PLEASE HELP! "Equivocal" Herpes result? In Disbelief

[mks06]

Hi Doctor---thanks for the incredible service you provide.  It is an incredible service.  I desperately need your advice here..freaking out to be honest--I just rec'd my results from a standard STD check-up.  All the standard stuff was tested (i.e. Gon, Chlamydia, Hep, HIV, Syphilis, Herpes) from an online testing source. (they used LabCorp).  Everything came back negative with the exception of Herpes...the results were: HSV-1 aB IgG at 1.27 H Positive; HSV-2 aBIgG at 1.02 Equivocal.  The testing service said that I was positive for Type 1 and equivocal for Type 2 (basically, not negative or positive).  This is what is confusing me:

-I was tested Feb of 07 and had negative results to everything.  I have never had a cold sore or outbreak of any kind, and do not engage in risky behavior.  (but, there has been some hand/genital contact that I've read your position on and taken confidence)  Again, my sexual contact has been minimal to none.  The testing service encouraged me to get retested in 1 month to see if the Type 2 antibodies go up or down.  

I'm in disbelief here about both Type 1 and Type 2 results.  I know that alot of people have Type 1 but how could I go 30+ years of my life negative (by last years results) and positive for Type 1 this year?  And, I don't know how to interpret the Type 2 results.  I'm scared that I'm going to be examining myself for any sort of red blotch for the next 30 days.  Do you think I should get retested?  Am I in jeopardy of passing this on?  I'm positive that I have never kissed anyone with a blatant cold sore and I haven't had contact with someone where Genital herpes makes sense.  I'm baffled and confused.  Can you weigh in on your viewpoint with these test results and what you would do??  Thanks much.

[H. Hunter Handsfield, M.D.]

Relax. You don't have HSV-2.  Your result might be technically equivocal, but an ELISA ratio of 1.02 is negative for all practical purposes.  All results under 3.5 are suspect, and the closer to 1.0, the more likely the result is false.  You might or might not have HSV-1, but even that is such a low level that it might be false, especially since earlier testing was negative.  (Less is known about low-positive HSV-1 results than about HSV-2, so it is harder to be certain.)

There is an important lesson here for you and for all forum users, especially the anxious types who are likely to seek reassurance when none is needed.  For all laboratory tests that exist, for every medical condition, the lower the risk that the disease is present, the higher the chance the test will give falsely positive results.  Therefore, testing when there is little or no risk often causes more harm than good, exactly as in your case.  This doesn't apply only to herpes.  For example, there is an ongoing debate about routine testing of men for prostate specific antigen (PSA), a marker for prostate cancer.  Also, many times on the HIV forum, Dr. Hook and I have advised people at low risk not to have PCR tests to detect HIV DNA after a low-risk exposure, because in that circumstance most positive results are false.

In other words, in general it is a mistake to be tested for herpes unless there is significant risk for herpes.  Since you are not at signficiant risk ("I have never had a cold sore or outbreak of any kind, and do not engage in risky behavior"), you should never be tested for HSV again, unless your risk profile changes.  (As you seem to know, the hand-genital exposure is meaningless.)

There are a few exceptions, which is why I said "in general" above.  The HIV antibody tests are so good that they are useful even in very low risk situations.  But partly that is because all positives are confirmed with a second test (Western blot), before the initial result is even told to the patient.  If HIV WB didn't exist, we would have the same problem with HIV testing as you have had with the HSV test.

Bottom line:  You don't have HSV-2. You may or may not have HSV-1, but that doesn't matter; if so, you probably caught it in childhood and will never have a problem -- just like half the US population and 90% of people in some countries.

Best wishes--  HHH, MD

[mks06]

Your response is a HUGE relief.  I left work early, had a mental breakdown in the parking lot, and yes, think I almost had a stroke worrying about this.  I really don't want to go through this worry again and think about it over the next 30 days, and the only reason I was tested for Herpes was that it was part of the standard panel that the online service used.  THANK YOU, THANK YOU, THANK YOU...I'm going to try to put this behind me now....thanks for all you do and your knowledge you share.

[H. Hunter Handsfield, M.D.]

You raise another issue for other forum users, especially (again) the worried-well:  It is generally a mistake to use online testing services. By seeing a provider, people can be told the sort of information I already provided about risk, which tests to have and which to disregard, etc.  You probably spent $400 or more for a battery of tests that you mostly didn't need (maybe none), instead of $75 for an office visit to inform you of the fact.

Everybody please stay away from online or phone-book STD testing options.

[mks06]

Hopefully, you will still get this.  I have a quick follow-up question from yesterday.  There is a local STD clinic in Los Angeles here that specializes in all the latest testing with a reputable doctor that you have to see.  They told me that they can do a specific Herpes Type II test (I can't remember the name, but I believe it is the same one done at University of WA..that is what their website says..they said it is much better than the Herpes Select test) that doesn't look at just numbers---it clearly indicates if you are positive or negative as early as 4 days post exposure.  They have a lab onsite and results are available in 10 minutes.  It is expensive for this one test---$295.  But, it would end this saga for me once and for all.  I value your comments here even though I think I know what you are going to say.......thanks so much again.

[H. Hunter Handsfield, M.D.]

They are referring to the HSV Western blot test.  The specimen probably will go to the Unviersity of Washington lab -- the place where the HSV WB test was developed, and the main lab that offers the service on a regular basis.

Personally, I think it is a waste of money.  There is no realistic possibility you have HSV-2 (and probably not HSV-1).  You don't need to spend almost $300 to learn that. But it's your money and your choice.

I won't have any further comments or advice.

[mks06]

Well--guess what?  You were right Dr. HHH as usual.  Admittedly, your words were extremely reassuring but my mind went in overdrive with worry.  I went to a  clinic this afternoon and they ran the biokit HSV-2 Rapid Test.  The doctor (who specialized in all types of STDs) was not a fan of online testing services like you and also did not like the Herpes Select test due to the confusion with the numbers.  As you knew oh so well--my Rapid test was negative for Type II.  He also said I do not need any further HSV testing in the future unless I have sores that appear.  Ahhhhh--we live and learn Dr. HHH----all I can say is that you were (and have always been from what I've read) right on the mark.  My apologies for any second guessing here.  Have a great weekend and thanks again for all you do.

[H. Hunter Handsfield, M.D.]

I should have remembered to say that in addition to Western blot, people with equivocal HerpeSelect HSV-2 results can have another commercial type-specific HSV antibody test, such as the BiokitUSA rapid test (which is what you had) or the Trinity Biotech Captia (R) test (in the US) or the Kalon HSV-2 test (in the UK and elsewhere).  The available research indicates that these tests are excellent tie-breakers when HerpeSelect is uncertain.

[learning_informing]

I am a little confused about this statment, "All results under 3.5 are suspect, and the closer to 1.0, the more likely the result is false.  You might or might not have HSV-1, but even that is such a low level that it might be false, especially since earlier testing was negative."  I was informed that anything 1.09 or above is positive; for genital herpes.  Can you please clarify.

[H. Hunter Handsfield, M.D.]

The answers are available on any of a hundred or so other threads on this forum -- or start a new thread of your own.