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

[anon9753]

I tried to have either test re-ran, however the labs stated it couldn’t be done. I believe my new partner has been tested but I’m not sure, however she has stated she never had a positive STD test. I’ll definitely get another WB fairly soon as it’s been three months since the indeterminate test (still no symptoms). I did have some questions in the meantime:

1. Is it possible the initial negative result was incorrect (collected 5/5/2020)?

2. If the quick fling (ended in august of 2020) did cause the infection, would it make sense that the WB a full year later be indeterminate?

3. What causes the WB to result indeterminate as opposed to positive or negative?

4. Does the EBV have any correlation to HSV2? Additionally, is Valtrex used to treat EBV?

5. Can an HSV2 infection cause any adverse affect on the kidney, liver, or heart?

Thanks!

[Terri Warren]

1. Is it possible the initial negative result was incorrect (collected 5/5/2020)?
Yes, that is possible. The blots should be reread. I ask for that often and they are happy to do it.

2. If the quick fling (ended in august of 2020) did cause the infection, would it make sense that the WB a full year later be indeterminate?
Nope

3. What causes the WB to result indeterminate as opposed to positive or negative?
They see only one or two protein bands vs. the four needed to call it positive.

4. Does the EBV have any correlation to HSV2? Additionally, is Valtrex used to treat EBV?
they are both in the herpes virus family, that’s the only connection and no, Valtrex isn’t used to treat EBV I don’t believe.

5. Can an HSV2 infection cause any adverse affect on the kidney, liver, or heart?
Not in the healthy adult, no.

Terri

[anon9753]

Hey Terri,

I wanted to provide an update, and ask some final questions regarding my “case”. Again i’ll provide a quick summary:

December 5, 2016 – Equivocal HSV2 Igg 0.96
February 8, 2017 – Negative HSV2 Igg <0.90
May 3, 2019 – Positive HSV2 Igg 1.16
May 5, 2020 – Negative HSV2 Western Blot
March 22, 2021 – Positive HSV2 Igg result of 1.23
August 12, 2021 – Indeterminate HSV2 Western Blot
February 2, 2022 – Negative HSV2 Western Blot

I tried to have the February 2, 2022 testing performed as a paired sample, but the form was not filled out correctly. With this follow-up negative result, i’m relieved but have the following questions:

1) If the most recent test was performed as a paired test instead of an individual test, what would the results have looked like/would it have made a difference in the test or results considering the negative result?

2) I was taking isotretinoin (accutane) for facial acne during the time when the indeterminate HSV2 result occurred. Could this medication have had an affect on the western blot result?

3) Recently, and after the completion of the isotertinoin treatment, I have started to develop some what i believe are pimples (not clusters, only individual spots) on my butt checks only. Can HSV-2 present itself as single points on the buttocks area, or is this more likely pimples/acne?

Thanks for all your assistance and insight!

[Terri Warren]

1) If the most recent test was performed as a paired test instead of an individual test, what would the results have looked like/would it have made a difference in the test or results considering the negative result?
No, except it is possible that they would have called the indeterminate a negative on the second reading.

2) I was taking isotretinoin (accutane) for facial acne during the time when the indeterminate HSV2 result occurred. Could this medication have had an affect on the western blot result?
No

3) Recently, and after the completion of the isotertinoin treatment, I have started to develop some what i believe are pimples (not clusters, only individual spots) on my butt checks only. Can HSV-2 present itself as single points on the buttocks area, or is this more likely pimples/acne?
Rarely. Usually lesions on the buttocks come in groups.

I thank you seriously need to stop doing this testing.
Terri

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