HSV IgG test results

I recently received a test HSV 2 IgG test result of 1.22 in August 2010.  This indicated that I am positive for gential (genital) herpes.I had a full STD panel done at my OB/GYN and all the rest of the tests were negative.  I requested the HSV test be performed because i had the first cold sore of my life.    I am not one who engages in risky sexual behavior by any means.  I truly understand that HSV 2 can be spread even if condoms are used religiously.  (i do use them religiously by the way).  The last time i engaged in sex was at the end of January 2010.  3 weeks later i had the first cold sore that i can ever remember having in my life and i am currently in my early thirties.  I have never had any lesions (blisters or ulcerative lesions) in my genital area or anywhere that I am aware of.   I have not had oral or penetrative sex with anyone else since January 2010.

I am scared to death of this positive result.  I have spent the last few days online reading anything and everything that I can regarding test results.  My OB-GYN was not helpful at all explaining this to me.  He gave me the "you have been exposed" to HSV 2 reply. From what I have read you either are positve or you are not.  

My result was HSV2 result was 1.22.   This test was performed 7 months after my likely exposure.  Since I had a cold sore, I am pretty positive that I have HSV 1 although I was not tested for it.  However, the cold sore pretty much confirms that, right?

Here are my questions:
(1)What are the chances that my result is a false positive?  
I read that there are a lot of false positive HSV2 results when your results are below 3.5. (2)Is this true?
3.  I am scheduling another HSV 2 test with my routine (non OB-GYN) physician next week.  I will ask for the biokit test.  If she does not have it or will not perform it, I saw you mention that you take phone patients(?).  If this is true, how do I become a phone patient?

All help wil be greatly appreciated.

[Terri Warren, RN, Adult Nurse Practitioner]

I'm glad you found this forum so we can help you sort out your questions.
1.  This could certainly be a false positive.  You have waited long enough for a strong positive to develop, so that's not an issue.  Also, you don't mention your HSV 1 status, was it negative or positive?  Did you get a swab taken of the cold sore, was it actually on your lip as opposed to in your mouth?  

2.  There are certainly false positives in your range of test values.  I see it often in my clinic, and the closer the results are to 1.1, the more likely the positive it to be a false positive, and the closer the results are to 3.5, the more likely they will confirm as positive.  

3.  There is no point, in my mind, in scheduling another of the same type of test (the IgG ELISA).  What you need is a western blot.  This can be ordered routinely through Quest labs in all but six states.  The code is 34534.  If she will not order it, you can become a phone patient of Westover Heights Clinic and we will order it for you.  You can see our website for phone info.  

Let me know how we can help.  It would be best if your own doc would order the test for you, and there is a nice article by Matt Golden that you can find online that makes a strong case for confirmatory testing with these low positive values.  Let me know how it goes, OK?
Terri

[WorriedSickWoman]

Hello Ms. Terri Warren:  

Thank you for taking the time out of your day to respond to my questions.  You asked me a couple of questions in response, so here are the answers to those:

(1)  I never got tested for HSV 1.  I went to my ob-gyn and asked to be tested for herpes.  He just ordered the HSV 2 IgG test from labcorp.  I did not get a swab taken of the cold sore.  It was on my upper lip and looked like a cold sore.  It first just looked like badly chapped lips, then it kinda crusted over and scabbed.  I think there were tiny pin-point blisters/vesicles, but i can't remember.  I treated OTC with Abreva, aloe, and blistex (don't laugh at my homemade cocktail) until it went away.  I was going to add tea tree oil, but by the time it arrived I was nearly healed.  It took about 2 weeks to heal.  I had never had a cold sore, but I'd seen plenty of them on other people.  So I really think that it what I was. I would love have false hope that it wasn't, but I really think that's what it was.  :(

I looked at my planner.  I slept with my possible source of exposure on 12/29/09.  I had the cold sore on 1/31/10.  It was gone by 2/12/10 (about 10-12 days later).  

I really hope that this test is a false positive.  I am praying for that.  I have been the most responsible of all my friends and family, am not promiscous, and am extremely selective about who I have sex with.  I need to know if I hae HSV 2 or not, so that I can act accordingly and let future partners (if there are any) make informed decisions as well.  I will definitely ask my provider to order the western blot test.  If she does not, without a doubt I plan to become a phone patient of Westover Heights.  

Thanks for your help, knowledge, and patience.  You are a Godsend and an incredible resource.  I'll post my results here also no matter where I get the western blot performed.  

[Terri Warren, RN, Adult Nurse Practitioner]

Your symptoms do sound like a cold sore.  However, the timing doesn't fit for your first outbreak being from the contact in December.  The average time from infection to symptom is about 5.5 days.  A month is way long, so perhaps you had it before you had symptoms.

Yes, do post your western blot results here for me, please.
Terri

[WorriedSickWoman]

Hello Terri:

I was retested on 9/20/10 using another ELISA type test I believe.  Even though I spoke of it, my provider did not/would not order the Western Blot.  Why is this test so difficult for clinicians to order?  Does it cost them extra?  And if it did, I am/was willing to pay for it..insurance coverage or not.  Why did I take a similar test?  Mainly becasue I needed to so *something* instead of sitting around feeling helpless and depressed to at least see if the IgG test results came back similar.  However, if you recommend it, I will still order a western blot.  

Here are my results:

IgM (which I know to ignore, but since it was part of my test results, I am including it)

HSV Abs, IgM        Result
-HSV 1 IgM Abs     Not detected
-HSV 2 IgM Abs     Not detected


HSV Abs, IgG        Result
-HSV 1 IgG Abs     <0.90     Index
-HSV 2 IgG Abs     <0.90     Index

Reference range for Herpes Simplex (HSV) IgG Abs:
Less than 0.90      Index.....negative
0.90 - 1.10            Index.....Equivocal
Greater than 1.10  Index.....Positive

This news gives me a lot of comfort.  I actually cried when I received it.  Although, I don't know why my HSV 1 was negative.  I am pretty sure that what I had initially was a cold sore.

You have been the most valuable resource through this ordeal.  ****As a result, I am still requesting your opinion of whether I still need to follow up with a Western Blot.****  If you say yes, I will need to become a phone patient of your clinic, because the clinicians in Georgia don't seem to want to order it.  If you tell me that you don't recommend it, I will still be willing to take the test if it contributes to your clinic's research data.  

Also, I would like to know if your hospital takes donations.  You have helped me so much (and many others) that I would not mind contributing what I can.  If you do not, is there an organization that I can make a donation to on behalf of your clinic?

[Terri Warren, RN, Adult Nurse Practitioner]

This negative result is definitely good news.  At least your test results are going in the right direction!  And that is important in interpreting your results.  If your value had stayed the same and moved more into the positive range, that would have been more worrisome.  I would say that if you can accept that this is negative, then you don't need to test again.  However, if this is bugging you, then you should get the western blot.

No, it doesn't cost clinicians anything to do with western blot.  The cost is your insurance's companies or yours.  My guess is that they don't know about the western blot.  Do you know if your doctor uses Quest labs or not?  If yes, it is easy to order.  I'm not clear about the hesitation for ordering the test.  If you decide that you want it, I would be happy to speak with your doctor and explain why this is valuable.  It might be good them to know about in the big picture.  You taking the western blot doesn't really help my clinic's research, it would just be good for you to know if you feel the need to be more certain.

We don't really take donations, but you are most kind to offer.  The American Social Health Association ( ashastd.org) is a non-profit organization that would accept donations.  In fact, they have a great herpes testing packet that you could order and give to your doctor.  It talks all about low positives and the western blot.  I think that it would be terrific if you got it for your doctor.  

In summary, I believe that you are negative.  I'm happy for you.  If you need more certainty in your own heart, we'll find a way to get you tested with western blot.  I do think going through your own doc who has been advised about the benefits of this test would be the way to go, if possible, and again, I'm happy to speak with him/her on our behalf if that would be helpful.

Terri

[fach]

I tested positive for lyme in Feb2008 and been tested several times for all STDs including hsv1 and hsv2 and my results have always been negative. Just recently I was tested again for the same series of STDs,everything came back negative except hsv 1 & 2 both came back positive I last tested in May 2010 n just tested positive May 2011 I am married and I know for a fact myself or my husband have not been with anyone but eachother as my husband is disabled and is under my care so I know where he has been lol but I confused it says exsposer is resent as a few months ago??? I have lyme disease would this affect the results of the hsv test???? Confused and frustrated :( pls help