Completely Weird Herpes Test Results.

[Joppa]

Possible exposure 10 days prior to test.

Overall Report:  NEGATIVE

Specifics:

Combined Tests:
HSV 1&2 Antibody Screen, IGM 1.03 (equivocal)
HSV 1&2 Antibody Screen, IGG 5.44 (HIGH POSITIVE!)

Further Type Testing:
HSV Type 1 Antibody Screen, IGG 0.72 (negative)
HSV Type 2 Antibody Screen, IGG 0.21 (negative)

To verbalize the above, I was high positive on the combination IGG test, but then showed negative for both Type 1 and Type 2 HSV.

I will number my questions so that they are easier to answer:

1. Naturally my first question is, how can I be so high on the combination and completely negative on the type tests?

2. Which of the following is the 5.44 most indicative of:  a) A too recent infection b) A past infection c) An error in the test?

3. If you had to guess, which would you think is more susceptible to dramatic errors.  The combined or the specific type testing?

3. Assuming they never Type Tested it, would the 5.44 alone indicate an acute infection, since it is so high on the scale?

4. Suppose the test came back more consistent. ie, a 0.70 on the combined.  What would this mean to me, considering both type 1 and 2 are reacting at least a little bit?

A little more information:

Underneath the Type 2 specific test result it says this:
Individuals infected with HSV may not exhibit detectable IgG antibody to Glycoprotein G in the early stages of infection.  Detection of antibody presence in these cases may only be possible using a non-type specific screening test.

This almost clearly implies to me that the 5.44 is more accurate, and that there is potentially a window of time... not necessarily before ANY antibodies are made, but before the HSV antibodies will exhibit the presence of Glycoprotein G.

5.  Does the IgG combination test look for Glycoprotein too?

Four doctors have evaluated these results, without the help of that last paragraph, and were completely stumped by them. Maybe my answer lies in that paragraph.  

I have retested today.

What is your take on this?

[yoshi2me]

Hi There Joppa ~

I have always read and heard that the window period for antibodies/IGG is twelve to sixteen weeks. If you are planning on being tested once then I would wait for sixteen weeks. Otherwise you could try it at 12 weeks. It's hard to say definately because this virus varies from person to person. It won't do the same thing is all of us that have it ... does that make sense?

As far as ELISA goes . . . that test (depending on which one) is not that great. It's not considered the "Gold Standard" in herpes testing. POCkit is a good test but it will only tell you if you have type-2 in your system. If you have type-1 and you have the POCkit done then your result will always be negative. Something else to consider about POCkit is that it's no longer available because the company was having distribution problems and then there was something about bankruptcy ... so you can probably kiss that herpes test goodbye.

If you have had more than one sexual encounter in your life time you may never know where you picked up herpes from. There are so many people out there that already have type-1 in their system and a handful of people that have type-2 and don't even know that they have it ... know what I mean?

I think the bottom line for you would be to find out once and for all what you have and which type so you can read, learn, and move on with your life. I have many helpful links and web sites if you would like to shoot me an e-mail. My addy is: ***@****

The herpes specific western blot in my opinion is the way to go ...

Hope this helps ~

Angela

[Joppa]

Thanks Angela, I think I've figured out my "real" question.

What is the window period for IGG and herpes.

Before you say "You should wait 3 months before testing for herpes antibodies", please be advised that the ELISA has a reported 3 week window period (average, can be less, can be more) ... and the old POCKit test actually had a 2 week window period for detecting antibodies.

As these tests become more sophisticated, the time periods shorten.

So Where or Whom can I find out the definitive answer to this question.  What is the *real* window period for IGG's?

Ive accepted the fact that I have type 1 ... and may have type 2.  What I want to know is whether I've already been living with it for a few years, or whether this is all brand new and there is a ton of unknowns ahead of me.

If the former, then this is going to be a piece of cake.  If the latter, then im in for a hell of a ride.

[Joppa]

Hi Angela -

It does help, except that whole thing was about IgM ... my positive was on the IgG .... and on subsequent specific IgG types for 1 and 2.

Its definitely a known issue that IgM's are not good things to lean on for diagnosis with HSV.  But that's usually why they test for both.  

My IgM came back equivocal (not pos or neg)
My Combined IgG came back a screaming positive (5.44), but this doesn't test for type 1 or 2.

As is expected if you get a positive IgG, they are thorough and attempt to find which type is causing this result.

When they did so I was negative on both types.

The major difference between the IgG combined and the Type testing is that theoretically the type testing looks for specific protiens.  In my case, they found none.

Theoretically those protiens may not be expressed yet, if I get tested too soon, and 10-30% of HSV strains do not ever express the Glycoprotein G.

But yes, its helpful to know the reason why IgM's are not too definitive.  

I'd be interested in knowing if she was referring to IgM or IgG when she said "Anything over a 3.5 is considered a definite positive".  I guess IgM ?

[Alan Rockoff, MD]

You have more faith in laboratory assays than you should.  There are mistakes in equipment and confounding factors (like the EB virus you refer to.)  If subsequent tests don't confirm the high level, I would forget about it.

Dr. Rockoff

[yoshi2me]

Terri Warren posted this explanation over at webmd to a question and I thought it was well worth sharing here too.

The IgM tests that are available now are neither type specific (that is, differentiating between HSV 1 and 2) nor are they always virus specific, that is, they could mix up varicella with simplex, and not infrequently do.

The IgM has traditionally be used to try to separate out old
infection from new infection, because IgM goes away over time and shows up early with many viruses. However, with herpes simplex, it is present with about 35% of recurrences, so it doesn't help sort out new infection from old infection either.

The index values on the HerpeSelect are useful only in making certain that the test is a true positive. Dr. Rhoda Ashley Morrow at the UW, who developed the western blot, says she is comfortable with test results over 3.5 being accurate positives. Anything under 3.5 should be confirmed with another test, preferrably western blot. However, if the test is done too early in an infection, it could have a low value because it is in the process of climbing, and just isn't there yet. See what I mean? Optimally, 3 months should pass before testing if you are only going to test once. Differences in values between say 5 and 7, have more to do with the controls (established positive and
negative values) that are being used for that particular test run. They have no meaning in terms of immune function,etc.

Hope this helps ~

Angela

[Joppa]

I called and spoke to one of the techs at URAP where they did the test and he said that the IgM is the first to show, typically within a few days of infection they're detectable.  The IgG exhibiting presence of Glycoprotein G should be detectable at 7 days or a tiny bit more in some cases.  I was at day 10.

There is also a strain of HSV (10-30%) that never express Glycoprotein G, and he said there's that 10-30% chance that I have that strain.  In those cases only the combination assay can determine if infection is present.

He says the high # is mostly indicative of either an error in the combination assay, the possibility that my EBV antibodies are reacting (I had severe mono a couple years back), another type of herpes antibody in my sysem is reacting, or a recent infection.

But my question would remain - a LOT of SOMETHING was detected (5.44) and it just doesn't make sense that you can detect so much of an antibody type and then have almost Zero antibody response when you look at the specific HSV types.

Also Im a bit concerned that im showing even a tiny response to HSV 1 and HSV 2.  This would suck if I have both! :(

[Joppa]

Also - its significant to note, my IgM's were not high.  My IgG's were.

IgM being high means recent infection, and IgG would still be low.  

Then again, maybe IgM already rose and fell, and now IgG is high...

Fun :)

[yoshi2me]

If worse comes to worse . . . you could always get the Herpes Specific Western Blot Test done . . . It's considered the gold standard in herpes testing. The test will tell you if you have type-1, type-2, both or not any in your system. It's the best test and it's only done at the Universiy of Washington. That's ok if you aren't in Washington though because your doctor can call the lab and they will give he/she instructions on what to do to obtain this testing for you. They will do this for dermatologists that are aware of this test as well.

Hope this helps ~

Angela

[yoshi2me]

Terri Warren will read your lab results for you on the herpes message board on WebMD:

http://boards.webmd.com/topic.asp?topic_id=90

Hope this helps,

Angela

[Alan Rockoff, MD]

I'm afraid I can't say much.  In general, when one gets a lab test that doesn't make sense, the best thing is to repeat it, as you have done and are doing.

In this particular case, I am not familiar with the details of the assays.  I therefore advise you to do what I do in my own practice when I get lab results on a test I don't know much about--call the lab director and ask.  If the director won't talk to you, ask your doctor to call.  The lab people themselves are most likely to know which tests sometimes show outlying results.

But it's hard not to think that it's the elevated combined test that doesn't make sense.

Best.

Dr. Rockoff