, I would not expect an equivocal for that, as you had. I would expect a higher positive.

Terri

[ConfusedBacon]

Hi Terri,

Sorry, lastly just a few more questions:

1. What is the possibility of valtrex affecting the IgG score long after infection but also long after a good stretch of not being on valtrex. For example, when I tested positive in 2015 and then took Valtrex from 2017-2021. Taking that break in 2021 until October 2022.

2. What are similar viruses that can cross react with antibodies? I had chickenpox back in 2014. This is the response I received from a Serology Scientist in Australia regarding the index values: “No, we do not provide the index values.
ConfusedBacon is correct that they can provide an indication, and we will sometimes report as weak positive.
However the assays are totally qualitative. A weak result may still be real (especially if early infection or waning antibodies) and a moderate result still has a risk of being false if there is a cross reaction with a similar virus.”

2. What is the possibility of a swab test being a false positive? I have been seeing a new doctor and we went through my medical record from when I got tested and nothing on the culture says I got tested for herpes but a written description on my record just states: “genital herpes.” My doctor is going to ring around the labs and retrieve the culture record because she’s confused why my culture result having no mention of herpes. I don’t doubt that I don’t have it – my IgG test indicates something and I’ve had mild outbreaks in the past (but then my doctor states the outbreaks could be anything else).

Thank you.

[Terri Warren]

1. What is the possibility of valtrex affecting the IgG score long after infection but also long after a good stretch of not being on valtrex. For example, when I tested positive in 2015 and then took Valtrex from 2017-2021. Taking that break in 2021 until October 2022.
I do not think that is the case

2. What are similar viruses that can cross react with antibodies? I had chickenpox back in 2014. This is the response I received from a Serology Scientist in Australia regarding the index values: “No, we do not provide the index values.
ConfusedBacon is correct that they can provide an indication, and we will sometimes report as weak positive.
However the assays are totally qualitative. A weak result may still be real (especially if early infection or waning antibodies) and a moderate result still has a risk of being false if there is a cross reaction with a similar virus.”

I would agree with this statement. We don’t know exactly what cross reacts with herpes antibody test to give a false positive.

2. What is the possibility of a swab test being a false positive? I have been seeing a new doctor and we went through my medical record from when I got tested and nothing on the culture says I got tested for herpes but a written description on my record just states: “genital herpes.” My doctor is going to ring around the labs and retrieve the culture record because she’s confused why my culture result having no mention of herpes. I don’t doubt that I don’t have it – my IgG test indicates something and I’ve had mild outbreaks in the past (but then my doctor states the outbreaks could be anything else).

I think since you’ve had your occurrences that it isn’t likely that the swab test is a false positive.
Terri

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