Herpeselect Test Results - Update

[Confused_again]

Doctor,
I posted here on 12/17/2005 under "Confusing Test Results". In short, here are my previous reslults for Herpeselect:

8 months ago:
Test # 1 :  HSV-1 ----Greater than 5.0
            HSV-2 ---- 1.36

Then 1 week later:

Test # 2 :  HSV-1 ---- 6.12
            HSV-2 ---- 0.99

I got retested few days ago, and when I went to pick up my results today, I only got results for HSV-1, which came back "Greater than 5.0". I called the lab to ask about the HSV-2 results, and the lady said there was a problem with the HSV-2 test, and that they had to retest. She said she'll have the results by tomorrow.

1) Why would they have problems with the type 2 test, and not type 1. Is this an indication that the test came back positive and they had to do further testing? or am I just being paranoid?

2) You said that Focus Technologies reformulated the Herpeselect test, however, my HSV-1 test came back with the same index ratios ( i.e <90 negative , 0.9-1.1 Equivocal). Does that mean the lab is using the old herpeselect test?

3) When I tested 8 months ago, there was no chance of recent exposure ( I was with my girlfriend for over 7 months and she tested negatve). If I got infected more than 7 months earlier, is it possible to still have low HSV-2 results ( 1.36 and 0.99) on Herpeselect?

This herpeselect test is very unreliable and confusing in my opinion.

Thank you very much.

[H. Hunter Handsfield, M.D.]

HerpeSelect is no more confusing and no more unreliable than many serological (antibody) tests, and less so than some.  It is a biological fact that measuring and interpreting antibody tests is a complex business, especially for HSV.  (It is no accident that it took more than 15 years for the diagnostic industry to come up with accurate HSV antibody tests that didn't cost $150 or more.)  HerpeSelect isn't perfect, but it is light years better than the situation before type-specific tests became available and widely used in the past 2-3 years.  Anyway, the manufacturer (Focus Technologies) did not design the test for patients, nor does it intend for patients to be given the numerical results. In theory, the provider receives the numerical results then simply tells the patient positive, negative, or (in come cases) something like "equivocal, consider retesting".  Admittedly this can be a problem when the provider him/herself doesn't really understand the test, but that's not the manufacturer's fault.

1) I cannot tell why the lab is doing additional testing, but it may be a good sign.  Perhaps they recognized an equivocal result and are doing additional testing.  The result you actually receive may be more reliable than otherwise; I see no reason to suspect it means the result will be positive.

2) Possibly yes.  My understanding is that the company did not provide credit to laboratories that had already purchased supplies of the earlier test.  Therefore, most labs probably will go through their current supplies and will get the new test next time they put in an order to the company or to a wholesale supplier.

3) Yes, that is possible; a few infected people never develop a strongly positive result.  But based on the results so far, it is more likely you are not infected with HSV-2.  Perhaps the pending result will sort things out.  If not, consider asking the lab to refer your specimen to Focus for additional testing, perhaps at no cost (which I suspect I suggested in your earlier thread, although I didn't go back to look); or to a reference lab for Western blot.

HHH, MD

[Confused_again]

I forgot to mention that the lab is Quest Diagnostics.

[t1234]

In the hands of a trained Physican there's no doubt that
the Herpes Select Test is a valuable diagnositic tool.
For example, if a patient reports symptoms consistent of Herpes
complaining of sores which are healing. It may be too late for
a "swab".  Perhaps a pregnant woman reports a history of sores
but has no symptoms.  In these examples, the Herpes Select would
be invaluable to a physician.

But in my opinion,  the problem arises when Clinics and STD Websites agressively market this test to the general public using what can only be discribed as "scare tactics" while failing to fully inform the public as to its limitations. It even gets worse with the marketing of IGM results as indicative of "recent exposure" which of course "hooks" the patient into repeated testing at sigificant costs.

[H. Hunter Handsfield, M.D.]

I deleted your new (third!) thread on the same topic, a waste of time and energy with no additional educational value for Forum users.  A limited number of new threads is permitted each day, and the limit is always reached--so unnecessary ones prevent others from posting new questions.  Further, it is frustrating to see that you simply are blowing off my suggestions.  If you don't like do not believe my answers, stop asking the same questions.

Your third HSV-2 result of 1.13 (I think it was) simply indicates your antibody pattern is durable.  The interpretation does not change; as I repeatedly told you, the most likely explanation is that you are not infected with HSV-2.  I also told you how to resolve it (communicate with Focus about possible confirmatory testing at no cost, or Western blot).  Do not rely on Biokit to answer the question.  A negative Biokit result would tend to confirm that you don't have HSV-2, but a positive result--which is possible--will just be confusing; you'll still need the confirmatory testing already discussed.

This is my last response.

HHH, MD

[t1234]

I do hope you get the confirmatory testing either from Focus Technologies or get a Western Blot.  I know the Western Blot is expensive, but you've already spent a lot of money.
So as things stand now, it may the the fastest with the least hassle and least expensive option in the long run. From your previous posts, I assume you know how to make it happen.

Best Wishes!!!!

[life_is...]

I know this site 3 months ago but I keep reading. I am very confuse too! but I don't have a money to donate yet to post my questions here..I'm just wishing that someday I can post my questions here. I was diagnosed HSV1&2 last october(herpeselect igm&igg both positive)I was a virgin before I get married. We've been together 6 months at that time but my husband was negative. I keep asking to myself, where did I get this? why me? Then, last nov. they diagnosed me again who has genital war(inside). My husband talks about divorce...I found myself crying...self pitty, anxiety, depression, fears & a lot of terrible things that happen in my life right now. What I've done wrong? I didn't deceive my husband bec. I didn't know that I have this...I didn't experience oral herpes/blister but only a canker sore. But down there(genital area)I experienced only a pimple look a like but it was deep in the skin. So we went to my GP for the 2nd test(herpes igm&igg) but even not herpeselect then again, came back positive. My OB told me that you are positive & u will always be positive no matter what but even though she said those, I insist for the 2nd hepeselect test(I'm still waiting) but before my 2nd herpeselect... we went somewhere(8 hrs. driving) for biokit test rapid assay hsv2 & I'm negative but still confuse bec. the receptionist only who doesn't know anything about this biokit who took my blood & my husband who read the procedure & then, after 10 minutes the doctor said that I'm negative but this doctor is not the doctor who usually do for biokit bec. the doctor who is incharge, wasn't there during that day. Right now, I don't know where I go, what to do...bec. DR.H said don't rely for biokit... I asked a favor for my husband that I need His support until the WB(no provider yet who accept to take my blood & send it back to University of washington) done before to decide for leaving...bec. I am nothing...I really am...I really understand him...

[Confused_again]

I completely understand your confusion. I the Doctor will recommend that you get an HSV-2 Inhibition test..this is done by Focus diagnostics, same company that makes Herpeselect. The test code at Quest Diagnostics laboratories is 17170X..This will tell you for sure if you'r positive or negative..However, it won't be able to find a doctor who will allow you to take this test as they are unfamiliar with it. I went to 3 doctors today with no luck!! I am seeing an infictious desease doctor tomorrow and Im hoping that he's more educated about this matter than the other ones i saw (2 of them said I dont need further testing as they think i'm 100% positive!!!)...

[t1234]

If you're in the US you can go to www.stdweb.com and
you can order a Western Blot on line.  They have a network
of labs who will do the blood draw and make it happen.

It's true that many health care providers won't do it for
what ever the reason.

I've been throught the herpes testing "merry go round"
myself so I know what you're going through.

From your background I doubt you have HSV2.  In rare
cases,  Herpes Whitlow, etc., there are ways of getting HSV2
without intercourse.  An HSV2 antibody test cannot tell
you where the sight is infection is.  It's just assumed
its genital because it would be very rare for it to be
otherwise.

But I think there's something wrong with the positive tests.  You may think they're using a Herpes Select, but some labs don't for economic reasons. Had that experience too.

No doubt a Western Blot would be definitive, so you're on
the right tract.

Can you tell us why you were orginally tested for HSV2?

Best Wishes!!!!

[life_is...]

why i got tested? bec. one time I was surfing in the internet & I read about this person that he has a herpes & he's looking for the right girl to accept him. It was intrigue me, about what is herpes all about. So i research...then i read that look a like pimple, I was so shock! bec. I had those time, I think I experienced 3 times. So when we went to OB but no bump or sore anymore & until now. She prescribed me anti-viral but I didn't take it. Its bec. I cannot accept the reality. I think mine is not 17170x but it was herpeselect(quest diagnostic). I was surprised.. I had 1 BF before i get married but we never had sexual intercourse. Yeah, I research diff. sites that's why I got tested for biokit which is negative and I do have already a tube for western blot but still looking for provider who take my blood. I will do this, to know the reality not to live for decades knowing that i have this, what if I'm not infected.. that can be awful for me. Gosh, I'm going crazy, I have anxiety, fears, depression & suffers other illness, sickness & diseases bec. of too much stress. I surrender my whole life to God. He is the only one Who can decide for my life ever since, now & forever.

[t1234]

I think any Medical Lab will do a draw.

But I think you will find you don't have herpes.

I wouldn't believe everthing I read on the net especially
about "bumps" or "pimples" being herpes.  If everyone who had bumps or pimples charged down and got tested for Herpes, it would overwhelm the health care system. Herpes symptoms
are ulcerated sores (blisters).

Good Luck and God Bless!!!!

[life_is...]

Thanks to all! now i understand that there are diff. kind of codes about herpeselect. Thank you so much to confused_again & t1234. May God Bless you... Happy New Year!

[Confused_again]

An Update---I did the HSV-2 Inhibition test and it came back Negative..So I will accept the fact that all my previous positives were false-positives..Thank you doctor HHH for all your advice and help..This site is really helpful!