Confusing Herpes Test Results

[Troubled246]

On the 11 February 2010 - I went for a full STD test 8 months post a relationship breakup. All STD results were negative apart from my Herpes Type 2 PCR by Urine Test.  I have never had physical symptoms of Genital Herpes, even though I have suffered from oral cold sores for as long as I can remember.
This was orginally communicated as negative, on 26 February I was contacted by my private doctor to let me know that my result was actually positive, the lab apparently had some problems with their machines, re-ran the tests and mine was now positive.
A further urine test and swab test was conducted by the lab on 15 March and was negative.  The lab agreed to run igm and igg blood tests for me.  This came out positive for HSV1 and negative for HSV2. The IGM test came out negative for both Type 1 and Type 2.  We agreed to rerun the antibody test, which I did on the 10 May. It came out as positive for HSV1 (no surprises again) and negative for HSV2.

I have printed the results below:

Current Result 10 May 2010
H.S.V. I (IgG) Positive 3.478 Index (Pos = > 1.0)
H.S.V. II (IgG) Negative 0.490 Index (Pos = > 1.0)

Result from 26 February 2010

H.S.V. I (IgG) Positive 4.671 Index (Pos = > 1.0)
H.S.V. II (IgG) Negative 0.022 Index (Pos = > 1.0)

The clinic has come back with a strange explanation citing that I was exposed to Herpes, developed antibodies (indicated by the rising level) but did not get the disease. ie. that I do not have Herpes. From what I understand from STDs such as Herpes etc, you can't be exposed to them a little bit, they are systemic?  They clam the initial positive urine was possibly indicative of exposure to the herpes virus but the viral load was likely small and that my body was able to develop antibodies to it and hence a level of immunity

What do you think about the whole state of affairs and what the clinic has interpreted as the outcome? Do I have Herpes in your opinion?

[Edward W Hook, MD]

1. Yes, absolutely.
2.  The fluctuations in measured values you report represent normal variation in the same way that your body temperature is not 98.6 degreesF all day, every day.  I have commented on the HSV-2 PCR above.  It is most unlikely that you have HSV-2.  I see no need for further testing.

EWH

[Troubled246]

Dear Dr Hook

I understand and respect fully your decision on not commenting on other medical experts advice.  But for clarity, I understand what you are saying as follows:

1. I should trust the positive HSV1 Antibody test (this makes sense as I have oral cold sores and have done since I was a child) it shows I was infected for HSV1

2. I should trust the negative HSV2 antibody test despite the fluctuating levels as the PCR Assay was likely to be a false positive and can't be relied on. It shows that I was unlikely to be infected by HSV2 as no antibodies were detected.

Thank you for all your help.

[Edward W Hook, MD]

As I said earlier, your positive antibody test for this virus indicates the presence of infection.  Scientific studies have shown that nearly everyone with a positive antibody test for the virus is infected and can asymptomatically shed the virus from time to time.   Exposure to HSV is common and antibodies are not produced unless infection has occurred.

Please realize that over half of Americans have HSV-1 infections and of those only 10-20% know it.   In most cases these represent oral-labial infections acquired early in life.

The meaning of a urine PCR test for HSV is unknown.  At present there are no FDA approved PCR assays for detection of the herpes virus that I am aware of.

At our Forum we do not engage in debates either directly or by proxy with either our clients or their health care providers.  The information we provide is based on years of practice, our participation in STD/HIV research, and knowledge gained from meeting attendance, discussions with other experts in our field and reading of the scientific literature.

For more information on HSV infections and testing, you may wish to use the resources available through the American Social Health Association website.  It is excellent (disclosure, both me and Dr. Handsfield are members of the ASHA Board of Directors).  EWH

[Troubled246]

Dear Dr Hook,

Many thanks for your response.  
But I wouldn't mind some advice on the actual response from the clinic, this is what they said verbatim:

"I apologize for the delay in getting back to you but I was confirming a
couple things with the Medical director.

The negative HSV 2 means that you do not have genital herpes. ie. you
will not suffer from this physically and will not have recurrent attacks.

The rising antibody titre, at that increase, indicates that you have
most like been exposed at some point to the virus and have developed
antibodies to it. The initial positive urine was possibly indicative of
exposure to the herpes virus but the viral load was likely small and so
your body was able to develop antibodies to it and hence a level of
immunity.

So I think in the end, you were exposed to Herpes, developed antibodies
(indicated by the rising level) but did not get the disease. ie. you do
not have herpes".

I thought the whole difference between an STD that is bacterial and one that is a virus is that one can be eradicated (bacterial like chlamidya, etc) and virus's like Herpes and HIV can't. If that is the case, then surely what the clinic is using as a justification for the positive result now being negative is not entirely honest.  

I do not wish to cause unnecessary problems for anybody, but this diagnosis did cause me a certain amount of stress, and I feel like my clinic is pretty much dismissing me with a very poor explanation, which when broken down does not stand up medically. I know I am not a medical expert by any means, and want to trust those in the profession that we put our trust in.  Any light you could shed on this explanation would be of great help Dr.
Thank you in advance.

[Edward W Hook, MD]

Welcome to our Forum.  I've read your interactions with Grace on the HSV Community site and agree with what she has said.  In turn, this also means that I disagree with some of what you have been told about your tests.  Here are my thoughts:

HSV PCR on urine.  I would not do such a test. PCR tests detect the presence of virus.  They are useful for evaluation of lesions to determine if they are caused by HSV or not.  If a PCR test (or a culture) is positive, the virus is present- with one exception. there are no commercial kits for HSV PCR, thus each lab does its own test which has not been uniformly standardized in the same way that commercial antibody tests are.  My guess is that your positive PCR is actually a false positive test result.

Antibody tests. Antibody tests for HSV do not detect exposure, they detect infection.  When a person has HSV, to the best of our knowledge, they carry the virus in their bodies from that point forward,  In some people the virus periodically re-activates as it does when you get recurrences of your cold sores.  Your antibody test show that you have HSV-1 but not HSV-2.  In most cases the tests are qualitative, and values of the test can go up or down from day to day and test to test based mostly on a variety of chemical principles too complex to describe here.  Fluctuation of the tests in the way that you have noted is of NO consequence.  Both tests show that you have HSV-1 but not HSV-2.

Bottom line, you have HSV-1.  There is no credible evidence that you have HSV-2. I would not worry about it, or test, further.  EWH