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Low positive for HSV-2 - some questions
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The STD Forum 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.

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Low positive for HSV-2 - some questions

Results:
HSV-1 aB IgG: < 0.90
HSV-2 aB IgG: 1.17 H

Test:
Test was through tSTD, which claims to use HerpeSelect ELISA.  Blood draw and test performed at Labcorp, which informed me the test ordered by tSTD's doctor was test #164905, which a little googling shows to be HerpeSelect.  However, further searching reveals Labcorp has switched to Captia as their default test.  But since my tSTD doctor ordered test #164905, it means I've had the HerpeSelect, correct?  Unless Labcorp adopted Captia and used the same test # for it, instead of assigning it a new test #.  I'm not sure which test I got and if it makes a difference in interpreting my result.

Symptoms:
I'm a hetero male, and have been asymptomatic in both the genital and oral areas, as far as I can recall/tell.  

Timeline (since this low positive could be indicative of a recent infection):
5/12/2009 - test performed 12 weeks after last potential exposure
Partner #1: Two instances of protected (condom) intercourse, last occurring 2/14/2009
Partner #2: Many instances of unprotected intercourse b/w Nov-2008 - early Feb-2009
Partner #3: One instance of protected (condom) intercourse Oct-2008
Partner #4: Two instances of protected (condom) intercourse summer 2008

Prior testing:
In 2005, I had IgG tests (not sure which mfr.) for HSV-1 and HSV-2: both negative at <0.90.  Between then and the timeline above, I've had many partners, and used condoms with all, except for one long-term partner where we engaged in unprotected sex, ending in 2007.

Questions:
1. What does the H next to the HSV-2 result mean?
2. After much (perhaps too much) online research, I am planning on finding someone to administer a Biokit HSV-2 test.  Is this a sensible course of action?  Should I take it now or wait for 16 weeks after last potential exposure?
3. Should I contact recent partners or wait for confirmatory test?
4. Is it safe to assume that if this is a true positive, that it's a recent infection, occurring within the timeline above?
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239123_tn?1267651214
Welcome to the STD forum.

As you seem to know, based on some of your questions, many low-positive HSV-2 antibody results (especially with the Focus HerpeSelect test) are falsely positive.  Among people with ELISA ratio around 1.17, under half actually have HSV-2.  Your sexual lifestyle suggests low risk for HSV-2 -- essentially no risk for partners 1, 3 and 4 (all exposures condom protected); partner 2 unknown, since you did not use condoms and presumably do not know her HSV-2 status.   If you have no symptoms of genital herpes and partner 2 isn't known to have genital herpes, I would have recommended against HSV-2 testing.

Also, as a general principle, I strongly recommend against tSTD or any other online testing service.  If experience from questions on this forum is any guide, 90% of the testing done is unnecessary and would not have been recommended by a knowledgeable STD provider.

I haven't a clue what service codes apply to which tests.  If tSTD uses Labcorp, I suggest you contact one of those two institutions to clarify the test done.  But most likely it doesn't make much difference.  Although there is less research on low-positive Captia results compared with HerpeSelect, they appear to behave similarly.  However, the replies that follow refer specifically to HS, not Captia.

1) H means high, i.e. above the nominal cut-off for a positive test.

2) The BiokitUSA test is one of the recommended ones to confirm or refute a low-positive test.  You can do it at any time.  If the Biokit result is negative, as I expect, you can be confident you do not have HSV-2.

3) No. 2 is the only partner from whom you were likely to have caught HSV-2.  Once you became concerned about herpes, it would have been smart to contact her then, rather than testing first.  But at this point, I suggest waiting for the Biokit result.  If that's negative, you need not contact anybody.

4) If Biokit is positive, you caught HSV-2 sometime since the definitely negative test result in 2005.  In that event, partner 2 would be a logical possibility.

Feel free to return to post your BiokitUSA result.  As indicated above, most likely it will be negative.

Next time you get the urge for STD testing, visit your local health department STD clinic and get professional advice.  And probably save $200 or more in the bargain.

Regards--  HHH, MD
8 Comments
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Avatar_m_tn
Thanks Dr. Handsfield.  Your response has put an end to my obsessive research since receiving the positive result.

One thing I was implicitly driving at, but didn't directly ask is this:
I described my sexual contact during 2008-2009 in detail .  Since I know was HSV negative in 2005, what are the odds that I picked up HSV-2 during 2005-2007, and am showing an HSV-2 IgG result of 1.17?

Part of my motivation for asking the question is if the odds are extremely low, that would increase the likelihood that partner #2 is the source of the infection, if in fact there is an infection.  I know she was tested after her relationship prior to me, but not sure how soon afterward (i.e., if it was more than 3mo. after) or if the tests included HSV.  I could make one phone call to her and find out.  Obviously the trade-off is  potentially alarming her between now and whenever I can get in for the Biokit test.

And yes, in some ways, I regret having taken this test!
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239123_tn?1267651214
"What are the odds that I picked up HSV-2 during 2005-2007...?"  I answered that.  It's very unlikely you have acquired HSV-2 at any time. Most likely your 1.17 result is falsely positive.

You're over-thinking the whole thing.  Just await your Biokit result.  It will be negative.  Then you'll have nothing to worry about and nothing to say to any partner.

As I said above, feel free to post your Biokit result.  Until then I'll have nothing more to say.
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Avatar_m_tn
After further discussion with both LabCorp and tSTD, I've confirmed that the test used was in fact the Captia assay from Trinity Biotech.

Although your responses were specific to HerpeSelect, from the limited info available on Captia on the internet, it appears that it has an even lower specificity than HerpeSelect.

I assume Biokit is still a decent confirmatory test for me (i.e., it isn't using the same antigens that Captia uses)?
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239123_tn?1267651214
There has been no research (at least none published) on Biokit as a confirmatory test for Captia.  I suspect it indeed is "a decent confirmatory test" in this situation, but I cannot say for sure.  However, if I were in your situation, I would have the Biokit and would consider myself home free if the result is negative.
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Avatar_m_tn
Dr. Handsfield,

Biokit test result is negative.

To recap:
2/14/09 - last potential exposure
5/12/09 - 12 weeks - Captia IgG test performed; HSV-2 result: 1.17
6/1/09 - 14 weeks - Biokit: negative. Completely negative, no faint dot so no ambiguity.

A few follow-up questions, if I may:
1. Should I bother re-testing via Biokit at 16+ weeks?  I assume you think WB would be a waste given the facts here.
2. My HSV-1 IgG was negative.  We know HSV-1 IgG false negatives are an issue, and I'm wondering if my HSV-2 IgG false positive opens up the possibility that I am HSV-1 positive, that the HSV-1 test produced a false negative, and that there was some cross reactivity picked up in the HSV-2 test resulting in a false (low) positive.
3. If I test for HSV in the future, a decision I would not take lightly after this experience, should I skip the HerpeSelect and Captia HSV-2 tests, knowing that something in my blood other than HSV-2 antibodies may result in a false positive, and go straight for the Biokit test?

Thanks again for helping see me through this.
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239123_tn?1267651214
Congratulations.  You are not infected with either HSV-1 or HSV-2. You do not need further testing of any kind or at any time. There is no reason to suspect you have a false negative HSV-1 test.

If you have future HSV testing, just have whatever standard test the lab does.  Most people with such low positive results have entirely negative outcomes when retested.
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Avatar_m_tn
OK, thanks again Doc.
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Avatar_m_tn
A related discussion, What does very low HSV-2 IgG mean? was started.
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