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Conflicting HSV Test Results
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Conflicting HSV Test Results

I was hoping you can help me understand my conflicting test results.

03/31/2009 HSV 2 IGG HERPESELECT           1.48 H

10/20/2009 HSV 2 IGG INHIBITION, ELISA      POSITIVE

10/12/2010 HSV WESTERN BLOT (HSWB)      
POSITIVE FOR ANTIBODY TO HSV-1 BY WESTERN BLOT. NEGATIVE FOR ANTIBODY TO HSV-2.

03/15/2011
HSV 1 IGG TYPE SPECIFIC AB 0.00
HSV 2 IGG TYPE SPECIFIC AB 1.37 H

03/31/2011 HSV WESTERN BLOT (HSWB)
POSITIVE FOR ANTIBODY TO HSV-1 BY WESTERN BLOT. NEGATIVE FOR ANTIBODY TO HSV-2.

Why am I showing positive in 3 of the tests and negative for the two western blots for HSV2?
Why are the Igg tests not picking up the HSV1?

I realized that in my panel of April 06 2009 for other STDs I had the following:
HEPATITIS B SURFACE REACTIVE
On a later check up my HEPATITIS B SURFACE WAS NON REACTIVE (MARCH 15 2011)

Could Hepatitis B cause cross reaction? If not, why are my HSV tests conflicting.
I have never had an outbreak of any kind, and my boyfriend for the past year hasn't either. His test results are as follows:
09/03/2010 HSV 1 and 2-Specific Ab, IgG     HSV 1 IgG, Type Spec 1.74 High
02/18/2011 HSV WESTERN BLOT (HSWB)
POSITIVE FOR ANTIBODY TO HSV-1 BY WESTERN BLOT. NEGATIVE FOR ANTIBODY TO HSV-2.

In your opinion, do I have HSV-2 or not?
Why the different results? What test is the most reliable?

Thanks so much for your time :)
Tags: HSV, hsv test
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300980_tn?1194933000
Welcome to the Forum.  The sorts of results you report are not uncommon. I do not know why you originally decided to test for HSV but your results are an example of the reason we do not routinely recommend HSV antibody testing unless there is a good reason for suspicion such as a partner with genital herpes or having had recurring genital lesions.  The tests are not good enough for general testing.

The "gold standard" for HSV antibody testing is the Western Blot assay performed at the University of Washington.  Using these tests it has become clear that the ELISA assays such as the HerpeSelect can occasionally report out antibodies to HSV-1 and antibodies to HSV-2 and this accounts for a part of the relatively high frequency of "low positive" HSV-2 result reports on the ELISA tests which are actually falsely positive. This appears to be the case in your situation.

Your test results indicate that you have HSV-1, just as your partner does. Neither of you has HSV-2. Further, the fact that you each have HSV-1 does not tell you the location of either of your infections- orals, genital, other..... thus, in terms of sexual relations with your partner, since you both have the same infection, there is no need for concern of transmission of your HSV-1 to your partner or vis versa.  

I hope this comment is helpful.  EWH
7 Comments
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Avatar_m_tn
Why are the Elisa herpeselect tests not reliable?
What is a logical medical explanation for false positive results?
Are the tests not specific? Are they not sensitive enough? What does the test look for and how do they determine what type of virus I have?

Thanks

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300980_tn?1194933000
HerpeSelect tests give too high a false positve rate in low risk persons to be reliable. This chemistry of these problems is too complex too describe in this setting and reflect the biochemistry of the herpes viruses and the the comlexities of human immunology.  EWH
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Avatar_m_tn
Could you please read the following response and explain further. I am extremely confused. Thank You


by Dr Sean Cummings, MBBS; T(GP); DRCOG; MRCGP; DFSRH; LLM, 4 hours ago
To: HSVType1_2
Hello

Western Blots are variable - they used to be the gold standard for many types of tests but in reality they have been overtaken by much more reliable IgG tests.

From these results - and without the benefit of actually seeing you and the results and taking our own tests at our own laboratory - I would say that you do have herpes 2 and you did have a brief infection with hepatitis B. I would go and discuss with a doctor your results and ask him or her to help you sort them out. I would also suggest a full hepatitis B profile to include surface antigen; surface antibodies; core IgG/IgM; core specific IgM; "e" antigen and "e" antibodies. The combination will determine where you are with hepatitis B.

best regards, Sean
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300980_tn?1194933000
Your specific qustion is difficult to follow however I agree with Dr.Cummins advice about hepatitis.  You need more testing and then to discuss all of the results, in contect with your doctor.

I disagree a bit with Dr. Cummins however about the HSV results. The Western blot result you had was the HerpeSelect Western Blot which is derrived from the same chemicals as the HerpeSelect ELISA.  In my laboratory the HerpeSelect ELISA tends to be more accurate than the Western blot.  This is not the same test as the Univesity of Washington Western Blot.  I had originally thought your Western Blot was from UW but that appears not to be the case.   I would revise my assessment to say (again) that your HSV-2 results may be falsely positve.  Further, you may or may not have HSV-1.  EWH
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Avatar_m_tn
My Western Blot was performed by the University of Washington...
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300980_tn?1194933000
Are you sure?- my understanding is that in the result you reported above, the HS in the HSWB mentioned in the result reported in your original question stands for HerpeSelect.  The Focus Diagnostics company which manufactures the HerpeSelect ELISA  DOES make western blot strips.  If the result of you Western Blot was from UW, you have HSV-1 antibvodies and not antibodies to HSV-2.  If your result is from the HerpeSelect Western Blot product, it is less clear if you have any HSV antibodies at all.   As I said earlier, the numerical result for your HerpeSelect HSV-2 ELISA is in the range where over half of results are falsely positive.  

You have still not indicated why you had the HSV antibody test to start with.  This is relevant in trying to help you sort out your results.  EWH

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