STDs Expert Forum
HSV-2
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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.

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HSV-2

I have been doing alot of research about HSV-2.
I have been getting cold sores since I was 20.

I have been recently diagnosed with HPV by a dermatologist October 2011. He took some of my skin and sent it to a lab. He also told me I have jock itch and to wash my groin area with Noxzema.

Two weeks ago, My primary care doctor told me to discontinue using supplements because it was effecting my liver (creatine)

I had a Std Screening 11/29/11. All tests negative except HSV-2. The test they used for HSV-2 was the Rapid HSV-2 Biokit by Biokit USA. They then sent my blood to Quest labs were they performed a Herpeselect IGG 2 by Quest Diagnostics. My score from that test was 1.66. I was advised to have a Western Blot test by the U of  W. I completed that this morning with Quest Diagnostics and they will be sending my blood sample to U of W tonight.

I have no lesions, no sores crusting over, no seeping, no scabbing, no lesions, no pain when I urinate. I am experiencing pain in the lymph node area of my groin. I do experience itching and tingling, not sure if it is from the jock itch my dermatologist said I had.

Would the dermatologist have notified me of herpes if he thought he observed herpes?
Other then hsv-2, why would my lymph nodes in my groin area be hurting? Would the supplements I discontinued taking cause my lymph nodes in my groin to hurt? Would hpv cause the lymph nodes by my groin to hurt?
If I do have hsv-2 is the swelling of lymph nodes a sign of a outbreak about to happen?
The Rapid HSV-2 by Biokit is also a IGG test so if it is positive can it be a low positive, since my herpeselect test by Quest was a low positive of a 1.66?
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239123_tn?1267651214
Welcome to the STD forum.  Thank you for your question.

Probably you do not have HSV-2.  Although an ELISA ratio of 1.1 or higher officially is positive, most people with real HSV-2 infection have results of 3.5 or higher.  At 1.66, there is a very good chance your result is false, and such results are most common in people who are infected with HSV-1.  Still, the combination of positive HerpeSelect IgG and Biokit favors your result being truly positive  You are doing exactly the right thing to be retested by Western blot.  All things considered, I expect it to be negative.

Here is a thread that goes into detail about interpretation of the HSV HerpeSelect test, which is the one done by Quest Lab: http://www.medhelp.org/posts/show/593272

Most of your specific questions probably are irrelevant, since it is unlikely you have HSV-2.  We can come back to them if your WB is positive after all.  Just a couple of comments:  Of course the dermatologist would have told you if he suspected herpes; but your symptoms don't suggest it.  There are many causes of groin pain; herpes is one of the less frequent causes.  HPV doesn't cause pain of any kind, anywhere.

Come back to let me know the WB result.  But let's hold off on further discussion until then.  We'll take it from there if it is positive for HSV-2, but there is no point in speculating when a definitive answer soon will be at hand.

Regards--  HHH, MD
12 Comments
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Avatar_m_tn
Ok, I will let you know when I get the WB results.  Last two questions until I get my Wb results. Are false positives for the hsv-2 rapid biokit by biokit usa common with people with hsv-1? Have you seen people in my situation (positive rapid hsv-2 biokit and herpeselect igg 1.66) with a negative western blot test for hsv-2?. I will write you back when I get my wb results. Thank You for your time and patience.
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Avatar_m_tn
Forgot to add in my last comment, no symptoms of hsv-2 and a history of hsv-1, even though it was in the initial comment. Thanks again
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239123_tn?1267651214
These questions get into exactly the sort of speculative game I will not play.  You will get no additional comments or advice from me until you report the WB result.
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Avatar_m_tn
My Western Blot came back as indeterminate. I just found out my HSV-1 results. They were 5.55.
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239123_tn?1267651214
Bummer.  I'm not ignoring you, but holding off on a response until I run this past a herpes diagnosis expert.  I'll respond soon, but it might be a few days because of the holiday weekend.
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239123_tn?1267651214
I have been in touch with a colleague who will go unnamed, except to say she is probably the most prominent researcher worldwide on HSV blood tests; she and her lab developed the HSV Western blot.  Some new information I learned is that although BiokitUSA usually is valid as a confirmatory test for an equivocal HerpeSelect (and vice versa), there are exceptions; she has observed rare false positive Biokit results in people with results just like yours, i.e. high HSV-1 and low/borderline HSV-2 on HerpeSelect.

In view of all your test results, she and I both agree it is most likely you do not have HSV-2.  However, at this point it is impossible to be certain.  At this point, there are two approaches that may help sort it out.  You should do both.

1) If and when you develop any genital area lesions -- red bump, blister, open sore, etc -- immediately (within 1-2 days) see a doctor or clinic for HSV testing of the lesion(s) by PCR.  Such lesions might be quite subtle, and although the penis is the most likely location, it could be anywhere in the "boxer shorts" area, i.e. from upper thighs to lower waist, buttocks, scrotum, etc.  You might call your dermatologist, explain the circumstances (you could print out this discussion), so the skids will be greased for an immediate appointment if and when a lesion appears.  You should also ascertain that the office has the necessary facilities to do the PCR test.  (Most likely this won't be helpful.  Since you haven't had a known genital outbreak, and most likely don't have HSV-2, I don't really expect it to happen.  But best to be prepared; you wouldn't want to miss the chance if the opportunity arises.)

2) Call the University of Washington lab (or ask Quest, or your doctor's office) to do so and ask them to save your current blood specimen for possible future testing, and advise them to expect another specimen in a few weeks.  Then plan on another WB test 8-12 weeks from now, with the expectation that the lab will retest both your current and new specimens side by side.  Such repeat testing often sorts out an otherwise uncertain WB result.

In the meantime, don't freak out.  The odds are you don't have HSV-2, and I expect any additional testing to eventually confirm that conclusion.

Good luck and happy new year.
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Avatar_m_tn
Thanks alot Dr. Hansfield. I appreciate you going above and beyond to assist me with my situation.

Unfortunately, the dermatologist that diagnosed me with HPV, ( He observed the skin, made a diagnosis and then sent a piece of my skin to Quest Labs), is not aware of PCR's done for HSV-2. This is the same dermatolgist that did not know that Western Blots can be done for HSV-2. If I observe a lesion, red bumps, or open sores I will go to the STD clinic that provided me with the Biokit and Herpeselect test for HSV-2.

I will try not to freak out. I will take a another Western Blot in a month. I just contacted the U of W client services department. They notified me they do not "hold" current blood specimens for future testing for comparing to future results. They notified me to just take the Western Blot again.

I will try not to freak out, lol. I'm happy the results were "Indeterminate" and alongside with your advise, It is giving me a bit of hope. I have spoke to one another infectious disease specialist and he feels the same way you do. I will update you with my results when I take the test again. Again, I appreciate your assistance with my situation.
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Avatar_m_tn
I just remembered that I took (3) Valacyclovir 500mg tablets. I took one on 11/30/11, 12/9/11 and the last one was 12/10/11 before 11am in the morning. Blood was drawn for the western blot on 12/17/11 at 9:00am. Would this have played a role with the "indeterminate" results?
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239123_tn?1267651214
Probably not.  Higher dose or more prolonged treatment with anti-HSV drugs might blunt the antibody response, but not with only the few doses you took.
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Avatar_m_tn
I did my second Western Blot test on  1/19/12. The results were indeterminate.
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239123_tn?1267651214
Sorry to hear it.  The main thing now is to be on the lookout for genital lesions that could be herpetic -- typically a red bump (or a cluster of them) becoming a blister then an open sore, all over 3-5 days.  Most people with HSV-2 come to notice such symptoms if on the alert for them; so if none appear, it will be additional evidence against HSV-2.  And of course if such lesions appear, they can be tested for the virus.

But for now, I'm afraid you are ethically obligated to tell future sex partners that you have had indeterminate tests for HSV-2; you probably don't have it, but cannot be certain.
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University of Washington
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