Need Your Advice: Herpes Testing Ethics

[confusedbeyondbelief]

Hey Terri,

Thanks for taking the time out to answer my question.

I posted to Dr. Handsfield two days ago, and gave him my situation: 22 y. old, caucasian M, 9 unprotected partners and 9 protected, 7/9 unprotected as one night stands. I just took first herpes test last week, and am awaiting the results. Personally I do not care about the disease, and the stigma doesn’t bother me in the slightest. What I am confused about, though, is testing. Dr. Handsfield told me, based on my stat., he doesn’t recommend me taking the IGg test, as it is “not perfect,” yet also told me that most results “are cleanly positive or negative.”

That statement confuses the hell out of me. I’m hoping if I list my concerns you can use your experience and help me out:

1. If I test low-positive IGg, is the emotional stress for past partners going to outweigh the benefit of telling them? Since I could have a false-positive, and they can too?

2. If my IGg/Western B. is a clean positive for herp, is the emotional stress for past partners going to outweigh benefit of telling them? Since they still may deal with faulty IGg results? (assuming most won’t go to the lengths and pay $200 for WB)?

3. Hypothetically, I take the WB 6 mos. post-exposure and am neg. I consistently put the IGg test in my STD checkups moving forward anyway: 1 year later range on IGg test goes up from 1.5-2.0 after consistent sex with a partner post-WB result. Do I need another WB to rule out pos. from new partner? (basically, will low-pos IGg testing just become a vicious money pit)?

4. If I get a – on this next test (8 weeks post exposure), is the most sound decision to stop taking ELISA IGg and move on, as Handsfield says?

I want to do what’s best & fight the stigma. But the low-pos IGg mental gymnastics suck (‘hey there’s a chance you were infected by me, get tested and maybe find out’). This is ruining my life. Please give me your answer as a herpes expert, not from the technical CDC/med community angle. Thanks 🙂

[Terri Warren]

1. If I test low-positive IGg, is the emotional stress for past partners going to outweigh the benefit of telling them? Since I could have a false-positive, and they can too?

A low positive result is easy to clear up with the western blot which I can order for you if you need that. I do not fear low positive results. I would not disclose low positive results to partners if you can do a blot. Over 7 years of practice doing IgG testing only 6% of patients tested in the low positive range. I do not think that is high enough to abandon the testing.

2. If my IGg/Western B. is a clean positive for herp, is the emotional stress for past partners going to outweigh benefit of telling them? Since they still may deal with faulty IGg results? (assuming most won’t go to the lengths and pay $200 for WB)?

See above.

3. Hypothetically, I take the WB 6 mos. post-exposure and am neg. I consistently put the IGg test in my STD checkups moving forward anyway: 1 year later range on IGg test goes up from 1.5-2.0 after consistent sex with a partner post-WB result. Do I need another WB to rule out pos. from new partner? (basically, will low-pos IGg testing just become a vicious money pit)?

AGain, only 6% of people who tested in my practice (several hundred) tested in the low positive range. And you only need to wait 12 weeks to test with the blot (UW advice) not 6 months.

4. If I get a – on this next test (8 weeks post exposure), is the most sound decision to stop taking ELISA IGg and move on, as Handsfield says?

Our advice is 12 weeks. At 12 weeks, the IgG test misses 30% of hSV 1 and 8% of HSV 2. But without symptoms, I think the IgG test for hSV 2 is a little better than that. The test for HSV 1 is clearly not great.

Dr. Handsfield and I don’t always agree about HSV testing.

Terri

[confusedbeyondbelief]

Hey Terri, I tested negative for herpes I/II (8 weeks post exposure). I have no symptoms of herpes either. Sorry if some of those questions were too bogged down. My main concerns are if I should keep taking the Igg test moving forward without having symptoms, and if so, what my plan of action should be if i get a low positive score? I know herpes isn’t a big deal objectively, but I’d feel bad if I stop taking the test and give it to someone in the future without knowing I have it. Please let me know what you think. When I said “not from the CDC perspective,” I just meant in your opinion is it ethical to stop taking the Igg test if I have no symptoms. Thanks

[confusedbeyondbelief]

Just saw your response, Terri. Thank you for that insight. Disregard my other comment. So my only other question would be is, theoretically, if someone was to have unprotected sex again after testing low-pos on IGG/negative on the WB, and their antibody levels go up on the next test they take after that encounter (let’s say from 1.5-2, something that is still in the low positive range), do you recommend that person taking another WB?

[Terri Warren]

Hmmmm. Now that’s mixing things up, isn’t it? New exposure vs. same old false positive? I can’t really make that call but likely NOT new infection or one might see a higher score.

Terri

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