Big difference in HSV scores in two wks. Thoughts?

[girlygirl77]

I've been dating a guy for 1 month and we have not been intimate.  Before we do, I've asked him to get tested.  I have had a test since my last partner and am clear.  His last partner was in Oct. 2011 (protected sex) and one time.  He has ha no reason to suspect anything (no symptoms).  He has had one test last wk which the dr told him was positive. So he has already checked with the last partner and she said she had a test in Dec and is negative.

He had another test yesterday to double check (Elisa) and his results were .909 HSV-1, 1.071 HSV-2.  This was considered inconclusive.  So he went back to get the values from the initial dr.  Test was HerpesSelect.  He received .97 HSV-1, 3.71 HSV-2. IGM tested positive on EIA but negative on IFA.

This seems confusing. I have recommended a specialist. He has never had symptoms or reason to think he has HSV.  Any thoughts?

[Edward W Hook, MD]

Glad to hear it. Take care. EWH

[girlygirl77]

He went to the doctor who offers the bio kit and the test was 100% negative.  The doctor double check in different lighting (as he is well-trained with it and offers it to many people in my partner's shoes).  After double confirming he actually allowed a picture to be taken to show me.

So we feel pretty good that he is clear.  This is a relief.  Thanks.

[Edward W Hook, MD]

If the Biokit, I would take that as strong evidence that your BF does ot have HSV-2.  I suspect the doctor you will be seeing could get a Western Blot done at UW.  EWH

[girlygirl77]

Thank you very much.  We are both very cautious people and he has been very transparent with me.  We have both been a bit rattled which is why he went for the 2nd test which produced the lower results.  His first test was from a primary care physican's office and she provided no interpretation so we began to do research.  We agree that the discrepancy suggests a tiebreaker.

We live in NY and he has an appt next wk with one of few doctors who does the biokit rapid test.  I don't know where he could do the Western Blot here in NY.  Any suggestions?

Thanks again.

[Edward W Hook, MD]

Welcome to the Forum. I will try to help.  I doubt that your partner has HSV-2 but we cannot be sure based on his test results.  As you may know, about 90% of persons with HSV do not know they have the infection.

Indeterminant results are most often false positive results unless the person has a suspicious history.  On the other hand, when a person has a result in the :"high positive" range (over 3.5) this represents past HSV-2 over 95% of the time.  In your partner's case, the discordance between the two tests is troublesome.  Antibodies do not decline in the blood fast so it is most unlikely that this is a recent infection and that he was losing his antibodies- this is just not the way the infection works.  Antibodies from infection go up and stay up.  

His high result could still represent a false positive result or there may have been a lab error.  I would suggest a "tie breaker" and go with the 2 out of 3 result.  Alternatively, he could seen testing with a different test such as the Western Blot assay performed at the University of Washington.  Most labs will send a specimen there and the result can take up to a month to come back but this is as close as we have to a gold standard for HSV antibodies.  

I hope this is helpful.  EWH