Low positive then negative retest–long seroconversion period?

[CluelessinCali]

Hi Terri. I am a 38 year old woman. Unfortunately, someone I partner with only briefly in August 2022 was maybe not honest about his HSV-status.

Anyway, I had a negative HSV2 IgG test result Sept. 2022. Then, I got retested December 7, 2022 and it came back 1.09 with a positive supplemental. I retested two weeks later on December 22, 2022 and it was 1.12 with a NEGATIVE supplemental (Merry Christmas to me?!).

I’ve never had classic vesicles, tingling, intching, nerve pain, or blisters. I’ve had other little bumps described as skin irritations off and on most of my life (friction from underwear band where the lower pelvis rests against a chair for too long, sweat-related bumps that go away), but now I’m paranoid any time a skin irritation comes up. I’m on the lookout for both typical and atypical presentations of bumps/blisters but I’m worried that I’ve missed a subtle atypical presentation.

I would describe myself as being asymptomatic. Nothing weeping, painful, etc.

At my OB/GYN’s urging, I retested this week, making it 3 months since my confounding positive & negative results from December 2022 and 7 months since the possible exposure. Should have the results next week so can follow-up later. I don’t know who the hospital lab sends out their specimens to, so can’t tell you whether the tests were LabCorp or Quest.

My questions:
1) How would you interpret an initial IgG of 1.09 with a positive supplemental, followed by a 1.12 IgG with a negative supplemental? Was the first test likely a false positive? I’m wanting clarity so I know how to move forward with my partner, who is accepting either way.

2) Could the second test in December, the negative result, be an artifact of incomplete seroconversion? Or, stated differently, could it take 7 plus months to complete seroconversion for HSV-2?

I would do a WB, but I’m unemployed due to a #metoo issue at my last job. Do you have any info on defraying the cost for low-income people?

[Terri Warren]

1) How would you interpret an initial IgG of 1.09 with a positive supplemental, followed by a 1.12 IgG with a negative supplemental? Was the first test likely a false positive? I’m wanting clarity so I know how to move forward with my partner, who is accepting either way.
I would say that an equivocal test result with a positive supplemental followed by a negative supplemental would indicate that the first is a false positive. I now have 117 patients who have positive supplemental with negative western blots.

2) Could the second test in December, the negative result, be an artifact of incomplete seroconversion? Or, stated differently, could it take 7 plus months to complete seroconversion for HSV-2?
I don’t think that is the case. We are seeing good agreement between people who get a negative supplemental test and, subsequently, a negative western blot.

I would do a WB, but I’m unemployed due to a #metoo issue at my last job. Do you have any info on defraying the cost for low-income people?
I am not aware of any help in defraying the cost of the western blot but I really do think the negative supplemental is very good news for you.

Terri

[CluelessinCali]

Ok thank you. The NP that ordered the positive and first negative test told me three months ago that she couldn’t explain the results and that I should assume I have HSV-2.

I’m resorting to writing you because I wanted the opinion of a subject matter expert.

I just got my retest results following possible exposure 7 months ago. To recap, I had a negative in Sept. 2022, a 1.17 IgG with positive supplemental on December 7, 2022 (different values from above original question –looked up the result values today), a 1.21 IgG with a negative supplemental two weeks later on December 25th, 2022.

Today’s result was 1.04 IgG with a negative supplemental.

Possible exposure: August 2022
September 2022: Negative
December 7, 2022: 1.17 IgG positive supplemental.
December, 25, 2022: 1.21 IgG negative supplemental.
March 26, 2023 retest: 1.04 IgG negative supplemental

1) Would you say I’m in the clear after a confounding possible false positive followed by two negatives? Is it safe to assume, considering that I am asymptomatic so far, that I do not have HSV-2 following a false positive and the two negative tests within seven months of the possible exposure?

2) What would cause the antibody activity in the first place if I’m not positive? What would explain the presence of the antibodies and the jumping around of antibody levels detected if I’m not positive? I seem to remember having my flu shot close in time (maybe same day or same week) to the “positive” HSV-2 blood draw. And while unrelated, I was also erroneously misdiagnosed with celiac disease and avoided gluten down to the molecular level (impossible) for two years following a false positive gluten antibody IgG, so I have some type of history of this (also possibly forced by taking the flu shot too close to the gluten antibody blood draw or having a positive ANA force the false positive on celiac disease IgG test).

I appreciate your sage guidance. Thank you!

[Terri Warren]

1) Would you say I’m in the clear after a confounding possible false positive followed by two negatives? Is it safe to assume, considering that I am asymptomatic so far, that I do not have HSV-2 following a false positive and the two negative tests within seven months of the possible exposure?
Yes, I believe so

2) What would cause the antibody activity in the first place if I’m not positive? What would explain the presence of the antibodies and the jumping around of antibody levels detected if I’m not positive? I seem to remember having my flu shot close in time (maybe same day or same week) to the “positive” HSV-2 blood draw. And while unrelated, I was also erroneously misdiagnosed with celiac disease and avoided gluten down to the molecular level (impossible) for two years following a false positive gluten antibody IgG, so I have some type of history of this (also possibly forced by taking the flu shot too close to the gluten antibody blood draw or having a positive ANA force the false positive on celiac disease IgG test).
It isn’t about your having antibody activity. It is about the test not being able to sort out herpes antibody proteins from other proteins in your blood. there is very good agreement between people who get a negative supplemental and subsequently, a negative western blot

Terri

Terri

[Author]

Posts