Result confusion

[Absolutebeans1111]

Hi!

I’m looking for some help and guidance interpreting test results as my medical provider is out of town for a week and I received HSV results over the weekend. I had unprotected oral sex approx 6 weeks ago. I ended up testing positive for oral gonorrhea a week after contact and was treated with antibiotics. Two weeks later I developed PID symptoms (discomfort, generalized itching in genital area, feeling of need to urinate, fullness in pelvis) and given more antibiotics that cause horrible diarrhea and discomfort. A week later I noticed small pinprick size whiteheads near my clitoris and after one opened the consistency was thick and white like a whitehead but I had it swabbed for HSV because of anxiety. That result of that PCR was negative for HSV 1 and 2. I continued to have weird pelvic/genital discomfort with a few more of the white pimple like spots showing up but quickly going away after 1-2 days. Last week after visiting my PCP she agreed given my concerns over the prior 6 weeks to complete the following:

HSV Type 1 and HSV type 2 Specific Ab IgG
HSV I/II IgG
HSV I/II Combo Abs IgM Screen

I got my results yesterday and they were as follows:
HSV Type 1 glycoprotein Specific Ab IgG – 0.08 IV
HSV Type 2 glycoprotein Specific Ab IgG – 0.20 IV
HSV I/II IgG – 4.28 IV (did not differentiate between HSV I or II
HSV I/II Combo Abs IgM Screen with reflex – 0.97 IV (did not differentiate between HSV I or II

I’m confused how/why my glycoprotein specific Ab IgG are both negative for I and II while my other IgG with reflex is positive and my IgM is indeterminate? Does my IgG with reflex mean a newer or older infection? With my PCR negative, my understanding is there is no way to confirm if I’ve had an actual outbreak, when or where my exposure was (orally vs genitally). Assuming I never have a confirmed outbreak, or until I do, is it standard of care for me to disclose to future partners or not? Should I push my provider for antivirals? Thank you so much!

[Terri Warren]

Compared to the type-specific tests, I have seen many false positives on the combined test. Honestly, I have no clue why a healthcare professional would order both. Totally inappropriate. You need to pay attention to the type-specific IgG test results which both appear to be negative.

The IgG tests are not perfect – they miss 30% of HSV 1 infections and 8% of HSV 2 infections, compared to the western blot, but being negative on both so far is good though not definitive. But ignore the combined test -it’s not the one you want.
Terri

[Absolutebeans1111]

Thank you Terri. I’ve read that the type specific tests can be false negatives early on in a new infection? Is that how you understand it? I’m getting very conflicting information regarding the interpretation of my test results and it’s causing a lot of distress. Would you recommend I get re-tested with the type-specific test in a few months? I’m having “not typical” symptoms for the past four weeks (6 weeks total since possible exposure) and just want to make sure I’m taking appropriate precautions, taking care of myself and giving informed/correct information to my partners in the future. Thank you so much!

[Terri Warren]

It is true that if a type-specific blood test for herpes is done too soon after infection, it can be falsely negative. It takes a while to develop antibodies to herpes. If you still have concerns, I suggest waiting until 8 to 10 weeks after the possible infection and retest. But this time, please acquire only type-specific antibody testing.

Terri

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