Postive HSV1 IGG and low HSV2 positive

[Mgmg7271]

Hi Terri,
I’m a 25F and I recently got an IGG test for both HSV1 and HSV2. This was part of a full sti panel I did at urgent care. I’ve had cold sores on my lips since I was a child so I was aware of my HSV1 status. However, I had never been tested for HSV2 due to having no reason to. I tested because of an encounter and I was paranoid of all stis. I was told by urgent care that they didn’t need to do the blood but I insisted and now I wish I didn’t. I tested 5 days after the encounter although that person says he had been tested in the last 6 months and was clean for everything. My HSV1 Igg came back at 38.3 but my HSV2 came back at 2.14 to my surprise. I started freaking because I was having burning and some itching, however I also tested positive for BV that same week on a swab.
Urgent care did not follow up for almost 3 weeks and just sent me my results with no explanation. I went to my OB at the 3 week mark from the first test and got another IGG this time from labcorp with the supplemental. My results were 1.67 IGG and the supplemental was NEGATIVE.
Before this encounter I had only been with one other person who also has a clean sti record and before that I was married for 7 years. Never had an outbreak or any hsv2 genital symptoms that I am aware of, no lesions or bumps. My OB isn’t being very helpful and she was also unaware of what the supplemental test even was. So this is only making me more nervous.
My questions:
1. What are the chances my tests were false positives?
2. Should I trust the supplemental negative? How accurate are they?
3. Is it true high HSV1 values can cross react with HSV2?
4. Should I get the western blot or go off the supplemental?
Thank you.

[Terri Warren]

1. What are the chances my tests were false positives?
I think the odds, with the negative supplemental, are about 90% or better that this is a false positive

2. Should I trust the supplemental negative? How accurate are they?
The negatives are quite good – and they have good agreement with negative western blots as well

3. Is it true high HSV1 values can cross react with HSV2?
Absolutely

4. Should I get the western blot or go off the supplemental?
I guess it depends upon how certain you want to be – I think infection in your situation is quite unlikely honestly but I can’t promise that.

Terri

[Mgmg7271]

Hi Terri.

Thanks for your response. I had some things change since posting this originally.
A week ago I started feeling what some would describe as prodome symptoms. This included: lower back pain that went down both sides of my butt and legs and down to my tail bone. Burning like hot water being poured on the back of my thighs/inner thighs and it feels like it goes into my groin. Razor burning feeling on my moms pubis but nowhere else (I had not shaved until 2 days ago but no rash or sores or lesions that I can see) however, it’s been over a week and if it was prodome I read I would see an outbreak within 48 hours?
Do these symptoms sound typical of HSV2 prodome? If so, why haven’t I had an outbreak genitally?

I went back to my OB on 12/14 (a week and one day after my last IGG test) with these concerns. They did a genital exam and said they didn’t see anything but this doctor was insistent that once the IGG is positive that means positive. That there’s no such thing as a low or false positive. But he still drew my labs that day both for HSV1 and HSV2. I got my results yesterday. HSV1 was at 36.2 and HSV2 was lower this time at 1.53 but the supplemental came back POSITIVE. This confused me even more.

My follow up questions are:
1. Why did my IGG go down but my supplemental turned positive? Do I basically accept the fact that I have HSV2 regardless of an outbreak?
2. Can you have the symptoms I described (leg/groin burning/ back pain and some genital burning) but no outbreak for over a week? Is this considered an outbreak?
3. How accurate are positive supplementals by labcorp?
4.Should I take the western blot to confirm once in for all?

Thank you.

[Terri Warren]

1. Why did my IGG go down but my supplemental turned positive? Do I basically accept the fact that I have HSV2 regardless of an outbreak?
NO
2. Can you have the symptoms I described (leg/groin burning/ back pain and some genital burning) but no outbreak for over a week? Is this considered an outbreak?
It is not considered an outbreak – if anything it might be prodrome

3. How accurate are positive supplementals by labcorp?
I have 97 patients who have positive supplemental tests and negative western blots.

4.Should I take the western blot to confirm once in for all
absolutely.

Terri

[Mgmg7271]

Thanks Terri,

I just wanted to follow up with my last follow up here.

Since the last post the only person I did not have HSV results for was my most recent sexual contact and the one that prompted me to get tested from being anxious. He got his results back and is negative. So at this point every person I have slept with in the last 7 years has had a negative HSV2 result/no symptoms.

My symptoms have gotten better. I believe some are stress related. Still no outbreak (no sores, cuts, lesions, burning while peeing etc) how common is it for prodome to last longer than 2 weeks without an outbreak?

With all my sexual contacts being negative and lack of an actual outbreak, would you recommend I still take the western blot?

I did see another doctor recently because I thought I saw a bump. She was very confident that I am negative and my results were due to my high HSV1 values. She expressed how I should have not gotten tested in the first place since I did not have an outbreak. I felt more at ease after this and noticed my symptoms less. I also recently got a hormonal IUD which she thinks is causing some of my back pain issues.

To summarize my follow up;

1. Would prodome last longer than 2 weeks without an actual outbreak of sorts? Specially for primary outbreaks?
2. Should I still pursue more testing despite the fact that all my 3 partners from the last 7 years have tested negative/have no symptoms?
3. Does the western blot cost less if I get a doctor to sign off on it? Or will UW bill me directly?
4. If I don’t go through you for the WB how will I receive my results?

[Terri Warren]

I don’t think that you need to take the western blot, no.
Prodrome doesn’t normally last two weeks
No more testing!
There is just no point in testing because all of your sex partners test negative.
If you do the blot, it might be cheaper doing it through your doctor because the office visit charge may be covered by insurance – with me, it is not. UW will not bill you if you don’t live in WA. I don’t know how people received results if not through me but I would assume through your own doctor.

TErri

[Mgmg7271]

Hello Terri, I have renewed my membership to ask a few more questions.

I can’t seem to let this go despite my partners being negative due to the things I’m experiencing. These symptoms have been going on for over 25 days and they are daily.
I feel pain in my lower back that’s worse on the right side and it goes down to my tailbone. The pain also radiates down both my buttocks and they often feel sore. I get pain and burning down both the back of my thighs and it radiates into both my inner thighs and groin area. It’s not constant but happens through out the day. Most recently (for about 5 days now) I’ve had pain in my left hip and a tingling numbness that goes down into my left labia majora and sometimes I feel it down my right butt. Often when this happens my left thigh and leg feels tingly and like it goes weak almost. I sometimes have itching but it’s not consistent. Although I recently just got diagnosed with another BV infection. I still feel burning and a “hair pulling” feeling on my pubic area randomly. But every time I inspect myself there is absolutely nothing there. Sometimes slight redness but I also constantly pull and check myself. But no bumps, cuts or anything other than a few tiny ingrown hairs here and there but they always go away in a day or two. I got a hormonal IUD placed a few weeks before all these symptoms started. So I wonder if this is also hormonal related? I can’t find relief. But there has been no sign of an outbreak at all. I don’t know how much of this is mental as well. It seems I’m very aware of every feeling down there even feeling uncomfortable at times if my underwear is too tight.

My questions:
1. Do the symptoms above sound typical for a new HSV2 infection to you?
2. Would symptoms like this last this long without an actual outbreak?
3. Do you think this may be hormonal? Mental?
4. Would you still advise against further testing since all partners were negative?
5. Should I be looking for other reasons for these symptoms

[Terri Warren]

1. Do the symptoms above sound typical for a new HSV2 infection to you?
They do not
2. Would symptoms like this last this long without an actual outbreak?
Likely not
3. Do you think this may be hormonal? Mental?
I think it could be due to many things, mental worry and physical. Herpes would not be at the top of my list
4. Would you still advise against further testing since all partners were negative?
Yes
5. Should I be looking for other reasons for these symptoms
You might have a muscle pull, a disc compression, many things!

Terri

[Mgmg7271]

Thanks so much Terri!
I ordered the WB kit just in case I decide to take it.

Just a few more questions due to my anxiety.

1. My burning nerve pain has gotten significantly worse in the last day. It almost feels like someone is holding a match over my legs and thighs and hips. This is day 26 or 27 of this. Have you heard of any symptom being this painful and lasting this long with HSV2?
2. I took valtrex last week for 5 days due to a cold sore (thanks stress) and my symptoms below did not improve at all. Is this another sign that this is not HSV2?
3. If I do take the blot, would those 5 days of valtrex affect my results at all?
4. My biggest fear with not letting this go is that this is somehow an outbreak or prodome symptoms and being intimate with my boyfriend. Would an outbreak ever present like this?
5. My IGG tests were as follows:
HSV1 38.3 HSV2 2.13(unsure of lab)- 3 weeks later my HSV2 was 1.67(labcorp, neg supplemental) A week later HSV2 was 1.53 (labcorp, pos supplemental) and 3 days later HSV2 1.31 (quest labs, no inhibition ran) if this was a new infection my IGG should have increased right?

6. at this point I’ve had my most recent doctor and yourself say there’s no need for more testing as I have no outbreaks and negative partners. If my other symptoms persist should I just do the blot?

Thank you.

[Terri Warren]

1. My burning nerve pain has gotten significantly worse in the last day. It almost feels like someone is holding a match over my legs and thighs and hips. This is day 26 or 27 of this. Have you heard of any symptom being this painful and lasting this long with HSV2?
I don’t believe that I have, no, especially with Valtrex on board.

2. I took valtrex last week for 5 days due to a cold sore (thanks stress) and my symptoms below did not improve at all. Is this another sign that this is not HSV2?
Yes, I think it is a sign that this may well not be HSV 2

3. If I do take the blot, would those 5 days of valtrex affect my results at all?
No, but I wouldn’t advise more.

4. My biggest fear with not letting this go is that this is somehow an outbreak or prodome symptoms and being intimate with my boyfriend. Would an outbreak ever present like this?
Outbreaks can present in many ways.

5. My IGG tests were as follows:
HSV1 38.3 HSV2 2.13(unsure of lab)- 3 weeks later my HSV2 was 1.67(labcorp, neg supplemental) A week later HSV2 was 1.53 (labcorp, pos supplemental) and 3 days later HSV2 1.31 (quest labs, no inhibition ran) if this was a new infection my IGG should have increased right?
Not necessarily

6. at this point I’ve had my most recent doctor and yourself say there’s no need for more testing as I have no outbreaks and negative partners. If my other symptoms persist should I just do the blot?
I think if this would bring you peace of mind, for sure I would recommend it. YOu’ve had such mixed reuslts

Terri

[Mgmg7271]

Thanks Terri,

I will be setting up the appointment to do the western blot through you.
However, I do not see any availability. Will this be updated soon?

Just a few last questions as I’ve decided since I can’t let this go the blot will give me the answers I need.

This week I am also going to get my back looked at in case my pain is back related as that is how these symptoms started.

1. I have had reacurring BV since getting an IUD (I’ve since then gotten this removed last week) the only genital symptoms I get sometimes is a minty burning feeling down there but I am still on antibiotics for BV. Would an HSV2 primary outbreak present as just burning with no sores/lesions or burning while urinating? Or is this most likely my BV infection?

2. I saw a post on how valtrex affects blood results. Does it cause false negatives? Or false positives? In either case, how long does one have to take it for that to affect blood work results??

3. Above you said outbreaks can present in many ways, if my symptoms somehow were an outbreak, would it last for over 27 days? Even after taking valtrex?

4. In the case that the test comes back intermediate, what are the steps to go about then?

Thanks so much!

[Terri Warren]

I’ve added some appointments for this coming Saturday. We are leaving the country for one month on the 14th and I don’t know if we will have internet so I’m not setting up anything beyond this for now.

1. I have had reacurring BV since getting an IUD (I’ve since then gotten this removed last week) the only genital symptoms I get sometimes is a minty burning feeling down there but I am still on antibiotics for BV. Would an HSV2 primary outbreak present as just burning with no sores/lesions or burning while urinating? Or is this most likely my BV infection?
I think it is more likely BV but normally, BV does not cause pain with urination

2. I saw a post on how valtrex affects blood results. Does it cause false negatives? Or false positives? In either case, how long does one have to take it for that to affect blood work results??
Valtrex, when taken with a brand new infection for more than a few weeks, can delay antibody development, correct.

3. Above you said outbreaks can present in many ways, if my symptoms somehow were an outbreak, would it last for over 27 days? Even after taking valtrex?
No, I think that is really unlikely

4. In the case that the test comes back intermediate, what are the steps to go about then?
Well, it depends upon how much Valtrex you’ve taken. If more than two weeks, you should consider not taking it and waiting three months to repeat the indeterminate – that is the advice of the UW.

Terri

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