Confusing HSV2 blood tests

[constantquestions]

Hi Doctors,

Firstly, I'd really like to thank you for this service. You all are truly saints

My situation: About 14 months ago, during a routine screening, my doctor performed HSV 1/2 blood tests. I've never had symptoms of either (a side note: I'm a bit of a hypochondriac, and would certainly notice anything abnormal if something had appeared - sore, ingrown hair, or otherwise). The test came back negative for HSV1, but positive for HSV2 at value of 1.35. I consulted doctors who agreed that the likelihood of a false positive in this scenario was high, and that while confirmation testing through a Biokit or WB could put the answer to rest, they'd put their money on a negative. ( I think I received five different professional opinions. I'm a bit of a nut when it comes to this stuff. I'm extremely careful when it comes to sexual practices).

About a week ago, I had a routine physical, and I mentioned to the doctor that I had received this confusing test 14 months prior. The doctor performed the blood test again, and the values came back nearly exactly the same -- with an HSV2 level of 1.4.

Does a repeat of this low positive still put me in a gray area when it comes to a diagnosis? I've read in other posts, and on various sites, that a low positive could indicate a recent infection, and that one can expect to see the titer level to increase over the months before leveling out. In fact, in one post I read by Dr. Hook, me inferred that the poster's repeat low-positive tests suggest that she was, truly, a false positive.  Also, where is the medical community right now regarding the debate over increasing the cut-off value to 3.0?

Bottom line, I suppose I'm asking what everyone on this forum is asking: what are the chances that I'm truly infected? As I mentioned, I've never had any sort of symptoms that would point toward an HSV infection. What should my next steps - if any - be?

Again, thank you so much for your service. You guys are top notch!

[Terri Warren, RN, Adult Nurse Practitioner]

I agree that the chances are reasonable that your test is a false positive result, but I do think you need to clear with this by doing  confirmation by western blot.  Your provider can order the western blot through Quest labs, the code is 34534.  

Not everyone who tests positive in this range are false positive, clearly, or the cutoff point would be higher.  So please do this additional test and find out what is going on.  The presence or absence of symptoms is not the defining factor here.  90% of those infected with HSV 2 deny having genital herpes so lab tests, accurate ones, are essential.  At my clinic, we confirm everyone who tests in the 1.1 to 3.5 range with either Biokit or western blot or both.  My impression is that about 70% confirm.  The closer the index value is to 3.5, the more likely they will confirm as positive.  

The FDA would need to change the test index value positive range, and I really don't see that happening in the near future, which is too bad, really.  All we can do is to continue to educate providers and patients about the low positive range.  

I'm curious, since you know about the western blot and Biokit, why you've not pursued confirmatory testing prior to this.  Were you perhaps waiting for serconversion due to a high risk exposure?

Terri

[constantquestions]

Thank you so much for your response. I didn't initially pursue confirmation testing because a doctor who I know to be pretty knowledgeable on the subject suggested that I wait for a period of time, then take the blood test again. He suggested that it was possible that I was seroconverting and if the result had risen to the 2.5-3.0 range, then I could be relatively certain I had, in fact, been infected.  

One reason that this is all confusing to me is that I had never engaged in high-risk behavior. As I mentioned in my previous post, I've had a very limited number of sexual partners,  which have been in long term relationships, and have been neurotically careful in those situations.  (it's just occuring to me now how nutty I'm sounding...sorry!)

[Terri Warren, RN, Adult Nurse Practitioner]

Well, maybe this boils down to what you can live with.  If you feel pretty comfortable with the possibility of a false positive, then leave it and move on.  If you need more reassurance, I would recommend the western blot.  And you don't sound nutty at all, just concerned and reasonably so.
Terri

[constantquestions]

Terri,

Once again, thanks so much for responding so promptly. I know you must be incredibly busy - and this service is truly a Godsend. Given the information I've provided you (which, frankly, is all I've got), the very low positives (1.35 and 1.4), low-risk behavior, and the absence of any symptoms, in your professional opinion do you think I can move forward reasonably assured that I'm simply looking at a false positive?

And honestly - you deserve some kind of award for all of your help!

[Terri Warren, RN, Adult Nurse Practitioner]

If you were my patient, I would have you do the western blot.  I have seen true positives in this range.  But that's how I manage patients because I know that there is more involved than genitals, there is also the mind and the need to have more certainty.  I'm afraid only you can decide this one, however.  What's the downside, really, unless money is a big issue.  It should cost you about $110.00.  

Terri

[brillopad]

May I chime in here as well? I also have a question regarding a low posive reading for the HSV 1/2 IGG Herpeselect, type specific AB. My results:
Type I: 4.66
Type II: 1.41

When I called for my results, I was told I had type II, which was devastating. I got a copy of my results and now am confused as to why I wasn't told I had type I, or am I reading that wrong? I have had very few sex partners as well, and both my brother and mother get cold sores, so it would not surprise me that I have type I at all. I have heard it can happen, so is this high type I reading possibly causing a low false positive in the type II?

As far as symptoms of anything go, I am generally a very healthy person. The only thing that I have had that was odd was a sudden onset of a low-grade fever and headaches (flu-like but without the sore throat and congestion) for a few days, then a small dark red spot on my lower lip that got darker and then went away. I thought it was a mild cold sore, but at the time I was thinking I had type II, so I was confused!

Thanks for any help!

[Terri Warren, RN, Adult Nurse Practitioner]

you have a low positive HSV 2 test that needs confirmation, for certain.
Your HSV 1 positive is definitely positive.
If you want more info, you need to post a new one ;-)
Terri