STDs Expert Forum
Confusing Herpes tests
About This Forum:

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.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

Confusing Herpes tests

Hi,
I am confused concerning HSV test results. I had a redness around my lip (mouth). I went to a clinic and the doctor believed it was a cold sore. To be sure, a swab was done. I also asked for a complete blood screening since my last one was some time ago (This is the first time I saw HSV offered in these). The HSV test that is free through our health care system is ELISA. The blood was taken on August the 16th. The swab was negative(swab 5 days after I saw the redness), HSV-1 was 0.3 and HSV-2 4.8. I never had any symptoms that I could link to genital herpes.

I started reading and understood that false positives are common for  3.5 results of these studies. I thus started to wish having a different test to verify. A private lab can perform Immunoblot in Montreal.

I had my blood taken on September 21 and just received the result. HSV-1: negative HSV-2: Indeterminate. The interpretation line goes like (my translation French to English): Results are indeterminate for HSV-2. We observe reactivity from the HSV-2 band but no reactivity from the common HSV band. We recommend doing a confirmation analysis with a second sample of serum in 4 to 6 weeks.

According to the Focus test package information http://www.focusdx.com/pdfs/pi/US/IB0900G.pdf, my case falls within the negative category but with this note: Rare samples may exhibit reactive, type-specific bands (gG-1 and/or gG-2) in the presence of a weak common antigen band. For these specimens, we recommend retesting the sample…  
I would very much appreciate your insight and experience on the matter. Thank you very much
239123_tn?1267651214
Welcome to the forum.  Thanks for your question, which came in while I was on the forum.  Most users shouldn't expect such fast replies!

First, your negative blood test for HSV-1 suggests you don't have oral herpes.  It is conceivable you have an oral HSV-2 infection, but that's quite rare.

Second, you have had conflicting HSV-2 test results.  The first was strongly positive; as you learned in your own research, most people with numerical results over 3.5 are infected.  However, the second indeterminate result leaves open the possibility you don't have HSV-2 after all.

Can you say more about exactly the kind of test done Sept 21?  Was that another ELISA test or perhaps a Western blot?  Or some other test entirely?

I would recommend that the next step be a herpes Western blot test, if that's not what was done Sept 21.  The WB, which in North America is done only at the University of Washington clincial laboratory in Seattle, is the definitive tie-breaking test for HSV and usually sorts things out.

However, I should emphasize that my best guess is that you do have HSV-2.  While you wait for additional test results, you should be on the lookout for genital lesions that suggest herpes (which could be very mild); and also for new oral lesions.  If blisters or sores appear at either location, see a doctor or clinic for PCR testing as soon as possible, preferably within 48 hours of onset.

I'll be interested to hear how this turns out.  Please return with a follow-up comment to let me know what happens and any additional test results.

Best wishes-- HHH, MD
7 Comments
Blank
Avatar_m_tn
I do not know why but a part of the second paragraph was cut even if the entire text had less then 2000 characters. The second paragraph should go as:

I started reading and understood that false positives are common for smaller 3.5 but not so much for larger numbers. But, nevertheless, I could find anecdotal examples of the contrary. I also understood that labial herpes of type-2 is very rare; therefore a type-2 positive should be considered as genital herpes. Most papers I read were not very clear to me especially because the raw data are not usually presented so that we cannot know what was the spreading of the > 3.5 results of these studies. I thus started to wish having a different test to verify. A private lab can perform Immunoblot in Montreal.
Blank
239123_tn?1267651214
Thanks for clarifying.  What was the second test -- was that an immunoblot?

The most common immunoblot test is by Focus, just as your ELISA test.  It's really a variation on the same test -- using a blot technology, rather than ELISA, to detect a positive result.  As suggested above, I would recommend WB as the next test you should do.

There are some superb herpes experts in Montreal.  I'm thinking in particular about a colleague at Institut National de Santé Publique du Québec.  While I can't name names in a public forum, I would recommend you seek consultation at the public health institute.  But my guess is that they would also recommend Western blot as the next step to sort this out.
Blank
Avatar_m_tn
Thanks for the quick reply.

The second test (the one that tested negative for common HSV but positive for specific HSV-2) with my blood taken on sep. 21  was indeed an Immunoblot.

Unfortunatly, as far as I know the Institut National de Santé Publique du Québec is not offering direct services to the public.

As far as Western blot is concerned, I knew about it and would really like to get this test. I mentionned it to the doctor at the STD clinic today when I received this indeterminate result. She did not know about it but she said that if I can send the blood to university of washington, my blood could be taken at the clinic without problem. The question is to know if it is possible to send blood with Fedex through the border, but I guess I have to ask Fedex about that. I think I should perhaps also call the lab at University of Washington, they might have had experiences with peoples wanting to send sample from outside the U.S.

Thank again
Blank
239123_tn?1267651214
At least some of the physician experts at the provincial health department have their own private or university-based clinics; or at a minimum the department could refer you to a knowledgeable provider.  There is plenty of herpes expertise in any city of Montreal's size. Keep working at it -- indeed, the best approach for WB testing is to find such an expert and then let his or her office handle all the testing recommendations and procedures.  In any case, for sure you don't have to arrange your own shipping.  Any lab that draws your blood should know how to take care of it.
Blank
Avatar_m_tn
Hi,

I wanted to give a quick follow up.

I figured out how to get a Western blot. It turned out to be quite simple actually. I do not think that it is much more complicated to do it from Canada than to do it from the USA. At the std clinic they had never sent human serum internationally. I went to a Fedex location myself and took care of it without any difficulty and everything was in Seattle the next morning.

I received the results today and it is negative for both types!

It seems that I am another anecdotal example (I found more than one examples searching the net and the literature) that someone with an ELISA greater than 3.5 but smaller than 5 might be negative.
Blank
239123_tn?1267651214
Thanks for the follow-up.  I'm glad to hear the happy outcome.
Blank
Continue discussion Blank
This Forum's Experts
239123_tn?1267651214
H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
300980_tn?1194933000
Edward W Hook, MDBlank
University of Alabama at Birmingham
,
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating: What Your Closet ...
Jul 09 by Roger Gould, M.D.Blank