Herpeselect Test Results for HSV 2

[colorado1234]

I am a male heterosexual that had unprotected sex four months ago.  After nine weeks I was tested for genital herpes using herpeselect 2 igG testing.  The results came back negative at .10.   I repeated the testing 8 weeks later and I had hsv 1 IgG testing and Hsv 2 igG using herpeselect again.  Hsv 1 results came back .08 and the hsv 2 results came back 1.6.  
1.)  Is it possible that hsv 2 infection of 1.6 is a false positive and should I be retested at a later date?  
2.)  If indeed I do have Hsv 2 is it safe to say it is a new infection that I had four months ago because my first test came back negative?
3.)  What is the scale for a false positive?

Thank you very much for taking time out of your busy schedule to answer this

[Edward W Hook, MD]

At this time your indeterminate result is the result of having antibodies which react with some of the antigens present on the HSV western blot but not enough to make the diagnosis of HSV infection.  Given your record of negative tests, it is most likely that these antibodies represent non-specific antibody reactivity (possibly to some other virus such as the herpes zoster [chicken pox] virus)  rather than an evolving antibody response to a recently acquired herpes infection.  Translated into every day English, your prior, low level positive result was a false positive.  You do not have herpes.  Hope this helps, Take care.  EWH

[information41]

quick update,
A while back I showed my doctor your response, it turns out that you went to Cornell with him and he showed me a picture of you and him in his office(small world).

I received my test results back.  Five and a half months my biokit came back negative and my western blot came back indeterminate.  I also did a hsv 1 and hsv 2 herpeselect test again which are both clearly negative at five months.  

He would like me to come back in a month to two months to repeat the western blot to see if I can find out more conclusive results.  I am going tomorrow to get my yearly check up and I would like to show him your response.  Also what are the chances that I am seroconverting at this point?  Would another test make sense for the western blot?

Also I want to be morally responsible, there is a woman that I care deeply about and we are talking about getting back together, should I tell her all of this?  Or have a been thorough enough and I can move on without the fear of transmitting something to her.

PS
I did not know that your father was also a famous doctor in this field.  Congratulations on helping others out and all that you do.

[Edward W Hook, MD]

The American Social Health Association (ASHA) has a very good, informative web site which is a good source of information (disclaimer, both Dr. Handsfield and I are on the Board of Directors for ASHA).  That is where I would go.  Good luck.  EWH

[colorado1234]

I am going to see my doctor this afternoon and explain the whole situation.  I have printed out your responses and will show it to him.  Do you have any medical journals that can be accessed online so I can get him up to date on the testing process?  Do you have any suggestions as to how to explain this to him so it makes sense to a doctor?  Any thoughts or ideas would be helpful so I give him a thorough explanation on my problem?  

[Edward W Hook, MD]

I'm sorry, I do not know too much about the logisitics of geting either the Biokit or how to get to see the folks at Hopkins.  My advice would be to seek the advice of the folks on MedHelp's herpes community - they are knowledgable and resourceful.  Alternatively, the ASHA hotline might be helpful.

You doctor can order the Western blot from the University of Washington (that is where it is done) through most major laboratories.

Good luck.  EWH

[colorado1234]

I just called the Biokit number and they said they only offer testing in New York City(which is the closest to my location).  How do I get my doctor to get this test and would you consider the Western Blot test easier to get results?  The doctors you mention at Johns Hopkins, do they take new patients?  I called and they said they were booked for a while.  Not sure what to do?

Thank you for all of your help

[Edward W Hook, MD]

1&2.  If you get a Biokit test you do not need a Western blot.  Both will take you to the same place.
3.  There are no statistics on this as it is not reommended that people who are negative get tested repeatedly.  Having said that, I have seen this happen a number of times.
4.  You might check one of the web sites such as the ASHA web site (disclosure, both Dr. Handsfield and I are on the Board of Directors of ASHA).  Alternatively, you might contact the STD specialists at Johns Hopkins in Baltimore- Dr. John Zenilman or Anne Rompalo are very good and may be able to help.
5.  The subject is tricky and fast moving.  I hope we have been helpful.  Take care.  EWH

[colorado1234]

According to you analysis I should

1.)  Get the Biokit Assay to test for hsv 2 igG
2.)  Should I get the Western Blot Test done?
3.)  How often do test come out as .10 and then go to 1.6?
4.)  I have been trying to find someone who specializes or understands testing results in the Washington DC area but I have been having problems?  Is there a reference guide or a list of doctors on a website that can assist me on this problem.
5.)  I am amazed at how my doctor who specializes in STD's are so out of the loop on this issue.  It is concerning to me that others who may or may not have HSV2 might have been misdiagnosed.

I wanted to thank you personally for providing some clarity of a topic that in my opinion is misunderstood by most practitioners.  I have no idea what is going on, however you have assisted me in taking my next step.  This is a wonderful service to those who are trying to become knowledgeable in such a tricky subject.  

[colorado1234]

The STD clinic that I went to, the Dr. told me that after 2 months that I was completely fine and I did not have genital herpes.  I did research on my own and saw that it might take longer for the antibodies to take place and I could have hsv 1 infection on my genitals.  So I went back and she said that she has no idea why I am getting more testing but I insisted that I wanted to be sure.  She calls me today and tells my I have hsv 2 infection and that she has never seen this before after a test came back negative after 2 months.  I am completely confused and I have no idea what is going on, can you please tell me what to do next.  My father is a doctor and I am not comfortable in talking with him about this.  Can you please tell me what to do so I am 100%?   Also where can i find listing of doctors in the washington dc area who are up to date and understand this so I can go in and feel comfortable with what is going on with testing???  
Thank you so much, I hope I am not rambling.  

[Edward W Hook, MD]

Four months after exposure, about 95% of tests that are going to be positive  in your situation will be positive.  When you combine that with the fact that you have not experienced and outbreak of any kind and the low level of your second result, it is most unlikely that you have gotten herpes from the exposure you describe.  Your most recent result is in the area where about 90% of results which are reported out as "positive" are actually false positive.  The reason for this is that as we have gotten more experience with this (very good) test, we have come to realize that most persons with low values (low is defined as less than 3.5) turn out to be false positive test results.   The company is most unlikely to change the cutoff value in the face of this new data however as it would require a very costly new FDA submission.  Thus we will have to work through it.

Low levels in this sort of test, tend to "bounce" around, such that a level of 0.10 one day can come out as 1.6 the next and still be negative.  this is one of the idiosyncrasies of the test.  You can sort this out by getting tested with a Biokit assay.  A negative result will indicate that your result of 1.6 was, indeed, false positive.

If, in the rarest of situations, your 1.6 represented developing antibodies, when taken in the context of your prior negative result,  it would indeed indicate a recently acquired infection.

Hope this helps.  My synthesis of all what you've said, as I've tried to indicate above, is that you do not have herpes and your second result is a false positive.  If I were you I would not worry further and would move on.  I would not get further testing with the HerpeSelect assay.  EWH