Possible false positive?

[Ann-onymous]

I am a 31 yo white female. Recently I was tested for HSV1/2 at Quest Diagnostics. My IGM was negative for both. My IGG serum results were: HSV1 <0.90 and HSV2 >5.00 with an HSV 2 IGG Inhibition ELISA testing positive.
My personal history: My husband and I have been faithfully together for 10 years. Before this, I had several sexual partners, with only one of these encounters unprotected. The only person I have ever had oral sex with is my husband. My husband was tested for all STDs before dating me, all negative, aside from HSV 1 (he gets occasional cold sores). I had never been tested prior to this. My husband and I haven’t used a condom in the last 9.5 years.
About 1.5 years after my husband and I started dating, I was stressed out in grad school, and I had a quarter-sized, non-painful blistered rash appear on my left buttocks, at the sciatica. Not having insurance, I went to the campus doctor and he diagnosed shingles (I had chicken pox when I was little), and put me on anti virals. It cleared up, however it returned again several months later, he still thought it was shingles, but he suggested I get tested for HSV 2. After speaking with my now-husband, he went to get tested, because he had insurance, and I didn’t. The plan was, if he were positive, I would get tested. He came back negative, and I have never had any symptoms remotely similar to this since. The only thing I have had wrong with my genitals has been yeast infections, or heat rashes, as I work outside in a hot climate. So we put it from our minds.
I was tested recently because I had a large, painful sore at the back of my throat. I have always gotten small canker sores, but never so far back in my throat. This one was larger and more painful than I was used to, and it hurt to swallow. My doctor had it swabbed and tested for strep (negative) and gave me both valtrex and a Z pack, as well as orders for HSV testing. I took both the valtrex and Z pack, went and had my blood drawn, and meanwhile the sore went away.
Now, I have a HSV 2 positive reading. My husband plans to be tested. My questions are:
1. I’ve read about how unreliable ELISA testing is. Based on my history and test results, what is the probability my reading is a false positive? In my situation, would it be worth it to pay the money for a WB, or should I accept the reading and adjust my life accordingly?
2. If my husband gets tested, how do we know his results are reliable? Should he get a WB too? Could he have gotten two false negatives in the past?
3. I am confused as to how I got oral HSV 2, when I have only had oral sex with my husband, and he has tested negative twice. Is it possible to have both oral and genital HSV 2? Could I have first had genital HSV 2 and somehow have given myself oral herpes?
4. My doctor gave me a prescription for valtrex to be taken if I have an outbreak. My question is, given that I have only had three “suspect” episodes, what would you consider an outbreak?

[Terri Warren]

1. I’ve read about how unreliable ELISA testing is. Based on my history and test results, what is the probability my reading is a false positive? In my situation, would it be worth it to pay the money for a WB, or should I accept the reading and adjust my life accordingly?

I don’t think a western blot is necessary here. Your symptoms (the “shingles” which most certainly were not), the positive antibody test at >5, all strongly suggest that the antibody test is correct.

2. If my husband gets tested, how do we know his results are reliable? Should he get a WB too? Could he have gotten two false negatives in the past?

He can certainly get the western blot as it is slightly more sensitive for HSV 2 than the screening test. It is also possible he just never got your herpes!

3. I am confused as to how I got oral HSV 2, when I have only had oral sex with my husband, and he has tested negative twice. Is it possible to have both oral and genital HSV 2? Could I have first had genital HSV 2 and somehow have given myself oral herpes?

What makes you think the sore on the back of your throat was HSV 2? Was the swab test positive for HSV 2? If yes, I missed that. Otherwise, I seriously doubt that that was HSV 2 because you already had well established HSV 2 genitally.

4. My doctor gave me a prescription for valtrex to be taken if I have an outbreak. My question is, given that I have only had three “suspect” episodes, what would you consider an outbreak?

The rash on your buttocks is an outbreak, very likely.

If your husband has gone this long without getting infected, the chances are reasonable that he will continue in this way. But if you want to be more cautious about transmission, you could take daily antiviral therapy to reduce the risk even more.

Terri

[Ann-onymous]

Thank you, This really helps to sort out this confusion.
My doctor did do a swab of my throat, but I think it was only cultured for strep, not for HSV. She never actually told me I have oral herpes, but since that was the symptom that initiated the test, that was what I assumed was the HSV.
If the “shingles” was my outbreak, why has it never had a re-occurrence in ~7 years? For that matter, is it normal that I took so long for my first outbreak? If my husband is truly negative, then it was well over 2 years for a first outbreak since exposure. What are the chances of a false-negative test?
Also, is it possible I may get an outbreak somewhere other than the spot on my buttocks? I mean I’ve never had anything on my actual genitals, so I’m wondering whether it could “move”?
My doctor only told me that I should be worried about HSV if I get pregnant (which I don’t intend to do) with respect to transmission to the baby during birth. Is there anything else I should know? I feel like HSV 2 has such a serious reputation, but I’ve been living with it for close to a decade with very minimal impact. Is one skin rash and possibly one inner mouth sore in 10 years common?

[Terri Warren]

If you had this genitally, then I think if your sore throat was HSV 2, you acquired it when you acquired the HSV 2 genital infection. You could certainly get another outbreak on your buttocks or in the genital area. It wouldn’t be “moving” around if it showed up in a new place in the boxer shorts area, it would just be traveling to the surface of the skin on a slightly different nerve. But if you’ve had no outbreaks in 10 years you may never have another one. That isn’t common but it happens to others as well.

Terri

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