hsv II glycoprotein g specific antibody igg 0.11

[Jessie0768]

After 13 weeks and 4 days after potential exposure to hsv II, I received serological igg type-specific testing for hsv II.  It was following a one time sexual encounter in which the condom broke. The test returned negative with a 0.11 with the cut-off between + and - at 0.85.  I've been tested for hsv II via an igg test twice before with both tests negative. I've had sex partners so having hsv II should not be a surprise as it is so common.  Additionally, I've had cervicitis in the past with cervical bleeding during intercourse with sti or hpv induced inflammation ruled out as the cause.  I also know that pap smears can miss cervical abnormalities so perhaps I did have hpv, and it was missed.  I was also in my early twenties when cervical abnormalities are not uncommon.  However, I've read differential diagnoses that state that if hpv or sti bacterial infection is not causing cervical inflammation check for hsv even if no herpes lesions are noted.  Also, I am positive for hsv 1 oral as I've had a cold sores so that rules out hsv 1 genital (mostly, I know). I also have significant fordyce spots which makes it difficult to determine what a good bump or a bad bump looks like on the vagina.  Recently,  I had what looked like folliculitis.  It was a single white-pus filled bump which I popped with no pain, no redness, no burning or discomfort on the hairline of my labia majora.  It left no mark, ulcer, or crust behind.  I shave my pubic hair, exercise and sweat quite a bit, and have been taking spinning classes.  I am hoping that this is the cause of folliculitis and that it does not indicate herpes.  The marks against me are multiple lifetime sexual partners, cervicitis, and the occasional bump such as mentioned above.  On the other hand, I tested negative at 13.5 weeks after last sexual encounter.  Partner did not report that he had herpes although I realize this doesn't mean much but is some comfort.  Additional neurotic thinking: what if I'm one of those people who just doesn't test well for hsv II meaning the test misses my infection? Was 13.5 weeks long enough to wait to be tested? If the igg test for hsv I can pick up my antibodies to hsv I is that any indication that, if I do have antibodies to hsv II, they should be picked up by an igg test? Maybe the cervicitis just was some undiagnosed bacterial infection or yeast infection or latent hpv? When people say that some people are hsv II positive but that the igg test will not pick up their antibodies does that mean that however many times they take the test it will always return a negative result? Or, is it a numbers game in that the more you take the test the more likely it becomes that at least one testing will reveal a true positive? I have also read that the hsv II type specific testing is highly sensitive between 96 to 100 percent  with a 95% confidence interval depending on the study.  So my understanding is that the test returns very few false negatives but is more more likely to return false positives.  I really should move on and trust the test but it's hard.  If anyone could give insight, it would be greatly appreciated.  

[Jessie0768]

Thank you, Fleetwood.  I've really turned into a crazy person.  I have all this paranoia because I am supposed to get married to someone who has never had sex so I am feeling added pressure to make sure I'm not introducing anything into the marriage that will pop up later.  Thank you for bearing with me.

[Fleetwood20]

Most every person with HSV2 tests greater than 3.5 on a Herpeselect. Low positives are more than 50% likely to be negative. If your partner now has a negative HSV2 IgG test then they are negative and the false positive proven.

There is no strain of HSV2 that does not give cause for the body to produce IgG antibodies.

[Jessie0768]

Also, as it seems you are quite knowledge and have probably followed many stories, have you ever seen someone on this forum test negative on herpeselect for hsv-2 a year out and then test positive via a western blot?

[Jessie0768]

Thank you so much for your answers.  I guess I am worried because the last partner I had sex with, a year ago, I revisited his test results.  I originally though they were negative.  However, I realized he had tested low positive, and his blood was sent for retesting at focus diagnostics.  When they retested his blood, it was negative so they didn't perform an inhibition assay.  This year, I asked him to retest, and his index value was negative with 0.4.  I am worried that I have some igG deficient hsv-2 or something.  I wonder what the likelihood of both him and I having a false negative would be?  Even if he doesn't produce detectable antibodies, would I? I think I will test one more time tomorrow to rule out the possibility of my 0.21 being some fluke or seroreconversion.  

[Fleetwood20]

My interpretation of Dr HHH's comments are related to timing mainly.

Beyond 6 months of possible infection, the WB is very accurate, in excess of 99% detection of a HSV2 infection, probably very close to 100%.

I'd suggest the current versions of ELISA IgG tests are also at the 99% point. (After 6 months).

The ELISA IgG tests do detect HSV2 quicker than the WB in the weeks after infection.

The other implication of the comments are that there is no point taking a WB if you have a negative IgG test for HSV2. You simply will not get a different answer. It really will be a waste of money, but perhaps not if you really want the peace of mind.

[Jessie0768]

Fleetwood, thank you very much for your response.  I took the test again and it was 0.21.  I have contacted Terri and will take the western blot.  However, does anyone understand why Dr. HHH would say this:

"WB actually may be less sensitive (i.e. miss more infected people) than IgG testing, at least for HSV-2.  That's one reason it isn't generally recommended as an initial test; it's main role is to confirm weakly positive or other atypical or unexpected results by IgG.  In other words, WB is rarely recommended when IgG is negative, especially for HSV-2.  There are exceptions, but that's the general rule."
http://www.medhelp.org/posts/STDs/Final-word-on-Herpes-test-Accuracy/show/2130911

"No HSV antibody test is perfect.  (Indeed no diagnostic test is perfect, although modern HIV antibody tests come close, happily.)  The Western blot is not 100% sensitive, meaning it misses a few infected people; that is, the non-WB diagnostic tests (e.g., HerpeSelect) actually is a little more sensitive.  The main purpose of a WB is to confirm another test that is positive--NOT to diagnose absence of HIV in someone with a positive standard test.  Also, WB tends to become positve more slowly than the type-specific ELISA tests."
http://www.medhelp.org/posts/STDs/Western-Blot-Test-Accuracy/show/247910

My understanding is that the Western Blot is more sensitive than igG for HSV-2, but what the doctor writes seems to be different. Thanks

[Bigtimeworried55]

Fleet, I just re-read my response. I don't understand where you are getting from my comment that those who don't have access to virals or can't afford them don't care about their loved ones. I'm not saying that all.

My greater point is understanding why people test to begin with. Why do people test? What are their reasons? I feel the ones I explained above will be at least one of many on why people test to begin with.

To your last comment. Shallow world? Fleet that's the world we live in at times whether you perceive it that way or not. Some people would like a choice when in a relationship with someone with herpes. Does that make their relationship shallow?  Many care and can/will decide on pursuing or continuing a relationship with someone with herpes. Does that make them shallow? Who are you or anyone for that matter to define that those people don't truly "love" someone infected in that circumstance. Ever think that maybe certain people don't like the idea of carrying a virus that is life-long? Being scared to put themselves at risk to contract such a virus even though the person they love has the virus. Are they shallow?

Bottom line, people have their reasons for making the choices they make when in a relationship with somebody with herpes. It doesn't make them shallow or not truly in love because of just a few of the reasons mentioned above.

There's many reasons why people continue to test or test in general. They actually rather give others they are sexually involved with a choice versus none. This is just one of the reasons why this virus is so widespread.

[Fleetwood20]

Your point 2 is simply a luxury for the very few percent in the world who can actually afford the sort tests that you have had performed. Instead of being grateful about this, you continually moan and disparage. The majority of peope don't have access to or can afford antivirals. It is a slap in the face to suggest these people do not love their partners.

A shallow world indeed to think that a relationship decision would actually be dependent on whether someone has herpes. The world is ugly enough without people pepetuating the stigma that herpes is a relationship issue, something to be avoided above true love.

[Bigtimeworried55]

Understood. I won't drag out this conversation as it's been confirmed by Terri Warren herself of patients that  have tested negative via IGG and Westernblot, however, as mentioned by you, positive via swab after weekly PCR swabs to finally catch it for those individuals.

That's not practical for people like myself. Swabbing weekly or every time something pops up to confirm a diagnosis just isn't.. It's a grey area you have stated above yourself that's frustrating and can be for many that frequent this forum seeking help.

You don't know if you fall in this category. I now have to resort to having multiple at home PCR swabs. How is that practical for anyone who believes they are in this small sample size of people always testing negative?

You don't have the answer. Terri doesn't. I don't. You just have to keep swabbing and eventually you might catch it during symptoms or shedding. It's not a life to live.

To answer your question:

1. I have had multiple symptoms that align with herpes, a few confirmed by Terri Warren, yet continuously test negative via blood serology. Anybody in my shoes with common rationale would be concerned, considering I never had these issues or symptoms before and it occurred after an exposure with someone confirmed HSV1 positive.

2. Silly question. Why do people post on this site to begin with? Having herpes can be tolerable and manageable for most. Having confirmation on your HSV status allows you to prevent transmission, look into virals to decrease shedding, informing loved ones on your status and finally to take the neccessary precautions to avoid spreading this disease and educating those you love allowing them to make their own decision on continuing a relationship or not. You think that's worth pursuing answers?  I think it impacts ones life quite a bit (especially sexually) compared to not having herpes.

That's all I will say about that.

[Fleetwood20]

I really feel we have worked through this multiple times but you aren't listening.

A single blister will typically not be a herpes lesion. A herpes lesion will be a patch with multiple little bumps within. You did not have this.

All of those people who do not test positive through a commercial IgG test (as I say, less than 2%) will test positive through swab or Westernblot. It is not known whether that less than 2% will always test negative in successive IgG tests.

The Westernblot is NOT just an IgG. You need to report the correct facts about this test. You have been sent to the website at UofW multiuple times yet you continue to be oblivious and ignorant and continue to perpetuate misinformation. I have written at length about this test and I dare say so have you. If not, reread it and understand.

You do not have HSV2. You have had a swab, you have had IgG testing, you have had a Westernblot, you have not had a typical herpes lesion.

You are negative. The only relevant questions you need to ask of yourself are:
- Why cannot I believe I am negative?
- What does it matter to my life if I had HSV?

[Bigtimeworried55]

Sorry for the grammatical errors above. My last sentenced stated, how can someone find "closure"  not exposure, without feeling they fall in the category of being infected but will not ever test positive via IGG on ANY test.

[Bigtimeworried55]

Fleet, I find your response rather disturbing. So you are acknowledging that a sample size (albeit small) can infact be infected with either types of herpes and continuously test negative via IGG for life? That's what your saying right. This includes the WesternBlot because that's also IgG.

I have had obvious lesions. However, cultures are not always accurate. My culture could have easily just not have captured enough virus to show a +, yet I have symptoms that align with herpes myself.

Not to hijack this thread, but I have had a single blister on my genital perennial area popped, leaked fluid, and dried with a yellow crust before peeling off leaving fresk pink skin behind. That's herpetic.

If the person above does end up getting symptoms, how can they or anyone not feel they may fall in that small sample size you allude to that will never blood test positive when having the virus.

I don't understand that or how that happens and people like me reading it then start to believe they fall in that category and have no explanation as to why or how they can possibly find exposure. How can anyone trust these tests without think they fall in this category?

[Fleetwood20]

With nothing that is suspicious in terms of a possible cold sore in your genital area, then a negative 13 week test is conclusive, you do not have HSV2.

The test is highly accurate for HSV2, it is irrelevant if previous partners had HSV2 or not given this test result.

There are exceptionally few people who are infected with the virus and do not test positive with IgG testing. The vast majority of those 0-2 in 100 cases have obvious lesions that swab positive.

You can move on with confidence.