Recent Positive Test on HSV-2 (HerpeSelect) IgG test through Quest

[AnonymousGuy]

I recently began a new relationship about 2 months ago and my partner requested that I get tested. We already had unprotected sex several times. About a week ago I signed up for the comprehensive STD test through http://www.tstd.org. The test included both the HSV-1 and HSV-2 HerpeSelect IGG test. I have never had any symptoms of an STD, and the last time I was tested was about 5 years ago (negative for all tested STDs). I do not recall if the old test included a test for Herpes I/II.

My most recent test indicated that I tested positive for Chlamydia and HSV-2 (with a 2.02 H score). I was concerned about the Chlamydia positive test, but I know it is easily curable and I have contacted all of my previous partners to let them know I had it. However, I was absolutely devastated to see I tested positive for Herpes II. I assumed initially that the positive score meant I definitely had Herpes II, as it was well over the >0.9 index range listed on the test. I almost immediately called my partner and asked her to come over so we could talk. It was an extremely emotional situation, as I was completely devastated at the thought I may have given her an incurable STD. On top of that, I felt like my “love life” was over as I knew it, as nobody would want to be with a guy that has Herpes II given the awful stigma associated with it. She was very understanding (she is an RN) and supportive, but of course distraught as well. She asked me if I ever had any symptoms, and she said it was strange I never had any sort of outbreak if I had it. I have in fact never had any symptoms of an STD. The only issue I can recall is my genitalia itching badly after shaving. I’m not sure what would cause a false positive (e.g., having Chickenpox before, etc..), but it seems that everything I have read online indicates that false positives are very common under the 3.5 threshold.

Given that the lab results were online and did nothing to explain how they came up with the index value of 2.02 H, I had no symptoms, and I knew nothing about the testing, I did a lot of online research. I was shocked to discover that it appears anyone under a 3.5 has a moderate chance of being a false positive, the CDC does not recommend HSV testing unless you show symptoms because of the risk of false positives, and the tstd did not indicate at all that there was a high risk of a false positive.

I had have several sexual partners in the past 5 years, most of which I had unprotected sex with. However, I have already spoken with the only two women I had a long term relationship with (i.e., we had sex a large number of times during our relationship) and they both said they were recently tested for everything and were negative (even for Chlamydia). I have no reason to believe they would lie to me. The remainder of the women I had sex with we dated for likely a month or so and maybe had sex a few times. My understanding is that while HSV 2 is obviously transmittable via sex, it has a low transmission level. So, if I had unprotected sex with someone 3 times, the odds of me getting the virus if they are not showing symptoms/shedding the virus would be extremely low.

All of that being said, I am in the process of having the Western Blot test done to confirm my results. I will be taking the test next week and it will likely take a while for the results to return. In the mean time, I would like to get your opinion on my situation. What are the odds that my test is a false positive? I’m assuming that if my body just detected the virus, the 2.02 H level may be lower because not many antibodies have been created? I took another test 3 days later just to confirm the first test, and I am currently awaiting those results. If they are much lower is that a sign of anything? Any advice you can offer would be helpful. Is it still understood that the HerpeSelect IgG test has a high false positve rate under 3.5, and is that rate even higher the lower the index value is?

Thanks,

AnonymousGuy

[Terri Warren]

You are wise to try and sort out this low positive HSV 2 result. Did you also test for HSV 1? If yes, what was the result? A value of 2.02 has about a 50-50 chance of being a true positive, certainly worth checking out. Has your current partner actually had an antibody test or HSV 2? When was the last time you had sex with anyone different than your current partner? If your current partner has been actually tested for HSV 2 antibody and test negative and it has been four months since you last had sex with anyone else, then a western blot is appropriate. I don’t know how you are going about getting it. Do not be confused between western blot and immunoblot and an inhibition assay. They are all different and only the western blot should be used to confirm or not confirm low positives. Antibody would only be created now if you were recently infected, thus the important of understanding the thing of your most recent sexual encounters with people that might be infected.

The CDC guidelines do say that some experts (myself included) recommend herpes testing as part of an STD screen and the new guidelines coming out next year will reinforce that and also address the low positive problem.

Yes, the lower the index value (over .91) the higher the likelihood that it will be a false positive.

Terri

[AnonymousGuy]

I tested for HSV-1 as well, but that test was negative.

My current partner has never tested for HSV-2, but she has tested for all other STDs and is negative. She was going to get tested, but thought it made more sense to wait longer for the antibodies to appear if she got it from me. Should she just get tested now to confirm that I did not get it from her? I would think that since we only had sex for the first time about 3 weeks ago, it is unlikely I would be seeing antibodies that soon if I recently received the virus.

The last time I had sex with someone other than my partner was about 3 1/2 months ago, and that was a single sexual encounter. My understanding that is, unless they are having a break out, the transmittal rate is extremely low for each instance of sex. So even if that person had HSV-2, the odds of me getting it from sex once are extremely low. Please correct me if I’m wrong.

I’m very nervous that there is a 50% I do have HSV-2.

Also, what could cause a false positive?

• This reply was modified 8 years, 1 month ago by AnonymousGuy.

[Terri Warren]

If you tested negative for HSV 1, the chances are a little higher that it is a true positive.
If you are testing in the low positive range because it is new infection, then it is likely from her. If you got it 3.5 months ago, one might expect a higher value. Yes, I believe she should be tested now to see her status. If she is negative now, you certainly did not get it from her. If you continue to have sex with her, then her value will always be a moving target, so there is no reason not to test now. I agree that it is unlikely but not impossible that you acquired HSV 2 from the partner 3.5 months ago.

I would not say that the transmission rate is extremely low without an outbreak unfortunately. Our research indicates that most transmission occurs when no symptoms are present.

How are you getting the western blot testing done?

Terri

[AnonymousGuy]

I am going through Westover Heights Clinic to have the test setup. I am scheduled to speak with a doctor in a couple of weeks and start the process.

I will pray that my test is a false positive, as you appear to indicate there is greater than a 50% I truly do have HSV-2.

[Terri Warren]

No, I’m pretty much sticking to the 50-50. I don’t think it is greater than that. Your lack of HSV 1 is built into my response 😉

We are now finished with your initial three posts. If you have other questions to ask me, feel free to add another round of three questions.

Terri

• This reply was modified 8 years, 1 month ago by Terri Warren.

[AnonymousGuy]

Hi Terri,

Thanks for the follow-up response. Just as an update, I had another test done on Friday and received the results today. My HSV1 is negative, but my HSV2 is 1.69 (lower than my previous 2.02). I’m not sure what to gather from that, but at least it is not higher. I understand there will be minor variations between tests, but if it had come out at something like 2.7 I would have been more worried. I plan on taking another test in 2 weeks to see if the antibody count increases at all. My current gf was tested in Monday and likely won’t get her results until the day after Christmas.

I have done an incredible amount of research on the IgG testing and false positive subjects, but have not found any explanation as to why false positives occur in people that do not have HSV1. Can you elaborate on the potential causes of false positives in people that do not have HSV1? I had Chickenpox when I was a child, is it possible that has anything to do with it? (And yes, I realize I’m grasping for straws. There are no words to describe the level of anxiety I have right now as I try to sort this issue out).

[Terri Warren]

I don’t think you can gather much from this. There is, as you already know, variation from test to test and this is certainly within the range of normal variation.

It is my opinion that probably most false positives are due to a cellular protein of a person’s own body that trips the test artificially. Chicken pox would not trip the test artificially. I’m working with a scientist who is developing a new test for herpes to try to sort out some of these low positives and that is what he believes, and I think that is a common response among the herpes testing experts, also.

When are you taking the western blot antibody test? Let me know the results – I will be very interested.

Terri

[AnonymousGuy]

I will likely take the test in early January. I will also be taking another HerpeSelect test in a couple of weeks to see if my test results vary anymore. I am a bit nervous because my exes within the last year say they tested negative for Chlamydia, but I must have gotten that from someone (unless it was a false positive). Also, what are your thoughts on the Biokit? I found a clinic in Houston that I could get that test done, and I have read it is pretty accurate. I’d like to know as soon as humanly possible whether I am infected.

[Terri Warren]

I’m not clear that continuing to take the ELISA test is going to help you at all here. But your call.
I have seen false positives on the chlamydia test before. Most labs now confirm the first positive with a different kind of test, not sure what yours did.
The Biokit may help you, yes. There is an interesting article by Rhoda Ashley Morrow comparing the ELISA, Biokit and western blot. You can look on PubMed for it and see if you find it helpful.

Terri

[AnonymousGuy]

The only reason I want to take the ELISA again is to see if my antibody count increases. If it goes up over 3 then I’m going to assume I probably have HSV2, though I will do the WB regardless. If it stays at the exact same level, at least that indicates I am either just a “low positive” positive person, or it’s a false low positive. Does that make sense? I would assume the count would go up if the infection was relatively recent and I was still creating antibodies.

I will look into the BioKit testing and hope for the best. Do you know of any clinics in Houston that do offer the BioKit? I would prefer to go to a clinic I can just walk into and take the test, rather than having to go through a doctor.

Also, I’m assuming this is the article you were referring to (for future readers’ reference): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276011/

• This reply was modified 8 years, 1 month ago by AnonymousGuy.

[Terri Warren]

You know, you can do that but even if it goes over 3, I would strongly encourage you to get a western blot. Yes, if it stays in the low positive range all you can know now is that you are either a person who just has a low positive index value or it is a false positive. Yes, I would expect if you had a recent infection your numbers would be heading up.

I am not aware of who is offering Biokit now. We used to do it and with a good strong pink circle, we could reliably call it a positive. But unfortunately we had too many patients who had very light pink dots that we could not accurately interpret. However, I think that improvements are in the works.

Once you know your partner’s test results, go for that western blot.
Though some research finds that there are more false positives in people who are HSV 2, in our lab, the numbers of false positives in HSV 1 positive and HSV 1 negative are close to the same.

Thanks for posting that reference link. The chart in Figure 1 is printed and laminated and available in every exam room in my clinic as this is a common issue we deal with about herpes testing.

Terri

[AnonymousGuy]

Hi Terri,

With regard to your statement about hsv1 positive and negatives, I don’t quite understand what you’re saying. Do you mean the number of false positives in people who have hsv2 is roughly the same regardless of whether they have hsv1? Please clarify if you can.

Thanks,

AnonymousGuy

[Terri Warren]

Yes, that’s why I’m saying. We see false positive in both groups.

Terri

[Terri Warren]

I think that the normal office people were not in the office today – will need to contact them on Monday.

Terri

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