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HSV 2 Type Specific Test AB 2.22
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HSV 2 Type Specific Test AB 2.22

For the HSV 1/2 IGG Type Specific Test, how high can a number be in the "in range/out of range"?
I got a result that stated 2.22 on the HSV 2 IGG Type Specific AB test and I am very confused and saddened.
Any help will be greatly appreciated.  I just got these results and I am having a hard time really understanding this and coping/dealing.
Thanks.
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27 Comments Post a Comment
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1174003_tn?1308164419
I am going to say that grace will need to look at your values and advise you that way.  She is trained in test reading and can provide you with the best of help.

You have another thread.  Lets keep everything in this thread.
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101028_tn?1348750963
what caused you to get tested in the first place?
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Avatar_f_tn
..does it matter why i got tested in the first place?  you know..i have read some of the post and i love how the questions dont get answered directly..i was trying to find an answer in regards to my question so i wouldnt have to post but couldnt find anything that gave a good response, a factual response..your response does not even address any of the testing question..i got tested and those are the results and i would like to know what it means since i am no expert in the matter..if you have any information i would greatly appreciate it..
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Avatar_m_tn
My research on the false positives is that any number below 3.5 should probably be viewed as potentially wrong.  The closer you are to the baseline 1.1, the more likely it will be negative when retested by Western Blot.  You should probably get your test done again with a different method (western blot) or at least with the HSV-2 neutralization (Quest Test #17170x) before you accept the diagnosis.
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101028_tn?1348750963
believe it or not I ask the questions I do for good reason. I can't really advise you properly on what to do next until you've provided some more details about the situation.

grace
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Avatar_n_tn
could you explain to me what the hsv 2 neutralization test is
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Avatar_f_tn
..super thanks for your response..appreciate it..where can i get more factual information and research the "I REALLY REALLY HOPE" false positive test score numbers?..where do you get your information from?..thing is..there is just so much out there i really dont know what to believe, what is factual, what is opinion based, what is research based..information overload..but i appreciate you taking time to respond..have a good one..
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Avatar_f_tn
..i didnt ask for the test..my doctor did..so thats why i got tested in the first place..i still dont understand what difference does it make..i got tested which is made out to be like something bad..i just want to know what the results indicate..what are other options..how accurate is that test and if i should ask for the western blot (whatever that is and how accurate is that)..or..if the 2.2 is a solid enough number to say i do have herpes 2..
thanks for your response and time and cooperation in answering the question..
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Avatar_f_tn
It is not that easy, myself I had OB on my genital, I tested (blood test) for 4 times and yet no body can tell am I really have Herpes or am I HSV1 or HSV2 . It has been 4 months now since my first OB at Jan 10. :(

So yesterday I OB again ... and as per Grace advise I will visit the doctor for cultures test this afternoon .

All I wanna say to you is just be patient and you ll get the answer. :-) cheers
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Avatar_m_tn
Honestly, if low positives mean more testing why not make the equivocal range from .9 to 3.5 so that there is no confusion?  Doesn't that make sense?  
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Avatar_m_tn
My research is from reading the papers you can find on pubmed.  This is where all peer-reviewed scientific literature will be found.  There are numerous publications (including some that are authored by people working at Focus who make the Herpeselect tests) in which they even say the false positive rate drops significantly once you raise the equivocal range to >3.0.

Seeing as my test came back with a 3.29 value for HSV2 and that I am waiting to get further testing that makes me feel a little better.  I have to be realistic though and accept that once you're above 2 the odds of a western blot coming up negative get low pretty fast.

As for the neutralization assay, if you get the test I specified above, they will automatically re-test your serum again if you come back positive for HSV2.  The second test will first expose your serum to authentic killed HSV2 virus proteins and then see whether or not your number as measured by the ELISA changes.  If it decreases, then it means that the antibodies that would have been detected by the ELISA stuck to the HSV2 which would be interpreted to mean that you truly do have HSV2 binding antibody.  If the ELISA value does not change after exposing your serum to HSV2 then it means that something unrelated to HSV2 is causing your blood to come up positive in their ELISA (this is a False positive).

Personally, I am going to be insisting tomorrow with my doctor that they re-test me by Herpeselect with neutralization AND western blot just to rest easy.

If anyone wants the references for primary scientific literature showing that this test has False positives I can post them.  Downloading the papers will in some cases require access to the journals (which many universities have access to) but some of the papers are publicly available.
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Avatar_n_tn
just to throw my 2 cents in - I think grace asks why you got tested just as a means to determine if you were tested due to the appearance of symptoms, if it was part of your yearly check-up exam, if maybe you found out a partner tested positive... just some things would make it more or less likely to be a true positive....I don't think it's meant as a judgement...

anyway - I was tested and my result was a 2.2 on the Igg test, retested and got a 2.04 - both within the range of a possible false positive.  So I went ahead and got the Western Blot test, and it was negative.  So from my experience - go ahead and get the Western blot - it's worth it to finally have a definitive answer about something that will affect your health and all your romantic relationships...
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Avatar_f_tn
..first..i hope all goes well with your culture test and thanks for sharing and responding..im just a little confused..you had OB..what is OB?..sorry..im just not familiar..again..hope everything comes back in good news..
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Avatar_f_tn
..thanks for responding..im still confused as to what is what in regards to test scores..so..bascially..low numbers mean more testing?..you do make sense, and that would be so much easier..
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Avatar_f_tn
..thank you so much once again..alright..so..let me see if i get this..there is room for a false positive if the number is less than 3.0..if this is so..further testing should be done..should they test again on the HSV 2 IGG Type Specific AB test and the western blot..or just the IGG or the western blot?..this is where i get confused..i appreciate your response, but you lost me with neutralization assays?..what..i have a question about timing..i was tested a little over 2 weeks ago..if i ask for another IGG test now would that be too soon..could i just ask for a western blot?..if you can send me a message in regards to the false positive references..again..thank you so much..you have been very helpful..and hope all goes well at the doctors..
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Avatar_f_tn
..thank you so much for sharing and responding..thanks..i just dont think any of that is relevant to be honest..to my knowledge..my partners have not been positive..but then again..maybe they just didnt know..i wasnt aware it was not part of the so called "full" STD check i would ask my doctor to run..you have to specifically ask for it..crazy..
..wow..thats what i got..sorry for asking so many questions now..but did you retest quickly after your 2.2 test?..how long did you wait?..did you have to ask your doctor for the western blot or did they suggest it?..thank you so much and you are right about that..a definite answer would change everything..and the western blot is more reliable/accurate in regards to getting a definite answer?..
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Avatar_n_tn
yeah, I think the question is asked because there is such a big possiblity of a false positive on the igg test in the under 3.5 range... so it's like - if you got tested because you had a bad genital rash that your doctor thought looked like herpes and you scored a 2.2 - it probably IS herpes and is NOT a false positive.  If you got tested as part of a yearly STD screen, never had a symptom and got a 2.2 - there's probably a greater chance it is one of the false positive readings...
When I got the results of my first test, my provider mentioned in sort of a casual way that sometimes a reading under 3.5 can be a false positive, and so I should retest.  I think my 2nd test was about a month later, same test, the igg.  when that result came back as 2.04, my provider was ready to call that "positive," final answer, and I would have been taking the valtrex and using condoms for the rest of my life.  BUT in the meantime, I had done a lot of research - on this site, reading Terri Warren's book (the good news about the bad news) - and learned about the Western blot test and how it is considered the "gold standard" and is the most accurate test.  So when I got the 2nd low positive, I wasn't ready to accept that as the final answer, and insisted on having the WB test.  My provider had never even heard of it and was reluctant to order it at first, but I was somewhat pushy about it and finally she said ok and ordered the test.  IAnd in the end - of course I'm so glad I did because my result was negative.
I'm not a medical person so I can't explain scientifically what the difference is between the 2 tests - the igg and the WB.  I just know that igg is the standard test, and with a reading of 3.5 or higher, it's considered accurate and no further testing is required.  With a lower score, the WB is considered the way to get a definitive answer in these gray-area, middle of the road cases, like ours.  
Personally, I'd say skip the 2nd igg and go right for the WB if your doctor is willing to order it... Hang in there...
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Avatar_m_tn
I'm not sure there is a difference between the HSV 2 IGG Type Specific AB test and the IGG.  All of the papers I've looked at refer to the UW western blot as the "Gold Standard" for HSV serology testing.  I'd definitely get the Western.  Aside from that, you can re-test your IgG with reflex to HSV2 neutralization which uses the same Herpeselect test, or you can use something completely different like the Biokit (which uses a different method for making the virus protein used in the test as well as being read out differently).

Neutralization is a way to double-check that the number that comes up on the ELISA is really because of antibodies in your blood recognizing HSV2 and not some non-specific cross reactivity of your antibodies for something on the plate (lets say the plastic well itself for example).  The idea is that they do the standaed Herpeselect test and get an ELISA value like 2.2 from your blood.  Then they expose your blood to virus and let all of the HSV2 antibodies stick to the virus (which means they can't stick to the ELISA test now) then you re-run this neutralized blood on the ELISA.  If the score drops by 60% or more and the reading is now 0.88 or lower, they say that your blood had HSV2 antibodies that now can't be seen by the ELISA anymore because they were stuck to the virus.  If the score drops 40% or less and your score stays at 1.32 or higher, they say that most of the signal in their test was due to non-HSV2 antibodies (like ones that stick to plastic for example) and they call it a false positive.  It's basically just another way to confirm their result while still using the same basic test.  For those interested in factual correctness antibodies against plastic wouldn't come up in the test because the ELISA uses a protein to block access to the plastic but the general principle applies, if you have antibodies to any other part of the test which doesn't have to do with HSV2, then they'll see that in a neutralization assay.

Here are some of the open-access references.  This one shows the odds of testing negative on western blot and biokit for different index ranges on the ELISA:

http://www.biomedcentral.com/1471-2334/5/84

The rest are all subscription required.

Good luck to you too!
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Avatar_f_tn
..super thanks..appreciate it..and i made a call to my doctor yesterday, waiting on him to return my call..i will ask him about the western blot test just so i can get that definite answer and take it from there..apparently mine is a bit tricky if anything, because i dont get genital outbreaks..mine is in regards to my cervix..and there is so little information out there..
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Avatar_f_tn
..thanks..all those terms get too technical for me..im going to ask my doctor today about the tests and im going to ask for the WB, just so i can get a definite answer..is there room for false positives on the wb too?..i havent noticed any outbreaks, but mine would be a bit tricky since it deals with my cervix..and there is little information on that..but i would rather know any how..thanks again..and i will keep on reading so i can understand all those medical terms..rhetorical question, but what is ELISA?..
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Avatar_m_tn
ELISA stands for Enzyme-Linked ImmunoSorbent Assay and is the technology upon which the Herpeselect IgG test is based.

The basic premise is that a plastic dish that has many individual wells (for many samples) is coated with a specific protein (HSV2 gG in the case of Herpeselect) which sticks to the plastic.  These coated plates are then exposed to your blood which lets antibodies in your blood (if you have them) stick to the HSV2 gG protein.  The plate is then washed, leaving only wells that either have no antibody stuck to them (from a person who has no anti-HSV2 antibodies in their blood) or wells that DO have antibody stuck to them (from someone who does have anti-HSV2 antibodies in their blood).  This stuck antibody can then be detected in the well using a reagent that changes colors if antibodies are in the well.  This color change is then read by a machine and the degree of color change is what is used to calculate your index score that gets reported on your test results.  The technique is very sensitive and can detect very small amounts of antibody.  The problem is that it is prone to false positives because things that have nothing to do with HSV could cause the well to turn positive.  Some ELISAs will change colors if saliva from the person running the assay falls in a well because of certain enzymes in a persons saliva.  Theoretically, the samples are run in duplicate to avoid this sort of random mistake from creating a false positive but there are other circumstances in which you can get a positive result from the serum reacting against non-HSV related proteins without actually having HSV antibodies.

The western blot uses entirely different technology in that it is looking for antibodies against many different pieces of the virus, not just the gG protein used in the ELISA.  It is also not dependent on the same reagents that cause color change in the ELISA.  As such, it is a good confirmatory test.

Sorry for all the jargon.
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Avatar_f_tn
..well..i had a pcr (polymerase chain reaction) culture test done and it stated i was positive for HSV-2..how accurate is this test?..for the HSV 2 IGG Type Specific AB test i got a 2.2..should i continue to get different testing and ask for a western blot..or is the PCR test that accurate..any help will be helpful..thanks..
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Avatar_m_tn
What did they do the PCR on?  Was it a swab from a lesion, urine, blood?  I haven't read-up on false positives in the PCR assay so I dont know how reliable it is.
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Avatar_f_tn
..the swab was from my cervix..i have been having this nasty discharge and it seems it could be because i have an everted cervix..i have had the silver nitrate procedure done for the cervix and i still had the discharge..apparently i always thought i was getting a full check when i asked for it (which i thought included herpes and it doesnt)..and this time he did a pcr on my cervix and it came back positive for HSV2 on my cervix..but i still have the discharge and he just did a cryo (freeze) on my cervix..im just overwhelmed at this point..thanks..
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Avatar_m_tn
Honestly, I have only done the background research on the serology tests.  I do not have a good answer for you as to how reliable the PCR assay is.  I would expect that it would be an extra sensitive way to pick up HSV2 genetic material which may be even more sensitive than an ELISA.  I would probably ask an infectious disease doctor how often this type of test comes back fasle positive.  You may want to try to get a confirmatory Biokit or Western blot test to look for antibodies in an alternative way.

Sorry I can't be more helpful this time.
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101028_tn?1348750963
actually we've already solved this issue in her other post :)
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Avatar_f_tn
..super thanks..you have been very helpful..
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