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Interpretation of HSV Testing Results
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Interpretation of HSV Testing Results

Need help interpreting HSV testing results.

Testing timeline:  

1)  HSV 1-2 IGG Herpeselect AB  (9/4/12) and UW Western Blot (10/24/12)
2)  HSV 1-2 IGG Herpeselect AB  (1/21/13) and UW Western Blot (1/21/13)

I have had no symptoms to this date.  I had general std testing done on 9/4/12.  My IGG test results were negative for HSV-1, but positive for HSV-2 (index value 2.48).  I later determined that this score was in the "gray zone" and perhaps false negative (though less likely so, given that I apparently had no HSV-1 antibodies to confuse the issue).  I then had WB testing done on 10/24/12.  Result:  "Indeterminate for HSV."

I then allotted a few months for full antibody profiles to develop, in case of recent contraction, and ran both tests again on 1/21/13.  This time, my IGG response to HSV-1 was still negative, but my index value for HSV-2 had risen to 3.62.  My second WB test was actually a seroconversion panel, specifically meant to isolate differences between my first and second samples.  This time, my WB results said positive for HSV-1 and indeterminate for HSV-2, for both samples, "no change in antibody status" (interesting, because they mentioned no HSV-1 positivity the first time around).

The very last point of possible infection would have been around August 28,2012, putting about 20 wks, 6 days between time of infection and the most recent "indeterminate" WB.  However, I know for a fact that the person whom I had sex with on this date has tested negative for HSV-2, so we are looking at about 9 months between the last real possible point of infection and this most recent indeterminate western blot.

How should I interpret these results?  My IGG value is now out of the gray range, but my Western Blot remains indeterminate, and should have seroconverted by now, if positive.  WB results indicate HSV-1 positivity, so perhaps this really is a confounding factor on IGG test. Thoughts?
Tags: HSV-1, HSV-2, Herpes, western blot, IGG Herpeselect, igg
239123_tn?1267651214
Welcome to the forum.  Your question has many parallels with another thread over the past couple of days.  My replies to your specific questions will be succinct, rather than repeating much of what was said there:

http://www.medhelp.org/posts/STDs/HSV-diagnostics-pitfall/show/1896434

Your test results are atypical, and considered in a vacuum -- i.e. without considering exposure, symptoms, etc -- come to a substantial likelihood, but not proof, that you have HSV-2, probably acquired recently, i.e. that you are seroconverting.  If so, still another round of testing, including another Western blot, should show a definitely positive HSV-2 result.  It is true that people with HSV-1 antibody have higher rates of false positive HSV-2 results, but that usually results in lower ("gray zone") ELISA ratio values, and WB usually still gives clear results.

But when we factor in your sexual history, my judgment is more like 50:50 that you really have HSV-2.  I suppose it is possible your most recent partner had a false negative HSV-2 serology.  Still, most people with new infections develop at least some symptoms, however mild or atypical -- and people who are particularly anxious about having acquired herpes (as the tone of your question suggests you were) probably are especially likely to notice mild symptoms.  Thus, your apparent lack of symptoms argues (softly) against a new HSV infection.

Unfortunately, I have no easy answers for working this out.  Most important, if you are not under the care of an infectious diseases specialist or other physician with particular expertise in herpes infections, I would advise you to seek such care and follow that person's advice.  A couple of options might be to seek still other blood testing, including the experimental assay being worked on by researchers in Illinois; or PCR testing, but that can be tedious and very expensive, and I'm not sure it's worth the trouble and cost (insurance would probably consider both of these as research procedures and not pay for them).  See the other thread for more information about these options.

Sorry I can't give you a clearer answer, but I hope these comments are helpful.

HHH, MD
3 Comments
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Hi Doctor Handsfield,

Thanks for the quick response.  I will look into finding an infectious disease specialist in the area.  I never imagined it would be so hard to get a definitive answer for this question.

Would you recommend I have a biokit test done?  If so, how much weight should I put on those results relative to the results I already have?
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239123_tn?1267651214
It couldn't hurt.  A negative result would lean me away from HSV-2; a positive one wouldn't make much difference in my assessment.

Your situation presents yet another cautionary tale against HSV blood testing when the risk and likelihood of herpes are low.
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