Regret

[navyvet1006]

I got my lab results back from Quest Diagnostics in regards to the Herpeselect IGG type specific test. I have never had an outbreak of either HSV 1or 2. Results were as follows: HSV1 1.47H, HSV2 1.50H stating I am positive for both. I do have a immune disorder and like I said never have had any outbreaks. About a week ago I did notice irritation on the back of my penis head, but the irritation went away after I placed Neosporin. Around May 25th I did have a condom break with a partner who I do not know. This is my 10th week since the regretful night since I have tested for HSV 1&2. Do you believe this is a false positive? I am so scared right now.

[Terri Warren]

These are both low positive values and need confirmation before you should accept them as positive results. I recommend the western blot but not until 16 weeks have passed. The western blot takes more time since infection to be accurate. The inhibition assay can be done earlier but I personally I don’t feel as confident about the IA as I do about the WB.

There is an excellent chance statistically that these are both false positives, but there in no replacement for the passage of time to figure this out. And don’t take any antiviral medicine if you want the most accurate testing to be done – it can interfere with the results.

Terri

[navyvet1006]

Can I call into your office when the 16 weeks are up and request a phone consult and order the WB from you? I think it will be difficult going through my doctor at the Vet. Admin. (VA)

Your answer to my first post has cleared my mind a little and left some hope still. I made the mistake in requesting the IGG test knowing I wasn’t ready for a result like this. But I am hoping for a false positive with both values, seeing as I have never had any symptoms so far in my life of oral or genital herpes.

• This reply was modified 7 years, 7 months ago by navyvet1006.

[navyvet1006]

Good morning Ms. Warren, I do have a question for you that has been running around in my head. Patients that are typically on chemo drugs and other immunosuppressant medications, do they typically have more severe and noticeable HSV lesions? What I am asking is I would know for a fact that I am having an outbreak and it won’t be a small bump or go un-noticed correct? Thank you.

[Terri Warren]

Yes, people who are immunosuppressed normally have more outbreaks that are more difficult to control. I can’t say that a small outbreak might go unnoticed, even in that situation. Yes, you can all into the office and get the test.

Terri

[navyvet1006]

Hi Ms. Warren, I read this article from Rhoda Ashley Morrow. “While confirmatory testing can clarify initially inconclusive results, Dr. Morrow cautions that the majority in the middle range are not falsely positive. “It’s good to remind people that most people who test in the gray zone confirm as positive.”

I had my doctor look at the irritation on behind the head of the penis, where the crown is and she did state that it “did NOT” look like herpes. I then got tested with the Herpeselect test from Quest with those low positive results. I am really worried now that the even on May 25th, 10 weeks ago maybe a true positive result?

HSV1- 1.47H
HSV2- 1.50H

I know this is very close to the low positive value, but would you think at 10 weeks these result are pretty solid for a true positive result?

Below is just a cut and paste from the article.

For those that have an index value that falls in a low positive range, between 0.9 and about 3.5, repeat or confirmatory testing is a reasonable option. Dr. Morrow summarizes the strategy she gives to people: “If, given all of your clinical and sexual history, and clinical presentation, you have reason to doubt a low positive test, your options include getting a confirmatory test.” For those looking for confirmation, there are three reasonably available and moderately expensive options that have data behind them to show they are useful: the Western Blot, Biokit Rapid assay, and the Focus recombinant inhibition HSV-2 ELISA (from Quest).

While confirmatory testing can clarify initially inconclusive results, Dr. Morrow cautions that the majority in the middle range are not falsely positive. “It’s good to remind people that most people who test in the gray zone confirm as positive.”

http://www.thehelpernewsletter.org/index.php?option=com_content&view=article&id=55:testing-winter-2009&catid=176:herpes-testing&Itemid=237

[navyvet1006]

I forgot to include that I am infused with a monoclonal antibody every two weeks for a rare blood disorder called PNH. The monoclonal drug is called Eculizumab. I am wondering if this glycoprotein could be interfering with my numbers?

This monoclonal antibody interferes like such: https://en.wikipedia.org/wiki/Eculizumab#Mechanism_of_action

Your opinion matters so much to me. I have had health issues since I was in the military at age 18 and still fighting a long painful battle. People like yourself, doing this for us have been what keeps me going and not ending this journey.

[Terri Warren]

I think Rhoda’s article in 2009 has been updated since then with studies showing about 50% of those who test between 1.1 and 3.5 are false positives. Indeed, Rhoda is an author on the one reference most cited on this topic. Since Rhoda developed the western blot, I think she would agree that it is a useful tool in trying to separate true positives from false positives.

I’m not familair with how Eculizumab might interact with the antibody test, honestly. Sorry!

Terri

[navyvet1006]

I really appreciate this board and your knowledge. Thank you for educating me, this is both scary but interesting to learn about. I might have a couple more questions for you before my 16 week mark to get the WB.

You really think that the test I had done could be a false positive though for both HSV 1 and 2?

[navyvet1006]

If anyone looks back and is also on a monoclonal antibody drug here is an article to reference. I will updated when I get my Western Blot testing completed also. I am hoping for BOTH negative outcomes, but I feel that it will be a positive in my situation sadly and I am just grasping at everything in denial.

http://www.ncbi.nlm.nih.gov/pubmed/1737638

Chicken antibodies: a tool to avoid interference by human anti-mouse antibodies in ELISA after in vivo treatment with murine monoclonal antibodies.
Larsson A1, Mellstedt H.
Author information
Abstract

Human anti-murine antibodies (HAMA) can be found in serum of many patients who have received murine monoclonal antibodies for diagnosis or therapy. These antibodies are known to give false positive results in sandwich-type assays (e.g. ELISA or RIA). This interference problem will increase in the future as more patients are treated with murine monoclonal antibodies in vivo. HAMA can also be found in sera from patients that has not been treated with monoclonal antibodies. In this work we have studied the interference of HAMA in sandwich ELISAs containing antibodies from different species. HAMA, present in the sample, may react both with the capture antibody and the detection antibody in these assays to give a false positive reaction. HAMA did not react with chicken IgG, and if one of (or both) the capture and detection antibody was of avian origin, the interference of HAMA in sandwich assays could be avoided.

[navyvet1006]

Hi Terri, sorry to keep bothering you, I am trying to understand what I am reading from the CDC. Does this mean that the Herpeselect Elisa HSV1 test is most times a bad choice in testing when there is no obvious cold sores because of the high chance of a false-positive?

Found it on the CDC website under Type-Specific Serologic Tests
The HerpeSelect HSV-1 Elisa is insensitive for detection of HSV-1 antibody

http://www.cdc.gov/std/tg2015/herpes.htm

[Terri Warren]

It is not the chance of a false positive it is the chance of a false negative. If the test is positive over 3.5 you can rely on that but if it is positive at 1.1 to 3.5, then you need confirmation done. Our new research indicates that the ELISA for HSV 1 misses about 25% of infections. That has not yet been published.

Terri

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