Inhibition Test Results - - Confusion

Doctor,

I asked you last month about my Herpeselect results :


Test # 1 :
HSV-1 ----Greater than 5.0
HSV-2 ---- 1.36

Test # 2 :
HSV-1 ---- 6.12
HSV-2 ---- 0.99 (Equivocal)

Test # 3 ( 8 months later) :
HSV-1 ---- Greater than 5.0
HSV-2 -- 1.13

You said that you suspected that I didn't have HSV-2, and I should get the inhibition test..Well I went to an ifectious deaseases doctor, and told her to order the inhibition test (17170x with Quest diagnostics)..She didn't really know what I was talking about, but gave me the prescription anyways..I got a copy of my lab results today and it says:

HSV 2 IGG HERPESELECT AB ----- 1.00 Index

Reference range :  <0.90 Negative
                  .90 - 1.10 Equivocal
                  >1.10 Positive

1- This looks to me like an HSV-2 Herpeselect test, or does the inhibition test shows results in a similar manner?
2- If this is indeed an inhibition test, how come my results for HSV-2 is equivocal?
3- If they did the wrong test, can I call the lab directly because my doctor is not very helpful.
4- Do you recommend that I get tested again? Or shall I just continue with my life thinking that I'm HSV-2 free due my consistent equivocal or low-positive results.

Thank you very much!

[H. Hunter Handsfield, M.D.]

With apology (and hope I didn't mislead you), I do not keep track of which labs do which HSV blood tests and certainly not their test codes.  The inhibition assay has been used by Focus and some of its investigators, and it provided information that led to the recent reformulation of the HerpeSelect test to reduce the proportion of results in the gray zone between 1.0 and 3.5.  But it may not be offered commercially.

1) The results you provide are typical for a standard HerpeSelect test.

2) Most likely you are truly HSV-2 negative and can be confident you don't have genital herpes.

3) I cannot speak for the lab or your doctor's office.

4) See no. 2.  If you want to pursue further testing, you could ask your doc or lab to send a specimen to a reference laboratory, such as University of Washington, where an inhibition test and/or Western blot might be done.  Or ask them to send it to the manufacturer (Focus) with the history of all your test results.  At one time Focus was doing such testing for no cost to sort out equivocal results; but I cannot speak for them and do not know if they still do it.

Good luck-- HHH, MD

[Confused_again]

Update:

I just called the lab, and they stated that the test done was indeed 17170X...When I asked about the name, the lady said it's called HSV 2 IGG Test..She didn't mention anything about Inhibition. Did I give the wrong code number?

[t1234]

I would go ahead and get a Western Blot which will be
definitive with no further confusion.

In your case getting repeatedly tested with a HerpesSelect
is just throwing money down a "rat hole."

[moet]

and how do you get a western blot test? Thanks

[H. Hunter Handsfield, M.D.]

Most labs, but perhaps not all, will know one or more reference laboratories that can do it; the doc requests something like "confimatory HSV serology by Western blot" and the lab will forward it on to an appropriate lab.  Alternatively, the doc can specifically request the local lab forward the specimen to the University of Washington Clinical Laboratory, rather than accepting the initial lab's judgment about where to send it.  The HSV Western blot was developed at UW 20+ years ago, and investigators there, led by Dr. Rhoda Ashley Morrow, are the world's "go to" experts for resolution of confusing HSV blood test results; they wrote the book, literally. The cost of WB at the UW lab was around $150 last time I checked; the local lab's handling fee and perhaps a blood draw fee by the PMD's office will be added, so look for a total cost in the $200-250 range.

HHH, MD

[Confused_again]

www.stdweb.com offers it..It's pricey though!

[moet]

thanks...worth the money to find out once and for all!!