Herpes Select Test Results

[Said43]

Hello Dr.  
Been in a relationship for over 6 months. After my divorce 2.5 years ago, I had testing done and results came back + for both 1 & 2.  My GF does not have either and gets tested annually.  We discussed my issues prior to any acitivity, have always used condoms (for the first time in my 49 years of life).  We fell in love and we were seriously discussing marriage etc.  She got a yeast infection and now is completely freaked out about Herpes and may end the relationship... Thanks for bearing with me...but the background is important.  I have read many of your posts regarding testing levels and accuracy and also know that the "Select" test is the most reliable etc.  BUT you have referenced levels that make me question my levels as positive.  Perhaps I am looking for affirmation from an independent source. It appears my results are quite low but would like your opinion.  Lastly, I am monogomous, Do not get outbreaks at all and take Valtrex 500G daily.

Select Test Type I  2.40 > .90 deamed +
Select Test Type II 1.40  >.90 deamed +

I know the potential infection are quite low given my no symptoms, low level of asymptomatic shedding, daily Valtrex use and condoms... Probably less than 1% of days....Any real words of wisdom?  New websites...Yes, she should get retested and up to 90% never exhibit material syptoms (symptoms) if ever infected but....difficult to get beyond the slight chance that she will get it and it will be horrible as compared to the overwhelming majority.  It appears that most current information available is at least several years old and resulting information was early in the decade.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.  There really are two important problems here, one medical and the other in the relationship realm.

To the medical issue first:  As you apparently have learned, your recent HSV-2 blood test is equivocal.  You have a technically positive result of 1.40, but HSV-2 results are not reliable unless 3.5 or greater.  That your HSV-1 result is positive makes it even more likely that your HSV-2 result is false.

In judging this, it would be very helpful to know more detail about your past test results.  Beyond simply "positive for both 1 & 2", it would be good to know the numerical values.  Can you did those out?  If not handy, you probably could get them by contacting the doctor or clinic where that test was done.  If the results were similar to the current ones, it would almost certainly mean you are not (and never were) infected with HSV-2.  If that result was more strongly positive, however, perhaps it was real.

If the early result isn't available, I suggest you have a confirmatory blood test.  There are two choices for that. One is to have another test by a different specific method; for example, if your current test was the Focus HerpeSelect test, you could have a BiokitUSA HSV-2 test; discuss it with your doctor or clinic.  Alternatively, have an HSV Western blot test, done at the University of Washington lab in Seattle.  Your local lab will know how to refer a specimen for that test.  WB is more expensive, but it is the ultimate gold standard for HSV blood tests.

As for the relationship, that's not the main focus of this forum.  But I am disappointed to learn that your new partner considers the possibility that you have genital herpes as important enough to make her reconsider the relationship.  It really isn't appropriate for an impersonal virus, which rarely causes serious health problems, to interfere with love, romance, and commitment.  As it happens, probably you don't have HSV-2.  But even if you do, I hope she will reconsider her seemingly thoughtless and insensitive response.

I hope this helps.  Best wishes--  HHH, MD

[Said43]

Thanks for your reply and comments.  I will get my past results and let you know.  I know the past test the Focus Select Tests....Regardless of what the past numbers were, what would make them any different two years later?  From what I understand then numbers should not go down over time and probably the inverse....It makes me quite suspect of my individual results if in fact, HSV I + exposure can cause a false positive for HSV II, basis a higher ratio or whatever is statistically within normal extremes.  I appreciate the process but when I was originally tested, this test was somewhat new and wonder if any other factors should also be considered.  Any comments in the itnerim of me gathering information would be appreciated.  
  

[H. Hunter Handsfield, M.D.]

HSV antibody test results sometimes fluctuate for unknown reasons.  But usually they are pretty stable, which is one reason I am inclined to believe you don't have HSV-2 -- i.e., I expect your older results to not be much different from the present ones.  Other than that, I have no further comments until the previous results are available.

[Said43]

I called my health provider... Test date 7/07
HSV 1 - 4.52
HSV 2 - 3.65
Complete loss as to the difference in results.  Any direction would be of help
Thanks -

[Said43]

Good Afternoon -
Additional information.  Follow up conversation with my Dr.... He was not familiar with BIOKit USA but had heard of the Western Blot.  I am opting for the latter early next week.  HIs thoughts for the diffferent values were lab conditions and its normal for antibodies to fluctuate. I countered that its quite unusual to have such a significant variance between tests values and lab conditions should be standardized...I am not a dr or scientist but his statements do not make much sense to me.  Thanks for your comments!~

[H. Hunter Handsfield, M.D.]

A certain amount of fluctuation is normal, but not usually as widely as your results.  A Western blot is the way to go.  Feel free to report that result.  Let's wait until then before any further discussion about it.

[Said43]

Western Blot came back positive for both 1 & 2.  Still confused about different reported results and how my levels tested so drastically lower.  Any comments Dr. Handsfield?  And last but not least, the women who was so much in love no longer feels that way....she wants to move on from this "experience" !  Nice huh...

[H. Hunter Handsfield, M.D.]

Welcome back.

The HSV Western blot does not give false positive results.  Therefore, you definitely are infected with both HSV-1 and HSV-2.  There is no explanation for the varying HSV-2 ELISA results.  It just happens and appears to be random; it has no meaning in terms of your infection.

You should assume your HSV-2 infection is genital, and that some of the time, the virus is present in the genital area and can be transmitted to sex partners.  You will need to explain this to future sex partners.  You can reduce the potential for asymptomatic viral shedding and for transmission by taking an antiviral drug like valacyclovir (Valtrex).

Sorry to hear about the relationship outcome.  If it's any consolation, someone who would terminate a relationship solely because of herpes probably would have been likely to find another reason in the not too distant future.

If you're like most people with newly diagnosed herpes, you'll likely have a number of other questions, which is not something this forum usually deals with.  I strongly recommend the MedHelp herpes community forum, where the moderators are very knowledgeable professionals who understand herpes well, including relationship issues.

Good luck--  HHH, MD