Low positive. Is it worth it to test further?

[Shadesofgrey]

Got the “you’re positive for Herpes” shock this year and after doing my internet diagnosis, found it may not be black or white.

11 months ago I got a full STD panel and tested HSV1 IgG 1.47 and HSV2 IgG 1.59 (>0.9= positive). Recently I tested again and I believe HSV2 was something like 1.59 or 2.19 (>1.1 positive) I don’t have the print handy to confirm but it was low; HSV1 was not reported.

I didn’t realize my PCP had stopped testing for HSV so my last test prior to all this was about 6 or 7 years ago and it was negative. So what could have caused my results to change aside from actually being infected?

I did/do not have any symptoms or blisters that I would have ever associated with herpes. Being a woman, I’ve had an itch and even a bad sting here or there (actually thought that was common) but although I was sexually active, an STI was furthest from my mind. So, I could have had a mild outbreak and not know it?

Doc says there is no chance of false positive and there is nothing I can do. Although from other forums my results sound questionable, being as prevalent as this disease is, I guess the chance of being positive IS realistic. And if I were to invest in a Western Blot, it sounds like I am still going to be told I’m positive every year.

The “greyness” of this really bugs me. I understand to have antibodies, you’ve been infected and sounds like that part is black or white. So if I test positive for antibodies for chicken pox because I was infected as a child, do I have dormant chicken pox? Am I shedding chicken pox virus regularly like Herpes? If so, I don’t tell people I “have” chicken pox, but I “have” herpes?

Or is it solely the test that is in question?

Thank you. Pardon my soapbox, I think I asked like 17 questions here.

[Terri Warren]

I doubt I will get all of your questions, but I’ll try to summarize a respond.
Both of your values are in the low positive range (1.1 to 3.5) At a 1.59 for your HSV 2, there is about an 75-80% chance that this is a false positive. We don’t know why exactly people have false positives on this test, but it appears to be due to one particular protein that some people who are true negatives have. Sometimes that effect happens with the western blots, too. Not very often but it does happen and then comes out as an indeterminate on the western blot. But we can sort that out too, if it happens.

And yes, if your low positive is a false positive, the regular screening test may always be positive (falsely). If you all of a sudden had a >5 result, that would be a totally different story.

When we talk about herpes, we talk about herpes simplex virus. The other herpes viruses are completely different and do not need to be disclosed.

Terri

[Shadesofgrey]

Thanks for the reply. So first, if we say some people react to the tests in a way that can result in false positive, I could see that always being the case. However in the past I’ve been negative so that will be hard to understand what else could have changed although hopefully there is some other reason.

Second, regarding chicken pox, this goes into a latent stage in the spine and I would show positive for antibodies similarly to herpes. How is herpes different in that it is still considered/described as active instead of latent, especially if you are someone who has never had an outbreak or never had one after the first episode? In other words, why is herpes always permanent and live as opposed to other viruses that your body has learned to fight off or prevent from progressing to active disease.

My docs sound very definitive so this <3.5 definitely hasn’t gone mainstream. I can understand how it can be recommended not to test. I keep thinking back to every discomfort wondering “was that herpes?” (If yes, it was not obvious). Should I push this further? I would be upset if I got more inconclusive results.

Thank you!

[Terri Warren]

The difference between a negative IgG (<0.9) and a positive (>1.1) can be very close indeed, if the negative it high, like .88 or something. And you don’t know when it is negative what the index value is.
There are eight viruses in the human herpes family – all have life long latency as a common characteristic. Why they are life long I don’t know, but we don’t feel that chicken pox antibody triggers a false positive on the herpes simplex virus testing.

I am attaching one of the articles about the false positive rates, and it has a chart that might be useful for your doctor as well.

Statistically, this is more likely to be a false positive than a true positive. You could either not do further testing on this or act upon this test for the rest of your life. Even if it is indeterminate, we have ways to understand and interpret that as well. Your call.

BMC Infect Dis. 2005 Oct 14;5:84.
Use of “biokit HSV-2 Rapid Assay” to improve the positive predictive value of Focus HerpeSelect HSV-2 ELISA.
Morrow RA1, Friedrich D, Meier A, Corey L.

Terri

[Shadesofgrey]

Hi. So, just to be clear when I reference chickenpox, why is genital herpes always described as an active disease while other viruses can go latent and no longer considered a threat? What does it do differently that makes the doctor say you have a lifelong disease (when you have no outbreaks) as opposed to a dormant virus from a prior exposure? Is it because it’s too hard to know if/when it is active in asymptomatic people? (Sorry if I am just being over-analytical? 🙂

From your article, do you suggest getting a biokit HSV-2 rapid assay? Is this something I can get through a lab or clinic without going to the doctor? I am willing.

I hope there will be something done in the field to re-address how these results are typically interpreted because I’ve seen three doctors and they were adamant that the test is conclusive (assuming it could possibly not be in my case). We have couples getting tested together all the time and if I were on the other side it would be hard for me to not believe the doctor!

Thank you for your time.

[Terri Warren]

We know herpes has established life long latency AND is active because if we ask people to swab their genitals daily, we find virus on days when people have no symptoms. Chicken pox is nothing like that.

I am not recommending a biokit here, I am more referring to the western blot data Biokit may be useful but in my experience, sometimes that also is difficult to read in people with low positives. You can also get a western blot without going to a doctor, by the way, through our clinic. It is more expensive than the biokit, though I don’t know where you would get a biokit.

What do you mean “we have couples getting tested all the time” who is we? This was your last question on this forum, so you don’t have to answer that, obviously.

Terri

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