Herpes results IGM positive IGG equivocal

The following was an e-mail from my girlfriend.  She was tested in early February and the test was from Labcorp.  She had a HSV2  2.44 with the IGM test and was told by her doctor that she was positive.  Like a lot of others she had no symptoms.  It had been well over a year since she last had sex.  The last 2 men she had relationships with over a period of 14 years had recently tested negative.  After researching the IGM test from Labcorp we both thought that this could be in error.  We've been using condoms from day 1.  I'm hSV1 pos, hsv2 negative.  Only 1 sexual partner in 37 years.  She then requested the IGG test from her doctor, an internist, and after 2 weeks found out that the result of the IGG was 1.06, which the doctor said was negative, but researching it more looks like it's equivocal.  I don't have a lot of confidence in her doctor considering she didn't even know there was another test. This weekend we had unprotected sex and after reading one of the posts on the forum of someone who had the same scores as her then tested positive with the Western Blot my girlfriend doesn't know what to think.

If it has been well over a year since she last had sex and she was positive on the IGG wouldn't her numbers be higher?

Here is her e-mail:

I was finally able to speak with someone at the doctor's office.  I'm thoroughly confused and conflicted now.  I got the nos. on my first result and they were 2.44 [indicative of a positive result for HSV-2], but still below 3.5, so possibly a false positive.

Then, my second results of the IGg test are 1.06, and the results state that anything over 1.09 is positive.  Supposedly if you've had chickpox, you carry an antibody which can make you test positive - and I think she said mono.  [Okay, so first I've heard of that.]  
My doctor says that when people have been infected for a long time, their numbers drop, making sometimes for false negative tests.  .

[Terri Warren, RN, Adult Nurse Practitioner]

Her doctor has no idea what he/she is talking about regarding herpes, sorry to be so blunt.  She needs a western blot, for sure.  Also, I don't know if her 2.44 was IgM or IgG but no matter, it is still a low positive.  What was her HSV 1 value?  The test code for western blot at Quest is 34534.  

I agree that her  numbers are going in the wrong direction, and that both are low positive and need confirmation.  She needs to get this cleared up once and for all so neither of you has to worry about this.  If she is positive, you can both deal with that, and if she is negative, then that will be a relief to both of you, I'm sure.

Terri

[OlderCAGuy]

Her HSV1 was negative.  I can get her values. I'm trying to get a print out of her test results.

What are the value ranges for the IGM test?  What do you mean by going in the wrong direction if she had only one of each test?  

She is asking her doctor for the Quest test.

[Terri Warren, RN, Adult Nurse Practitioner]

Sorry, I meant your values, not hers.  YOUR values are going in the direction of negative, not positive, but still, you need the western blot and she needs the ELISA.  
Sorry I created that confusion.  
I'm not clear about the range for IgM testing, because we never use it and so strongly recommend against it, I'm not familiar with those.  I'm guessing they are similar to the ELISA but it is truly not meaningful.

Terri

[madman99]

Hi I have having issue with my penis for long time... My issue is I masterbed a lot I use to it 3 to 4 a day and went down to 3 times aweek and now once a week I do it when I get home after work now the main issue when I masterbed I get red sore or a cut...  I am sexual active person. My last sex was on tuesday morning with a partner...I have been a blood test every year for hiv, herpes last one I think was done 3 or 4 month ago. It still was small tinny shinning soft it is like wax on top my penis and side the sore those came after I masterbed 3 weeks ago I still have them so tuesday after my sex I went strait to my blood test urin test and hiv the hiv I got tested right away was nagtive.. And blood test going to take 2 weeks I explain my issue with my penis and they took a swab from it and they told will take 3 weeks for swab... Now it getting better the looks still havee the wax spot and sore apear to gone just a bit now my main issue my penis is senstive and little burn and when I touch my penis the hole penis  get bit harden I need your help please

[OlderCAGuy]

I'm really confused now.  I didn't give you my values.  I was negative.  Been with the same woman for 39 years before dating my girlfriend.  We've had unprotected sex once and hasn't been yet determined that she is positive.   Why would I need the western Blot?

She had blood drawn on Thursday by Quest for the Western Blot.

[Terri Warren, RN, Adult Nurse Practitioner]

was finally able to speak with someone at the doctor's office.  I'm thoroughly confused and conflicted now.  I got the nos. on my first result and they were 2.44 [indicative of a positive result for HSV-2], but still below 3.5, so possibly a false positive.

Then, my second results of the IGg test are 1.06, and the results state that anything over 1.09 is positive.

Did you not post this?  If these are your values, then you need a western blot because your first test was 2.44.

Did you not post these notes?

Now I'm confused!

Terri

[OlderCAGuy]

In my first post the I posted her e-mail to me at the bottom.

My Girlfriend:
  is the one who was able to speak to someone in the doctors office.
  is the one with the 2.44 IGM and 1.06 IGG test.
  has never had an HSV2 outbreak.
   is HSV1 negative.  
   has had two last relationships over 14 years and both males tested negative for HSV2.
   just went to Quest last Thursday for the Western Blot.

Me:
   have HSV1 positive.
   Negative for hsv2.
   never had an hsv1 outbreak.
   Have had oral sex with the same woman for 37 years and neither one of us has had a    cold sore.

We, my girlfriend and I:
had unprotected sex once, the day after her doctor told her she was negative from 1.06  IGG test.  Have abstained from unprotected sex since.


Hope this clears up the facts.

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, that clears things up.
My guess is her western blot will be negative, given the history.
Terri

[OlderCAGuy]

OK, she got her Western Blot results and they are positive for HSV2.  The doctor said they're isn't a number with the Western Blot test just a  positive or negative result.  Her doctor did bring in another doctor and said that she tested positive for the anti-bodies.  She also said that if she ever did "shed" that she would definitely know the tingling feeling that she has never experienced.  

Her doctor also told here that since she has never infected anyone in the past 14 years that it would probably never give it to me but there are no guarantees.  

So can we go to a normal sex life or will we have to  abstain from sex without a condom and absolutely no oral sex?

[Terri Warren, RN, Adult Nurse Practitioner]

Asymptomatic shedding, by definition, is giving off the virus without symptoms. That includes tingling.  She cannot know when she is shedding virus.  

And without testing every person she has been with, she can't know for certain that she has never infected anyone.  80-90% of those infected with herpes don't know it.

So the answer is, yes, you can have sex with her, of course, but she should be on daily therapy to reduce the risk of transmission to you and condoms would provide greater protection.  In the end, the decision about risk must be yours together.

And yes, the western blot only gives positive - negative results.  That is correct.

Terri

[OlderCAGuy]

The last 2 men she has been with were for over 14 years and both of them have been tested for HSV2 after they broke up with her and they both tested negative.  She had unprotected intercourse and oral sex with both over the period of 14 years.  Just luck?

[OlderCAGuy]

Also she saw a different doctor that suggested that she not start any medication because of her past 14 year history with the other two men and no outbreaks.

[OlderCAGuy]

She asked her doctor for a Western Blot and her work was done on a Immunoblot Herpes Select by ARUP labs in Utah.

I thought the Western Blot was done in Washington?

[Terri Warren, RN, Adult Nurse Practitioner]

The western blot is NOT an immunoblot.  That is a completely different test, and one that we stopped doing several years ago because we couldn't quantify the results.  I would suggest that she try again to get an actual western blot.  The Quest code is 34534.  If she is doing this through LabCorp, they have to write in the request for the western blot.

Terri

[OlderCAGuy]

That was the code written on the lab slip but I read the results test and it definitely says IMMUNOBLOT from ARUP labs in Utah.

[OlderCAGuy]

I just talked to a person at UW labs where they do the Western Blot and she said to order the kit from them, have the blood drawn, and sent back to them.  She said they don't process blood work from quest.  So I'm really confused as to why she would go to Quest , put a procedure code on there for a test that they don't do.

[OlderCAGuy]

Quest 34534 test and fraud.  According to Quest website the 34534 is sent to University of Washington.  Yet my girlfriend submitted the lab slip to quest with this procedure on it and it was sent to ARUP labs for an Immunoblot test in Utah.  The test at Washington may be more expensive and therefore they save money to sending it to Utah.  Either they need to fix their website or send it to the right labs.  My girlfriend is looking into this.  This really is starting to look like a case of fraud by Quest Labs.  If I don't get a good answer from them we'll be filing a fraud case with the state department of corporations.

http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?fn=34534.html&labCode=MET

[Terri Warren, RN, Adult Nurse Practitioner]

The University of Washington receives lab samples and processes them from Quest every day.  We send our western blots weekly THROUGH Quest labs.  The code for western blot is indeed 34534.  The problem appears to be on that end.  First, ARUP is a lab that competes with Quest.  I'm not at all clear why Quest would send any lab to ARUP.  ARUP only does immunoblot, not western blots.  How did your girlfriend get a Quest lab slip?  Is she certain she went to Quest?  I'm sorry I can't help you with where the problem here is here, but you definitely got misinformation from the UW folks.  I order western blots across the country for people, using Quest labs as the mean of transport to UW.  Again, Quest doesn't DO the western blot, they just serve as the transporter and biller of services to UW.

Terri

[question45]

So explain to me if these other two men were negative, did she have it before them? or were their tests false negatives.

[OlderCAGuy]

That's what we're trying to figure out.  Is how she could be in monogamous relationships for 14 years having unprotected sex and they not get it?  

Also I found out that depending on which Quest Lab you go to the 34534 could be sent to U of W for the Western Blot or sent to ARUP labs for the Immunoblot.

I talked to a woman at the Quest lab and she said that she would call the draw site and tell them specifically what should be on the lab slip to send it out to U of W for Western Blot.

[Terri Warren, RN, Adult Nurse Practitioner]

Good, I hope that settles it.  
I will say that the code of immunoblot is INDEED a different one than the western blot.  the explanation you got sounds like tush-covering to me.

Terri

[OlderCAGuy]

With regard to transmission.  If she is positive and has not passed it onto any of her partners in the last 14 years wouldn't that be the same as me?  I had tested positive for HSV1 yet I've never had a cold sore (everyone else in my family has) and I had been married for 36 years to the same woman and had oral sex with her for those 36 years and had kissed her for those 36 years and never transmitted it to her?

[Terri Warren, RN, Adult Nurse Practitioner]

No, I don't think your assumptions are necessarily true.  First, have all of her partners in the last 14 years been tested to see if they are infected or have they just not had symptoms?  And has your wife been tested to determine that she doesn't have HSV 1?  It's a little  hard to know for sure unless testing is actually done since most people who have herpes don't have symptoms that they recognize as being herpes.

Terri

[OlderCAGuy]

Her partners have been tested and were negative.  My wife was never tested and passed away last September so I'll never know.

[Terri Warren, RN, Adult Nurse Practitioner]

Well, good that she knows for certain.  I'm still not clear that that says what will happen to you, in terms of transmission.

My best to you and your partner.
This will be my last post on this thread.

Terri