Testing Igg Positive after Negative Western Blot

[anon9753]

Terri,

First off thank you for all your helpful research and insight, it is very informative

My (Male – heterosexual – 32) situation dates back to 2015. I have never experienced any visual or physical symptoms. All information and test results concern HSV2 (all HSV1 results have been negative). All samples were taken at Quest Diagnostics.

On December 5, 2016, I received an equivocal HSV2 Igg result of 0.96. My PCP mentioned I may have been exposed and to be tested again in two months for confirmation. Again no symptoms, nor did any any partner disclose any HSV information.

On February 8, 2017 I received a negative HSV2 Igg result of <0.90. I felt very relieved and didn’t think about it until I began a long-term relationship (July 2017) and decided to get tested again.

On May 3, 2019, I received a positive HSV2 Igg result of 1.26. I again felt very concerned. I did a ton of research and saw your information that positive results between 1.10 and 3.50 without symptoms have a high chance of being false positives. It took me a while to complete (since I’m not in WA State), but decided to get a Western Blot test.

On May 5, 2020, I received the negative HSV2 Western Blot result. I felt ecstatic, considering this had been in the back of mind since the first equivocal result. I did end the long term relationship, and may start a new one soon so I decided to get tested again. I was sexually active between when the relationship ended and the test below.

On March 22, 2021, I received a positive HSV2 Igg result of 1.23. One note is that I did receive my first dose of the Pfizer COVID-19 vaccine on March 17, 2021.

These positive values are low that I wish to believe they are false-positives, yet it is still very concerning thinking that i could be asymptomatic and pass HSV2 along without my knowledge. Should I request and submit another Western Blot test for additional confirmation? My main question now is how I should proceed, or at least your recommendation. Thank you!

[Terri Warren]

For people who have low positive IgG results for HSV 2, I find that they will always have them, or at least an equivocal result. YOu did the western blot to clarify your position. I think you should continue to believe that and stop doing IgG tests as a screening mechanism. If you do the western blot again and it is negative again, I think you should believe that you will always be reactive on the IgG. And if you decide to the IgG again, you should be looking for a value that is significantly higher, like 3.5

Terri

[anon9753]

When you say “have them” do you mean positive for HSV2?

I think I’m going to get another Western Blot to be sure. Do you know why people sometimes are reactive to an IgG test though negative for western blot?

Lastly, do you know if asymptomatic carriers tend to test low or negative (for both IgG and Western Blot)?

[Terri Warren]

Yes, I mean low positives for HSV 2.
Some people have a protein in their blood that trips the IgG erroneously. We don’t know what the protein is or what it relates to – we only know it interacts in some way with the IgG test.
Asymptomatic carriers can either test high or low positive on the IgG. The western blot gives no numbers.

Terri

[anon9753]

Hi Terri,

I wanted to provide some clarifications, updates, and ask an additional question.

A brief background again:
December 5, 2016 – Equivocal HSV2 Igg 0.96
February 8, 2017 – Negative HSV2 Igg <0.90
May 3, 2019 – Positive HSV2 Igg 1.16 (I previously and incorrectly had this value as 1.26)
May 5, 2020 – Negative HSV2 Western Blot
March 22, 2021 – Positive HSV2 Igg result of 1.23
August 12, 2021 – Indeterminate HSV2 Western Blot

Dating History:
April 2017 to January 2020 – One girlfriend (had unprotected sex), who had tested negative and never showed symptoms
July 2020 to August 2020 – A quick fling who mentioned she was very recently tested and was negative (had unprotected sex)
April 2021 to Now – Current new girlfriend, says has never tested positive (no unprotected sex)

I’m still as confused as ever. I still have never showed any signs or symptoms (also have never taken any HSV medication), yet still feel very concerned with this new Indeterminate WB result. I have been trusting these WB results (and also the women I date), however I feel as if I may have unknowingly passed this on to someone. Should I wait three months and conduct another WB test? Should I even trust the original Negative WB result? What exactly does an indeterminate result mean? I understand that the WB test is the gold standard, but what happens when that gold standard yields mixed results? Any help would be greatly appreciated. Thank you

[Terri Warren]

Whoever ordered the western blot should ask for the two blots to be reread. I suspect that one or the other is incorrect. The UW lab will want to reread this for clarity. The only other possibility here is that the quick fling or the new partner actually caused a new infection and was not accurately testing negative for HSV 2. Has the new partner actually been tested?

Terri

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