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STDs (Expert Forum)
Help with conflicting results
Answered by
Edward W Hook, MD - HIV Prevention, stds
Welcome to the STD Forum, which 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.
Help with conflicting results
by questions_23231, Oct 03, 2008 06:52PM
I've received conflicting results on testing for HSV-2, and am seeking some unbiased assistance. I've complicated my situation by going between a Planned Parenthood location, and my gynocologist's office, so both are asserting that their tests are accurate (both use LabCorp for processing). Although I've called LabCorp, I'm unsure who manufacture's the tests they use (I don't think they understood the question I was asking).
My test results are as follows (all other testing conducted was within "normal" ranges):
- positive for HSV-2 on 5/28/08 (1.26 for HSV 2 IgG, Type Spec) Performed at PP since I was considering starting a new relationship
- negative for HSV-2 on 9/4/08 (no result number provided since negative; however was for HSV 2 IgG, Type Spec) This test was run by my gyn during my annual exam, per my request
- positive for HSV-2 on 9/30/08 (1.20 for HSV 2 IgG, Type Spec) Performed at PP since I was "hoping" to confirm a negative
As mentioned above, both offices are asserting that their results are accurate. The only obvious difference I can think of it that I was on Valtrex when I was tested on 9/4 since it was prescribed when I was originally diagnosed. I was not on Valtrex for the first and third tests since my gyn's office told me to stop taking it. My understanding is that Valtrex shouldn't affect the results, but I could be wrong.
Obviously it seems more likely that I am positive for HSV2 since it's unlikely I'd get 2 false positives, but I was under the impression that the test results usually go up over time, versus down. I've considered getting tested using a different lab (Quest) since my understanding is they may use a different test kit, but I'm concerned that I may further confuse the issue.
At this point, I'd really like to receive some unbiased guidance of the results, and how I should proceed.
Thanks!
My test results are as follows (all other testing conducted was within "normal" ranges):
- positive for HSV-2 on 5/28/08 (1.26 for HSV 2 IgG, Type Spec) Performed at PP since I was considering starting a new relationship
- negative for HSV-2 on 9/4/08 (no result number provided since negative; however was for HSV 2 IgG, Type Spec) This test was run by my gyn during my annual exam, per my request
- positive for HSV-2 on 9/30/08 (1.20 for HSV 2 IgG, Type Spec) Performed at PP since I was "hoping" to confirm a negative
As mentioned above, both offices are asserting that their results are accurate. The only obvious difference I can think of it that I was on Valtrex when I was tested on 9/4 since it was prescribed when I was originally diagnosed. I was not on Valtrex for the first and third tests since my gyn's office told me to stop taking it. My understanding is that Valtrex shouldn't affect the results, but I could be wrong.
Obviously it seems more likely that I am positive for HSV2 since it's unlikely I'd get 2 false positives, but I was under the impression that the test results usually go up over time, versus down. I've considered getting tested using a different lab (Quest) since my understanding is they may use a different test kit, but I'm concerned that I may further confuse the issue.
At this point, I'd really like to receive some unbiased guidance of the results, and how I should proceed.
Thanks!
Doctor's Answer
by Edward W Hook, MD, Oct 03, 2008 10:21PM
, Oct 03, 2008 10:21PM
The results you report suggest that you are rather unlikely to have herpes. The two results from Planned Parenthood are in the "low positive range" where as many as 80% of results can be false positive. The result from your OB is, as you have been told, negative. The fact that the values have not increased over time increases the probability that what you are dealing with is a false positive and not a developing antibody response since, if you were developing antibodies, you would expect the result to go up over time. The reason for the two FPs from PPH is that whatever it is in your blood that causes the FP is still there. This could be a cross reacting antibody such as antibodies to the chicken pox virus (herpes zoster) or some other chemical reaction.
At this point, my guess is that you have a FP. You can sort things out in two ways. the cheapest and easiest is to get your doctor to get a BioKit HSV-2 assay. If the BioKit result is negative, you know you do not have HSV-2. A somewhat more expensive approach is to have your doctor send a specimen for a Western Blot test; the Western Blot is the generally accepted gold standard test. If the Western blot is negative, you do not have HSV-2. My guess however is that you will have an indeterminate Western Blot which, given your situation and history of past tests will indicate that he earlier positives were false positive and that you do not have HSV-2.
Hope this helps. Let us know what you decide to do. EWH
At this point, my guess is that you have a FP. You can sort things out in two ways. the cheapest and easiest is to get your doctor to get a BioKit HSV-2 assay. If the BioKit result is negative, you know you do not have HSV-2. A somewhat more expensive approach is to have your doctor send a specimen for a Western Blot test; the Western Blot is the generally accepted gold standard test. If the Western blot is negative, you do not have HSV-2. My guess however is that you will have an indeterminate Western Blot which, given your situation and history of past tests will indicate that he earlier positives were false positive and that you do not have HSV-2.
Hope this helps. Let us know what you decide to do. EWH
I contacted my OB about pursuing further testing. The nurse collected copies of all the test results and contacted the lab manager to inquire about the next step. Ultimately the lab manager suggested re-running both tests since Planned Parenthood and my OB ran different tests (PP- HSV 1 and 2- Specific Ab, IgG and OB- HSV I/II IgG Rflx I-II Type Sp). Of course, I don't really know the difference between the tests, but I agreed since I understood their desire to confirm a positive result before proceeding with additional testing. Although no one can really explain what is going on, both tests came back negative so I'm currently going under the assumption I don't have HSV-2. Regardless, my doctor has agreed to retest, using both tests, during my next annual exam.
At this point, I'm cautiously optimistic that my prayers have been answered! I truly appreciate your guidance and assistance during one of the more difficult times in my life. Thank you for your help!