Should I test? And other questions…

[Krissy]

Last week I tested for an HSV simplex type 1-2 IGG and IGM blood test (3.21 IGG and 2.07 IGM). At the time I took it, I didn’t know that it wasn’t recommended if you didn’t have an outbreak, nor that this test didn’t distinguish 1 and 2. I’m living in Brazil, so I don’t know the test brand. At the time I tested, I had a single bump on my anus (following diahrea)for about four days. It was small and hard, and itchy. It never appeared to blister or scab. (I have been diagnosed with hemorrhoids). At the time of the test, I had a new sex partner of a few weeks and we had not used a condom once. 7 months prior, I’d tested negative with an earlier partner. Both claim to have never had visible herpes. I did not have anal sex with either. My doctor told me that based on the numbers, it was likely a recent infection. My most recent sexual partner took the combined test after I got my positive result. But now doesn’t want to read his result, so I don’t know. Since that time, I’ve taken separate type 1 IGG and type 2 IGG blood tests, but I have not looked at my results and I’m not sure if I should. In these two weeks I’ve been very distressed and confused by the research. I’m concerned that reading the results will only cause more distress and confusion and lead me to a situation where I feel like I need to disclose stressful but ambiguous details to a future partner.
Will recent partners results be useful in determining my own status? Should I look at my HSV-1 and 2 results, or is it better to toss them and wait and see if I have an outbreak before doing further testing? If I should wait and see, should I be disclosing my combined HSV1/2 3.21 status? If it was a recent infection, should I expect my number to go up over the next few months? Is it likely to have anal HSV if I’e never had anal sex? What’s the likelihood that an hsv2 igg will be a false positive? I’m hoping you can help me determine an ethical but practical action plan, minus uneeded angst. Thanks!

[Terri Warren]

With an index value of 3.21, there is probably a 90% accurate positive HSV-2 test. While there is still a chance that this is a false positive, combined with the bump around your anus, I feel pretty sure that this sounds like a herpes infection. You could certainly look at your results now but with a 3.21 already known, I’m not sure why looking at the results would cause more distress. At least if you are infected now and know it, you can do things to protect future partners like taking daily antiviral medicine and asking them to use condoms to reduce the risk of transmission. If you lived in the United States, I would encourage you to obtain the herpes Western blot to confirm your lower positive results but you do not. You may get more information by looking at your most recent results to see if your index value is greater than 3.5.

Terri

[Krissy]

Thanks, Terri. I think there might have been a misunderstanding. The 3.21 was a result of the HSV 1 and 2 IGG combined test. It was not for a HSV-2 type specific test. I don’t know yet what my HSV 2 result is. Or my HSV 1.

My understanding is that the HSV 2 specific tests for 3.5 or below are often false positives, and that the CDC doesn’t recommend these tests without an outbreak.

Is that correct?

And if it is correct, then should I test for the HSV 2 specific antibodies, if my combined test was only 3.21 and I have not had a doctor diagnosed outbreak?

What does a 3.21 combined test result mean?

No doctor evaluated the bump because it cleared up so quickly, I couldn’t see anyone before it was gone. I sought the blood test on my own because I’m hyper conscientious/anxious about my health. When I had discomfort in the exact spot before, the proctologist diagnosed me with a hemmorhoid. I also wax and shave. So, sure…wishful thinking…I’m obviously wanting to hear that I don’t need to worry about it unless I have a diagnosed outbreak…

But at the same time, is it safe to assume that an undiagnosed bump plus a 3.21 result from the HSV 1 and 2 combined test means I’m positive for HSV-2?

Thank you again.

[Terri Warren]

Yup, I didn’t understand that. Are you sure? I didn’t know that combined tests gave index values. And I didn’t realize that you could even order a combined test any more.Yes, you need a type specific test. Anyway, it could all be from HSV 1, no way to know anything from that test. Or it could all be from HSV 2. You need the type specific antibody IgG test.

Terri

[Krissy]

“Yup, I didn’t understand that. Are you sure?…”
Yes, I’m sure. I’m in Brazil. The combined test is standard here.

“You need the type specific antibody IgG test.”
I understand I need one to know which type I may have. But that’s my whole question. If the CDC doesn’t recommend HSV blood tests for people who don’t have diagnosed active lesions, then I shouldn’t have every gotten the first test to begin with, right? Therefore, should I get the type specific test, or just stop now?

Also, I’m still curious about my previous questions:
What does a 3.21 combined test mean?
What is the likelihood that this is a false positive?
Also, am I right in my understanding that as many as 50% of <3.5 IGG HSV-2 tests are false positives? Or was that date for a different test?
Thank you,
Kelly

[Terri Warren]

Like I said,I cannot tell you what it means because it doesn’t separate HSV 1 and 2 so I cannot tell you if you have HSV one or HSV-2 or neither or both. I have seen this test be false positive compared to the type specific testing.
I cannot tell you the likelihood of a combined test being a false positive – we have no data on that,only the type specific test, as you quote
If you read the Center for disease control guidance on screening tests they say that HSV testing should be considered if someone is requesting a full STD screen. And if you had a bump that your clinician was concerned about, doing an antibody test is completely appropriate. The only problem is they ordered the wrong test.

This is your final post on the subscription. If you have more questions, feel free to renew.

Terri

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