Interpretation of HSV Testing Results

Need help interpreting HSV testing results.

Testing timeline:  

1)  HSV 1-2 IGG Herpeselect AB  (9/4/12) and UW Western Blot (10/24/12)
2)  HSV 1-2 IGG Herpeselect AB  (1/21/13) and UW Western Blot (1/21/13)

I have had no symptoms to this date.  I had general std testing done on 9/4/12.  My IGG test results were negative for HSV-1, but positive for HSV-2 (index value 2.48).  I later determined that this score was in the "gray zone" and perhaps false negative (though less likely so, given that I apparently had no HSV-1 antibodies to confuse the issue).  I then had WB testing done on 10/24/12.  Result:  "Indeterminate for HSV."

I then allotted a few months for full antibody profiles to develop, in case of recent contraction, and ran both tests again on 1/21/13.  This time, my IGG response to HSV-1 was still negative, but my index value for HSV-2 had risen to 3.62.  My second WB test was actually a seroconversion panel, specifically meant to isolate differences between my first and second samples.  This time, my WB results said positive for HSV-1 and indeterminate for HSV-2, for both samples, "no change in antibody status" (interesting, because they mentioned no HSV-1 positivity the first time around).

The very last point of possible infection would have been around August 28,2012, putting about 20 wks, 6 days between time of infection and the most recent "indeterminate" WB.  However, I know for a fact that the person whom I had sex with on this date has tested negative for HSV-2, so we are looking at about 9 months between the last real possible point of infection and this most recent indeterminate western blot.

How should I interpret these results?  My IGG value is now out of the gray range, but my Western Blot remains indeterminate, and should have seroconverted by now, if positive.  WB results indicate HSV-1 positivity, so perhaps this really is a confounding factor on IGG test. Thoughts?

[Terri Warren, RN, Adult Nurse Practitioner]

I can see how this must be difficult for you, such confusing results.  And I honestly don't know how to guide you with this.  Normally, if a person is indeterminate because they are seroconverting, this resolves itself by six months from possible exposure, as you note.  

Generally, our guideline is that if you have an indeterminate western blot for six months or longer, it is likely negative.  However, your ELISA is well out of the gray zone and that is a little concerning.  Have you ever had any symptoms of herpes?  Why were you testing initially?  

Terri

[Question1234567]

Yes, I have been going crazy trying to figure this out.

You seem to be suggesting that sometimes people take longer than 16 weeks to seroconvert - is this correct?  I suppose it is possible that my last sex partner received a false negative test, though that seems unlikely, because prior to me, she was seeing one man exclusively for over a year, they had regular unprotected sex, and I am told he has also tested negative.  At any rate, even if we assume she had it and I got it from her, that's still 20+ weeks prior to my most recent WB "indeterminate" (i.e., more than the 16 supposedly required to develop full antibody profiles)

I have never had any genital symptoms of herpes, and to my recollection, i have never had a cold sore on my lip.  In the last few years, beginning around 2008, I have noticed I occasionally get what appears to be a pimple near the lip area.  I thought perhaps this could be herpes, though I am unsure.  My first western blot did not mention any HSV-1 positivity, so for a time I entertained the idea that perhaps I had an oral HSV-2 infection, though I understand this is rare.  Also, my most recent WB indeterminate now claims there is HSV-1 positivity in both samples, so if the above symptoms are actually herpes, I imagine it is probably HSV-1 related.

I tested initially because I hadn't had any STD testing in quite a while, and because the girl mentioned above did tell me she had a history of Gonorrhea. Figured it was prudent.  My primary care doc asked me if I wanted to include herpes in the battery of tests.  Again, that seemed prudent.

What do you make of the fact that my Western Blot test says both samples are HSV-1 positive, but my IGG tests claim neither is?

Have you, in all your experience, ever seen high ELISA values in individuals that were nonetheless eventually found conclusively seronegative?

Are there, perhaps, atypical signs of herpes that I should be on the lookout for?  Is an itch here or there a possible symptom?

I have written to Dr. Anna Wald at the University of Washington and she has said she'd be willing to take a look at my results.  We have yet to speak further, but in your opinion, are there certain questions I should ask her?

From what I understand, an indeterminate result means you have some antibody activity toward the virus, but not the usual full spectrum.  I thought, for starters, I would ask her if there are more bands on my second test to see if it appears I am in the midst of an incomplete seroconversion.