Positive test followed by a Negative Test for HSV

[clarification123]

Hi there,

I previously posted in this forum as my boyfriend had genital HSV and we has questions regarding discordant couples. He was diagnosed 5 years ago (before we met). Following a sexual encounter, he developed a lesion on his genitals and sought out medical help. The doctor was unsure if it was herpes or not and figured that it may just be an irritation due to friction. A diagnostic blood test (i’m unsure if it is was testing IgM or IgG antibodies) revealed that it was herpes. My boyfriend said that a swab test was also taken. We do not have the exact results at this time but we are working on obtaining the file.

Since Christmas, my boyfriend has been on a daily dose of valtrex to prevent transmission. A few weeks ago we went to an STD clinic together in order to determine which type of herpes it was. Blood was taken in order to perform an IgG specific type test which would take about 10 days to get the results. The doctor phoned this morning saying that the test came back negative for both types of HSV and that the inital test done 5 years ago was most likely a false positive (maybe due to a different strain of virus from the herpes family like chickenpox picked up by the text). WE WERE STUNNED! We asked if the fact that he was taking a daily dose of valtrex could affect the test results. The doctor said that it did not as this type of test looks at specific antibodies for hsv-1 and hsv-2 and that valtrex could not suppress or modify the amount of antibodies in the blood. The doctor assured us that these results confirmed that my boyfriend absolutely did not have herpes.

What should we do next? It is safe to say that he is herpes free after all?
Thanks so much

[Terri Warren]

If the blood test was an IgM, it could easily be a false positive. Even IgG tests have false positives. The HSV 1 antibody test misses 1 our 4 HSV 1 infections. As you can tell, these blood tests are not perfect. The Valtrex would not impact the current test because he had plenty of opportunity to develop antibody before starting the medicine. While it is possible that he might have HSV 1 and the test missed it, I think it is really unlikely he has HSV 2.

Have you been tested?

Terri

[clarification123]

Hi Terri,

Thanks for your response. It is greatly appreciated. I wanted to add that my boyfriend has had what he thought to be ‘outbreaks’…maybe 3-4 in the past 5 or 6 years. However, perhaps they weren’t truly outbreaks afterall given the situation. Maybe it was an irritation of some sort, but thinking that he had herpes, he just assumed it was an outbreak. This mild pattern is not typical of hsv-2 from what I understand, as such, if he does have herpes, it makes sense that it is most likely type 1 (as you mentioned).

When he was given the diagnosis, no values or information were given to him. As such, we don’t know if they came to this diagnosis via the results of the swab or the results of the blood test (which was maybe IgM tests). Therefore, the fact that a swab test may be of no importance in this situation. However, given this clarification, do you still think that the IgG test could be a true negative?

All we know for sure is at this point is that the recent IgG test showed that apparently he does not have herpes. I have had the IgG testing and I am negative for both types.

The reason why it is important for us to know if he has herpes or not (as well as the type) is because I would rather get oral herpes than genital herpes in order to prevent any complications during pregnancy. As such, our plan was for me to ‘purposely’ get the virus on my lip thus preventing me from getting it genitally and avoiding complications down the line.

Given the additional information on the situation, would you suggest retesting to see if the test will show a positive result for hsv-1 and if so, should he stop valtrex before retesting just in case?

Also, please let me know if I have used up my questions…I think I had 2 left from my previous subscription.

Thanks!

[clarification123]

Just to add, in another post you advised another client to stop taking valtrex before getting retested as it could affect the results:

(You are in a bit of a pickle here, for sure. Yes, the daily Valtrex can impact the antibody test. I would say that optimally, you would be off of it for 4 months before retesting.)

But in my response you said that valtrex would not affect the test results. Is this because it was a different test?

Thanks so much!!!

[Terri Warren]

If a person has possible brand new herpes, they should stop taking Valtrex before doing the test because the medication can slow or stop antibody development when a person is first infected. In your situation, infection, if present, is long standing and there has already been an opportunity for antibody development a long time ago so the admonition does not apply Does that make sense?

Many people (in fact probably most people) have mild herpes outbreak, regardless of type.

If you guys really want to know if either of you has either type of HSV, then the western blot is your best bet. Otherwise you are sort of guessing. I think the screening test is quite good for HSV 2, but just not for HSV 1.

Terri

[clarification123]

Hi again,

We would like to do the WB test rather than repeating thr type-specific test. How do we go about getting a WB test if we are not in the states? I assume valtrex won’t affect the results…

Thanks

[Terri Warren]

You can contact Roger Smith in my office about how to do this. He can send you a kit, but you will need to have someone draw your blood wherever you are. If you can’t arrange that there is no point in sending the kit. Valtrex at this point will not impact his test results. We cannot be as certain about your test results at this time if he is positive because you could be incubating virus and not have it show up on a western blot.

Terri

[clarification123]

Hi Terri,

(I bought additional follow-up questions). So, we got a hold of my boyfriend’s old patient file and read them over. There was never any mention of swab test results in 2010 (when he initially contracted HSV, or so they thought). There is only a note saying that he has genital herpes and that we was giving a course of valtrex for the infection. We are starting to think that he was only visually diagnosed, or that paperwork indicating a positive swab test was lost…

In 2013 he did a blood test to find out the type of HSV. He had never been on suppressive therapy at this point. The test that he did (as per the document found in the patient profile) was the Herpes Simplex IgG/EIA test. Results:

Type 1 = 0.44, non-reactive
Type 2= 0.25, non-reactive

Both tests were done using the Platelia kit. The nurse told him that he was still infected with HSV. However, according to the reference values that I found, the results of this test would indicate that he did not have either type of HSV.

He passed another type specific IgG test 3 weeks ago, and the results were negative for both HSV-1 and HSV-2, as confirmed by the doctor. (I did not ask for the levels, sorry). He was on suppressive therapy at this time.

1 ) Was the test in 2013 in fact negative for both types of HSV?

2) Would you agree that the possibility of him having HSV-2 in non-existent, and that if infected, it is HSV-1?

3) Given this new information, should we still proceed with WB testing? Or after 2 negative IgG specific blood test is he clearly negative for both HSV-1 and HSV-2?

4) If we do decide to do the WB, is there still a chance that it shows up negative?

5) Could you please explain what you mean by ‘incubating the virus’ (from your previous reply)

Your thoughts on how to proceed are greatly appreciated.

Again, thank you so much!

[Terri Warren]

I’m not familiar with that brand (think it could be BioRad but not sure) and I don’t know the cutoff values. But it sounds like you do know the cutoff values and that the giving of results was an error, should have been negative. Sheeesh

1 ) Was the test in 2013 in fact negative for both types of HSV?
Looks like it to me but you are the one with the cutoff values to know that for sure.

2) Would you agree that the possibility of him having HSV-2 in non-existent, and that if infected, it is HSV-1?
Agreed

3) Given this new information, should we still proceed with WB testing? Or after 2 negative IgG specific blood test is he clearly negative for both HSV-1 and HSV-2?
It certainly looks that way to me (more confidence in the HSV 2 result than the HSV 1 result)

4) If we do decide to do the WB, is there still a chance that it shows up negative?
Yes

5) Could you please explain what you mean by ‘incubating the virus’ (from your previous reply)
Oh, that the virus is reproducing in him and that soon there will be enough of it to trigger the immune system to produce IgG antibody

Terri

[clarification123]

Hi Terri,

It was in fact bio-rad. No cut off values were given, but it did say non-reactive so I am assuming that means negative. From what I researched, anything below 0.8 for this specific test is considered negative. So, it was in fact negative.

1) So do you suggest still doing the WB to get a final answer?

2) Incubation shouldn’t be an issue here as he was ‘diagnosed’ 5 years ago right?

3) If all these 3 test come back negative (2 IgG tests and the WB), should we still assume that he has type 1 as there was a history of herpes-like symptoms before OR should we assume that he is truly negative?

4) In your opinion, if you rule out hsv due to a negative WB result, what else do you think it could have been?

5) What are the chances that all 3 tests come back negative and that he does in fact have HSV.

6) Finally, what is your expert and professional opinion on this case? Do you think he is infected or not?

thanks so much for your help

[clarification123]

Hi again,

just to add to my previous post, here are the exact numbers from the second IgG test done in August 2015:

Type 1 = 0.8, negative
Type 2= 0.3, negative

Interpretation:
lower than 0.9 = Negative
between 0.9 and 1.1 = Equivocal
above 1.1 = Positive

The IgG values fluctuated from the IgG test in 2013…is this possible? Both tests still remain negative though…

Has your clinical impression now changed based on this increased IgG level for type 1?

thanks!!!

[Terri Warren]

My clinic impression is that the test is negative for HSV 2 but I can’t really say about the HSV 1. The fact that is misses 1 out of 4 infections and the HSV 1 value is pretty high for a negative makes me question the actual interpretation here. Fluctuations are completely normal in the same range (positive, negative)

Terri

[clarification123]

Hi Terri,

thanks for your clinical opinion on the matter. I guess the thing to do here is to order a WB to see if HSV-1 is present or not as the previous results showed negative, yet high, IgG values of 0.4 and 0.8 for HSV-1…we will be in touch with your clinic to get that arranged.

Also, would it please be possible to clarify some of the questions from above that weren’t addressed?

1) You mentioned that incubation could affect the WB results and make them show up a false negative, but that shouldn’t be an issue here as he was ‘diagnosed’ 5 years ago right?

2) If all these 3 test come back negative (2 IgG tests and the WB), should we still assume that he has type 1 as there was a history of herpes-like symptoms before OR should we assume that he is truly negative?

thanks so much for your help
I will keep you posted.

[Terri Warren]

1) You mentioned that incubation could affect the WB results and make them show up a false negative, but that shouldn’t be an issue here as he was ‘diagnosed’ 5 years ago right?

Correct

2) If all these 3 test come back negative (2 IgG tests and the WB), should we still assume that he has type 1 as there was a history of herpes-like symptoms before OR should we assume that he is truly negative?

If the western blot is negative for both HSV 1 and 2, that is as definitive as it can get and you should assume he is negative.

Terri

[clarification123]

Hi Terri,

The saga continues…

Just to recap the situation:

-boyfriend was visually diagnosed with genital HSV in 2011. Symptoms were micro-ulcerations and redness at the tip of the penis only.
-In 2013 he did the Herpes Simplex IgG/EIA test. Results:

Type 1 = 0.44, non-reactive
Type 2= 0.25, non-reactive

Both tests were done using the Platelia kit. The nurse told him that he was still infected with HSV. However, according to the reference values that I found, the results of this test would indicate that he did not have either type of HSV.

-in summer of 2015, did another IgG test to determine type as he was under the impression he was infected. Results:

Type 1=0.8, negative ( values lower than 0.9 were considered negative)
Type 2=0.3, negative

-doctor advised him that he did hot have hsv due to 2 negative tests and that it was most likely balanitis and refused to send him for a western blot.

-finally got the western blot test referral via another reluctant doctor who also thought he was was negative for both hsv 1 and 2…

-result of the WB is positive for hsv 1.

1) What to do next with 2 negative IgG tests and 1 positive WB for type 1? Does he have gential hsv 1 or not? Could he have been exposed to oral hsv ealier in life and be asymptomatic and in fact have balanitis and not genital hsv?

2) Should I get a WB too? My previous IgG test showed that I was negative for both types but since it missed 1/4 hvs 1 antibodies I could potentially have hsv 1 and not know it. If so, i would be protected correct? our goal is to prevent transmission to me genitally to reduce complications during childbirth down the line…

3) if he does in fact have hsv1 genitally, can I give myself the virus orally (from someone who has had cold sores since they were a child) and this way i protect myself against getting it genitally?

Thanks for you time

[Terri Warren]

I’m sorry, you are out of questions at this time.

Terri

• This reply was modified 7 years, 10 months ago by Terri Warren.

[clarification123]

Hi Terri,

I just paid for more questions.

Thanks!

[Terri Warren]

1) What to do next with 2 negative IgG tests and 1 positive WB for type 1? Does he have gential hsv 1 or not? Could he have been exposed to oral hsv ealier in life and be asymptomatic and in fact have balanitis and not genital hsv?

He certainly has HSV 1. Where he has it we would have no idea unless he has a positive swab test from an oral or genital lesion. He could have had oral herpes since childhood or he could have had herpes balanitis (though I think that is far less likely)

2) Should I get a WB too? My previous IgG test showed that I was negative for both types but since it missed 1/4 hvs 1 antibodies I could potentially have hsv 1 and not know it. If so, i would be protected correct? our goal is to prevent transmission to me genitally to reduce complications during childbirth down the line…

I would say if you want to know for sure if you have HSV 1 or not, in terms of risk of transmission from him to you during pregnancy, that yes, a western blot would give you that info most accurately of any test. but if you have had cold sores since childhood, I think the chances are excellent that you have this. .

3) if he does in fact have hsv1 genitally, can I give myself the virus orally (from someone who has had cold sores since they were a child) and this way i protect myself against getting it genitally?

No, not if you already have HSV 1. Again, back to the western blot.

Terri

• This reply was modified 7 years, 10 months ago by Terri Warren.

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