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Hi,
I recently has STD screening by my GYN as a matter of routine they ask each visit. I had never had this before and they said it would be good to have even though I had low risk factors. So, this time I said yes. Everything came back good except herpes. My IgG test showed HSV 1 >8 and my HSV 2 2.88 indicating both positive. I was told at some point in my life I must have been exposed to the virus. I have never had any signs of genital herpes, so I guess I am asymptomatic and rarely get cold sores on my lip- the only time is when I am sick with a cold or flu, which is very infrequently- maybe once a year if that.I am questioning the results because I’ve read several things: 1. the CDC does not recomment routine blood testing for herpes unless there is specific problems to indicate a problem and 2. values in the 1.1-3.5 range are 50% false positive and another blood test may be in order to determine if it is really a positive or false positive/negative.
What are your thoughts in this? How do you think I should proceed?
My background is that I was married for the last 20 years and it was a faithful marriage. I had several partners before this marriage and rarely had any type of infection. Since my husband’s passing, I’ve been in a monagomous relationship with a man who was just out of a 10 year relationship and had 2 short-term sexual encounters and 1 one-night stand with oral sex only. We have been together for a year and a half and are both 67 yrs old.
My Dr says he most likely has it too and it doesn’t matter who gave it to whom. But she suggested he get tested. He agreed and had blood drawn but his Dr said that since I have no signs or outbreaks it was unnecessary, but they did the test anyway. We are waiting for the results. Given my numbers, do you think I got this recently within the last year if my results are accurate? What is your take on his Drs. opinion about the test for him not being necessary?
Thanks for any info.
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The CDC does not recommend routine testing of the population for HSV, that is correct, but they do state clearly that many experts recommend HSV 2 testing as part of an STD screen so it is completely appropriate that this was done for you. We never do an STD screen without including herpes antibody testing, which is the mostly likely thing that we find positive in an infection screen.
It is true that 50% of people with an IgG between 1.1 and 3.5 are false positives. The closer the value is to 1.1, the more likely it is to be a false positive. Overall, in the seven years of records that we have kept on this topic, 5.5% of the population that we test for herpes falls into this low positive range. That means that 95% of the time, we get a clear positive (greater than 3.5) or negative result. So most of the time, confirmatory testing is not needed. But occasionally, like in your case, it is needed. You need a herpes western blot from the University of Washington. This can obtained by requesting a kit from the University of Washington be sent to you or your provider for blood to be drawn and returned to them or you can become a patient of our clinic by phone and we can arrange for blood to be drawn at a lab near you and sent to UW. Right now, those are the only two ways it can be obtained. It used to be more widely available, but for a variety of reasons, too complicated to describe here, this is it. And you need to know for your future sexual life. I’m not sure that your doctor fully understands the implications if this test is truly positive. If the confirmatory test is positive that means you are both infected and infectious to others. It does NOT mean you have simply been exposed to the virus. It is important to know your partner’s status. If he is negative then you have things to discuss. Since you’ve been together for a long time, if he is not infected, he may not get infected but there is definitely a chance that he could be. Perhaps he won’t care, which is fine, this is a decision for the two of you to make between you. But I think it best that you both know where things actually stand with this virus in your bodies so you can make intelligent decisions about what to do next. If the confirmatory test is positive, by the way, and he is negative, there is no way to know how long you have been infected. If he is positive, you can’t know if it came from your current partner or from 30 years ago.
I hope this is helpful for you. If you other questions, please ask. You have two follow up posts you can make with your subscription.
Terri
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I understand that you are upset, but I think you should hold that emotion in check until you get a confirmatory test. And I seriously doubt that you will find many counselors who specialize in herpes. I wouldn’t advise taking the Valtrex until your partner is tested. If you are both positive and you have no symptoms, there is no need to take it. If he is negative and your confirmatory test is positive, then you can discuss it as a couple and you may need to take it to reduce the risk of transmission because you can transmit without any symptoms.
The western blot looks at the wide range of proteins associated with herpes antibody while the screening test you had done only looks at a single one. It is more comprehensive and is considered the gold standard in herpes testing. You need it. I hope you will figure out how to get it now. If you call the clinic to establish care, we can order that for you as early as Monday. What state do you live in? Six states in the US will not allow tests to be shipped out of state.
You still have one more question to go.
Terri
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So unfortunately, New York does not allow tests to be sent out of state. If you want to do the western blot, you will need to be go to another state to get tested. We send many people from New York to New Jersey or CT. It would probably be easiest now given where you live to go through the clinic to get this done. We’ll identify the closest lab to you and will put an order in there. Don’t let this obstacle stop you from the western blot. And Quest labs, that we use for ordering the test, will bill your insurance and your supplemental insurance.
Now we have reached our initial question and two follow up questions as new subscriber. If you have more questions, you can register for $10 for two more additional follow up questions.
When you get your western blot results if you want to talk about them, let me know, OK?
Best
Terri -
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Once we order the test and you have your blood drawn it takes anywhere from 1-3 weeks to get the results. The way this works, if you use us, is we do about a 10 minute phone consultation with you to establish your care with us. This may be done by one of our physicians or nurse practitioners. We then determine which Quest laboratory is most convenient for you and set up a time for you to go in for your blood draw. We then need to fax them some special instructions of this lab to be drawn and shipped. This process takes about two days to complete. You go in, make financial arrangements for the blood draw and test, your blood is drawn and shipped to the University of Washington, they run the test and get us the results. We then contact you with the results. If the test is easy to read, it takes about a week, if it is more complicated (which many low positive are), it can take up to three weeks. Most often the results are a clear negative or positive, but sometimes with these low positives we get an indeterminate result.
Terri
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Statistically, there is a 60% chance it is a true positive and a 40% chance it is a false positive.
If the western blot is indeterminate, that means that they cannot call it a positive or a negative. However, if the indeterminate lasts for 6 months, then it is very likely a false positive (as no seroconversion has taken place).
Yes, I think that decision is good. That way if he has a low positive, then you can both get western blots, a little togetherness!Terri
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I think it is very common once a person has any kind of positive diagnosis, be it correct or incorrect, to notice symptoms, that may or may not be herpes. If you have actually blisters on the labia, you need to have these swab tested immediately. Can you get in tomorrow? Or go to Urgent care today? What you need is the PCR swab test, far better than culture.
Honestly, chemotherapy is the time that many people find out they have herpes because the chemo suppresses the normal immune response, allowing symptoms to emerge. I think you would be far more likely to have lesions during chemo than now.
Again, if you actually have blisters GET THEM SWAB TESTED!
Has your partner gotten test results back yet? Do you know you can order the IgG online without a provider order?
Terri
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I’m sorry, you’ve reached your three initial questions and three follow up questions. You might want to add more as I think we have more to talk about here.
I try to keep this fair for everyone in the same way, don’t mean to be difficult!Terri
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You can just keep adding questions.
If you want to use online testing, there are several avenues for that. I like healthcheckusa.com. You just go to their website, look up the HSV 1 and 2 IgG and order it. They don’t let you use insurance, though. They send you a lab form, you take it to the lab and get your bloods drawn . Then they give you the results online. But I must say that the people that talk about results often don’t know what they should know about herpes, so you can ask me for sure.Terri
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I’m so glad you are feeling better now. And good that you taught your doctor something! If you would like a reference to an article about the low positives, I would be happy to provide you with that for her. This diagnosis is certainly nothing medically compared to cancer, and in time, if you are positive, which is unclear yet, I think you and he will do a good job of developing proper perspective about this problem.
Terri
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Sex Transm Dis. 2005 Dec;32(12):771-7.
Herpes simplex virus type 2 (HSV-2) Western blot confirmatory testing among men testing positive for HSV-2 using the focus enzyme-linked immunosorbent assay in a sexually transmitted disease clinic.
Golden MR1, Ashley-Morrow R, Swenson P, Hogrefe WR, Handsfield HH, Wald A. -
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You can call my clinic and ask for a phone consultation appointment to get a western blot drawn. They will help you with all of that.
Terri
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