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Antibodies - HSV-2
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Antibodies - HSV-2

My HSV-2 IgG test results are as follows -

Negative at 3 weeks, 1.4 at 6 weeks, 1.10 a 9 weeks, 1.14 at 13 weeks.

I am low negative for HSV-1.  How do the antibodies build in your system? I assumed the immune response would be immediate and the numbers would go up considerably. My doctor said something about the numbers spiking in response to the mild initial outbreak (2 genital ulcers, not painful - visual diagnosis by GP) and now they have gone down. I have not had another outbreak since mid-December. I am not taking medication.  Are these numbers going to go up more, like after 6 months or is the antibody level set after a few months?  I read that a true infection is usually over 3.5. It's been over 3 months.  My main question, if low IgG does not indicate a mild infection why am I so close to an equivocal result? If equivocal is negative and I am 1.1, wouldn't that mean something?  I know I am clinging onto hope with these low positives, but none of my doctors can answer my questions.  Also, can you please tell me the risks of daily valtrex and no condom?  What are the chances of passing it along?  Thank you for your time.
  
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"I have not had another outbreak since mid-December" implies that you have had at least one symptomatic episode that was diagnosed as herpes, or that you interpreted as herpes.  If there was a positive test for HSV-2 from the lesion, then the diagnosis is definite.

Taken by themselves, the blood test results themselves leave some doubt.  It is true that most people with positive results have ELISA ratios of 3.5 or higher, and that low positive results may be false.  However, that has been observed primarily in people who also have positive results for HSV-1.  So technically, your 6 week and 13 week results are positive, whereas your 9 week result is right at the cut-off level.  Still, given the very weakly positive results, I am not convinced you are infected with HSV-2.

There are 4 ways that this might be sorted out (aside from confirming a positive lab test from a lesion, as I suggested above).

1) Wait for another outbreak and see a provider promptly, ideally within 1 day, for a direct test for the virus by culture or PCR.

2) Wait until 6 months i.e. June, and have another standard (HerpeSelect) blood test.  [Both these options may be unsatisfying, if you don't have another testable outbreak or if a later test is no different.]

3) Have a repeat blood test now with another brand of test.  For example, your doctor could do the BiokitUSA test, which is done in the office; or find a lab that offers the Captia(R) HSV-2 test, manufactured by Trinity Biotech.  While neither of these is formally considered a confirmatory test, a second positive result using a different technology usually means the first result was truly positive, and a negative result would suggest you are not infected.

4) Have a blood specimen sent to the University of Washington clinical laboratory for a Western blot test, the ultimate gold standard of HSV antibody testing. However, it is expensive ($150 or more, depending on what your lab adds for shipping the specimen to Seattle) and may not be covered by your health insurance, since the test is not formally approved by the FDA and your insurance company might consider it experimental.

I hope this helps.  Best wishes--  HHH, MD
3 Comments
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Will the antibody levels ever drop into negative results as time goes on?
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239123_tn?1267651214
No.  Once a person has HSV-2, the antibody test usually remains positive for life, al though the ratio numbers may fluctuate.  However, there are exceptions, and a few infected people may develop negative test results (called seroreversion).  Herpes experts have differing opinions on what seroreversion means, i.e. whether it only happens in people who never really had HSV-2 anyway; or if someone was truly infected, whether it might mean that some people's immune system actually clears the virus from the body.

Cross that bridge if and when you come to it.  First follow the advice about determining whether or not your current results are valid.
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H. Hunter Handsfield, M.D.Blank
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