Please help me understand: HSV 2 3.55, WB "indeterminate"

[rmakas]

I’m 39 year old bisexual male. I’ve had chicken pox once when I was 10, and mono for about 2 months when I was 18. I’ve had recurring canker sores on the insides of my lips, and sometimes tongue and soft palate, from stress and mouth injury (biting cheek/lip) since I was a teenager; these would manifest as a single ulceration inside my mouth, and never as a clusters of blisters, so I don’t believe these are (HSV) cold sores. I have never experienced any herpes outbreaks or symptoms thereof.

1/16/15, I had oral give/receive sex with a male (HSV status unknown).

3/11/2015, LabCorp IgG STI blood draw: HSV2 positive value of 3.55 (index 0.00 – 0.90).

5/24/15, Blood draw and shipped to UW for Western Blot: “Low level antibody detected by Western blot assay. Indeterminate for HSV. No antibody to herpes simplex virus type 1 detected by Western Blot Assay. Atypical reactivity was noted against proteins on the HSV-2 Western Blot.”

Let’s say I didn’t have sexual contact between the 3/11/15 blood draw and the 5/24/15 blood draw. Would it be a logical conclusion to assume the odds are very good that I’m not carrying the virus that causes HSV2? I’m thinking the answer is yes, to the extent that I don’t bother retesting HSV unless a breakout consistent with HSV should occur, so that I can get on with my life and stop losing sleep over this; given the uncertainty of the results and the effect on my psyche, I understand now why the CDC doesn’t recommend HSV testing unless an outbreak has occurred. Having never had an outbreak, I wish I had never gotten tested for HSV in the first place.

In the future, I plan to continue using condoms, and getting STI screenings 2x a year — WITHOUT HSV TESTING (again, unless a breakout consistent with herpes should occur).

Thanks for your input.

• This topic was modified 7 years, 8 months ago by rmakas. Reason: Cleaned up a little bit

[Terri Warren]

If you have not had sex after your January encounter, then a western blot done on June 16 would be considered accurate. That is true if you have not taken any antiviral medicine and are still indeterminate. That is the University of Washington interpretation of two indeterminates, with no sex for six months in between.

I understand that this is difficult for you, but I respectfully disagree your interpretation of the CDC guidelines. True, they do not recommend screening of the general population, but the do state that some experts recommend herpes as part of STD testing. Eighty percent of those infected with HSV 2 deny having herpes (i.e no recognized symptoms) but they are all infectious to others. Would you prefer to find out you have herpes by infecting another person? Because that’s how people who are not tested often discover they are infected. If you know that you are infected, you can begin to recognize outbreaks and avoid sex when having them, you can take daily antiviral therapy to reduce the risk of infecting another person by half, you can reinforce in your own head the need to use condoms to reduce the risk of transmission and also reduce your own risk of acquiring HIV or another STI. To me, testing for herpes is an essential part of an STD screen. We can agree to disagree.

Terri

[rmakas]

Thanks for your input, this confirms my understanding of the “indeterminate” result. It is true that I have not taken any antivirals.

The HSV screening I had was somewhat traumatic due to seemingly unreliable results. That is why I’m nervous about doing it again! Perhaps what I’ll do for my next STI test is use my LabCorp facility again for gonorrhea, chlamydia, syphilis, HIV — I’m hopeful that these tests are a little more reliable than the HSV IgG test they do. Then skip the LabCorp HSV screening and instead do a UW western blot.

[Terri Warren]

that sounds like a perfectly reasonable plan. It isn’t that the results are not reliable it is that they are inconclusive – for now.

Terri

[rmakas]

Hi Terri, I had another UW western blot test and was hoping for help interpreting the results. Let me know if I need to purchase another question, I’ve lost track, and I’m happy to do so. In summary:

3/11/2015, LabCorp IgG STI blood draw: HSV2 positive value of 3.55 (index 0.00 – 0.90).

5/24/15, Blood draw and shipped to UW for Western Blot: “Low level antibody detected by Western blot assay. Indeterminate for HSV. No antibody to herpes simplex virus type 1 detected by Western Blot Assay. Atypical reactivity was noted against proteins on the HSV-2 Western Blot.”

On 6/15, I had a legion appear just inside my left nostril that looked like a pimple or blister, which lasted about a week before it went away. It didn’t crust over that I could tell, but otherwise met the criteria for a cold sore, albeit in an odd location, consisting of a one or perhaps two blisters (was hard to see). On 7/4, I had another lesion in the same nostril, but about 2cm further up, where I almost couldn’t see it, which lasted about a week before it went away. No fevers or flu-like symptoms. I had convinced myself it was an HSV2 outbreak in an odd location (I have performed oral sex on a number of men and women, and part of my inside nostril could very well have brushed up against genitalia at some point), but it also could have just been a pimple or something else. It’s pretty easy to think every little bump is HSV when you’re not sure of your status.

7/28/15, Blood draw and shipped to UW for Western Blot. Exact same ‘indeterminate’ HSV2 result as from 5/24/15 draw & test. And same “No antibody to HSV 1” result.

As for sexual partners, I’ve had four since 2/24/2015, all of whom I would consider very low risk for HSV, so to keep things easy, I’m going to assume they were all negative (but of course plan to have ongoing STI tests in the future to be sure).

How should I interpret this? Do you think I need to do a third WB test at some point in the future before I can have closure on this?

Thanks so much for all your great work here and on other online forums.

PS: I had contacted Rene regarding her study on indeterminate results, but while there is a LabCorp nearby, there is no Quest anywhere near where I live; I believe she was working through Quest for her blood draws.

[Terri Warren]

I think another western blot would be pointless. In my experience, unless someone is having a true first infection and not enough time has passed for antibody to be made yet, those indeterminates stay that way. It is possible that with current testing technology, you will get closure on this. There are other tests coming (we hope this study will facilitate that) that may help. But the general though is it you stay indeterminate for 10-12 months, you are really negative.

Perhaps you could contact your local LabCorp and explain that you would like to participate in a study that requires a blood draw and could you use them for this purpose, for a fee?

You are now out of questions. I’m so sorry your life is in a bit of limbo with this.

Terri

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