Next Steps: HSV2 IgG low positive with two negative supplemental tests

[cmr892]

I am 29F and am a little confused about my situation. I did see people with similar experiences, but for some reason I feel like mine is a little different. Between Aug 2021 to Jan 2022 I was sexually active with multiple partners, all males, some with protection and some without. In Nov 2021, I was diagnosed with strep throat, a test wasn’t done, just an exam. I was given a 10 day round of antibiotics, within 1-2 days my symptoms for strep throat went away, however I got a yeast infection soon after starting the antibiotics. This was expected and I took a single dose of Fluconazole. I also self treated with otc Monistat, which seemed to help, however over the next few months I seemed to be having constant problems with vaginal discomfort that I assumed was a stubborn yeast infection. I had an earlier STI screening for HIV, Chlamydia, and Gonorrhea [all negative] at Planned Parenthood a month prior, so I didn’t consider otherwise. I continued to self treat my suspected yeast infection up until Dec 2021, these episodes seemed to be triggered with certain sexual partners. In Dec 2021 I had an uncomfortable sexual experience where I was digitally penetrated, it was painful and soon after I noticed a lesion on my opening of my vagina. I didn’t think anything of it, thinking it was a tear caused by the digital penetration. My problems continued with pain and discomfort, I was having sleepless nights and it started to become constantly itchy. In Jan 2022 I noticed my discharge went from a milky white appearance to a pale yellow. This lead me to go to urgent care. The PA I saw did an examination and suspected I had Gonorrhea due to the amount of discharge I had. He also examined the painful lesion on the opening of my vagina and said it looked like a herpetic lesion, but was suspicious of it because it was a single blister and didn’t present as a typical herpes outbreak. My test results were negative for Chlamydia, Gonorrhea, Yeast infection, BV, and herpes not detected…

[cmr892]

My tests did come back positive for Trichomoniasis, which I was given Metronidazole for. I was also given an antiviral medicine due to the PA at urgent care not trusting the validity of the PCR done on the lesion. I was encouraged to make a follow up appointment with my PCP, which I did 2 weeks later, 7 days after stopping the antiviral [I did complete the entire prescription given]. My PCP did a full STD panel and the results were the following: HCV antibody NEGATIVE, RPR NON-REACTIVE, Hep B NEGATIVE, HSV1 2.35 and HSV2 .94 EQUIVICAL and a NEGATIVE supplemental. I was instructed to take another test 4 weeks later for the HSV2 for confirmation testing, those results were 2.82 with a NEGATIVE supplemental test. The dates for the two sets of tests were 2/10/2022 then 3/10/2022. More information about the tests used 2/10/2022 HSV Type 1 IgG [result 2.35] and HSV-2 Type Spec Ab, IgG w/Rflx 163033-LC [result .94 with negative supplemental] then 3/10/2022 was just HSV-2 Type Spec Ab, IgG w/Rflx 163033-LC [result 2.82 with negative supplemental]. I have not spoke my PCP about the new test results yet, I just saw them 3/15/2022. Before the second test we discussed if it was equivocal again with a negative supplemental we would agree that it was negative. However, because the value increase so much, it really freaked me out and I’m not sure what I should think. I’m considering doing the Western Blot test for peace of mind and based on what I’ve read in the forum, it’s probably going to be what you recommend, but I just wanted to reach out to hear from an expert on what you thought about the dramatic increase of the HSV2 value. I should also note, one of my sexual partners, who I had relations with around the time I got the vaginal lesion got his HSV 1 and 2 results back as 45.5 HSV1 and .90 HSV2. Thank you for your help and please let me know if you have any questions about the situation.

[cmr892]

Hello, it’s been longer than 10 days since I’ve posted and I have not had a response yet, when you have a chance will you please look at my post and provide your thoughts?

[Terri Warren]

I’m so sorry I missed your question.
There is a pretty good correlation between negative supplemental test and negative western blot so that’s good news but I would still recommend the blot due to the 2.82 index value. While not high, it is still a little higher than I would like to assume is negative. Have you ever had a cold sore on your lip or in your nose? The HSV 1 value is also in the low positive range. I think there is a reasonable chance that your HSV two will not confirm and a small chance that your HSV one will also not confirm as positive. Good news is that the PCR test was negative. If you’re going to take the western blot, I would discourage you from taking longer courses of antiviral medication prior to that testing as it can confuse the western blot test to be falsely negative.
Terri

[cmr892]

All’s forgiven, thank you for the relay! I have never had a cold sore before, neither on my lip or nose. I was only give the seven day antivirus medication, so I am not taking that anymore and will plan to avoid any future antivirals until after the blot is done. My PCP has scheduled another IgG four weeks since my last one to see if anything changes with the supplemental result, but I definitely plan on pursuing a Western blot once I get those results back. I will follow the instructions on your site to set up the consultation with you and call the university to get the kit. I’m glad it seems plausible that it’s a false positive, I’m looking forward to getting a definitive answer. Thank you for all you do and hope to do the consultation soon!

[Terri Warren]

I look forward to our conversation. Glad you going ahead and getting the kit

Terri

[cmr892]

Hello, this is not a question, I just wanted to provide an update on my situation. I’m not sure if I have used my allowed posts for my original question, if you would like me to purchase this as an additional question, please let me know. Bit of back story, I received three positive IgG HSV2 tests with values ranging from .94 to 7.65 between Feb 2022 to April 2022, two of these tests had negative supplemental results through LabCorp. I also had a negative PCR swab done in Jan 2022. I worked with my PCP to get a Westernblot sent to Washington University. I just got my result back today and was pleasantly surprised that the results were both negative for HSV type 1 and HSV type 2. I just wanted to let you know since my last IgG for HSV2 was 7.65 yet the WB was negative. Thank you for all your help, I truly believe that I would be living life believing I was HSV+ if it wasn’t for the work you do in educating society about the faults of IgG tests, Westernblot is truly the gold standard for HSV testing and is worth every penny 🙂

[Terri Warren]

I’m just delighted to see that you posted your western blot results. for those reading this that have positive IgG tests, regardless of index values and without symptoms ever, I would encourage you to consider the blot. I am now regularly seeing false positives at numbers far greater than 3.0. I have now seen a false positive at 17! Please – if you have any question about a diagnosis that has been made via IgG test, get a better test. The western blot is the gold standard.

Terri

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