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Possible HSV-2 False Positive?
Hi,
I recently had a type specific antibody test for HSV types 1 and 2. The results came back as follows.
HSV IgG Type 1 - 2.75
HSV IgG Type 2 - 3.15
HSV IgM - negative
What is the probability this is a false positive for the HSV-2? I had another test a few weeks before and it was negative for both, which is odd, since I have thought I had type 1 since I was a child. Can HSV-1 at this level be causing a false positive for HSV-2? I am obviously going to get the Biokit test done when I can find one, but was hopeful and praying that my odds are good this is a false positive. Anything under 3.5 is suspect correct? Especially since HSV-1 is present? What are my odds? Is this 50:50, or worse? The test was performed by Doctors Laboratory/Sekot Laboratory. I am assuming it was a EIA test. Any input is appreciated.
I recently had a type specific antibody test for HSV types 1 and 2. The results came back as follows.
HSV IgG Type 1 - 2.75
HSV IgG Type 2 - 3.15
HSV IgM - negative
What is the probability this is a false positive for the HSV-2? I had another test a few weeks before and it was negative for both, which is odd, since I have thought I had type 1 since I was a child. Can HSV-1 at this level be causing a false positive for HSV-2? I am obviously going to get the Biokit test done when I can find one, but was hopeful and praying that my odds are good this is a false positive. Anything under 3.5 is suspect correct? Especially since HSV-1 is present? What are my odds? Is this 50:50, or worse? The test was performed by Doctors Laboratory/Sekot Laboratory. I am assuming it was a EIA test. Any input is appreciated.
MEDICAL PROFESSIONAL
Interesting results. I'm a little surprised by the WB result, but I agree with your own physician and the others you cite. So congratulations: you do not have HSV-2. If new concerns about genital herpes arise in the future, I suggest you stay away from the ELISA tests and rely on Biokit and/or Western blot.
Western Blot Results in from University of Washington.
HSV Type 1 - Positive
HSV Type 2 - Negative
I also took a biokit again, and it was negative.
My GP plus another physician and two Ph.D.s, one a microbiologist, another an immunologist all say that they view this as certainly negative.
My sexual history seems to lead to the same conclusion. My ex of 5 years is negative, as is everyone else I have slept with since we split in january. (I got them all to go get tested).
Final thoughts?
HSV Type 1 - Positive
HSV Type 2 - Negative
I also took a biokit again, and it was negative.
My GP plus another physician and two Ph.D.s, one a microbiologist, another an immunologist all say that they view this as certainly negative.
My sexual history seems to lead to the same conclusion. My ex of 5 years is negative, as is everyone else I have slept with since we split in january. (I got them all to go get tested).
Final thoughts?
MEDICAL PROFESSIONAL
These results are unequivocally positive for both HSV-1 and HSV-2. Had this been your only test, I would have concluded for sure you are infected with both viruses. The same conclusion is warranted for the re-run test, i.e. the 3.92 value. These results ARE the IgG test outcomes. (HerpeSelect is an IgG test.) That you have had no symptoms doesn't influence me at all; most HSV infections are completely asymptomatic.
However, given the discrepant results -- some positive, some negative including the BiokitUSA test -- at this point you definitely should have a Western blot test. Most likely it will confirm positive results for both viruses, but I would not make a definite diagnosis until and unless confirmed by WB.
Let me know when you have a WB result and I will have some final comments at that time. In the meantime, you should assume you have genital HSV-2, with the potential for transmission to sex partners, despite the absence of symptoms.
However, given the discrepant results -- some positive, some negative including the BiokitUSA test -- at this point you definitely should have a Western blot test. Most likely it will confirm positive results for both viruses, but I would not make a definite diagnosis until and unless confirmed by WB.
Let me know when you have a WB result and I will have some final comments at that time. In the meantime, you should assume you have genital HSV-2, with the potential for transmission to sex partners, despite the absence of symptoms.
I guess I should specify what similar results on the retest meant. When they retested the sera from the first test (the one with a 3.15) they got a 3.92.
Could the fact that the Herpeselect ELISA uses recombinant antigens and the biokit uses lectin purified antigens have anything to do with the disparity?
Ok.
So I got a retest on the first sera, and results were similar. I sent in a second blood sample monday. I talked to the lab today.
Results are:
HSV-1 - 2.93
HSV-2 - 4.51
Now for some history I should probably include. I was in a monogamous relationship for 5 years until the first of this year. My ex tested negative for both back in August, and we have been seeing each other again for the past 6 weeks. She went and had an type 1 and 2 IGG drawn today, and had a biokit test. The biokit test was negative, and we are waiting on the results of the IGG. I have had two possible risks since the start of this year. One person I was dating, and another was someone I saw casually and the condom broke. I have asked both of them to get tested and will see what the results are. My GP still seems to think the ELISA is giving a false positive since I have been asymptomatic my entire life, and my ex is negative after 6 weeks of unprotected sex.
So I got a retest on the first sera, and results were similar. I sent in a second blood sample monday. I talked to the lab today.
Results are:
HSV-1 - 2.93
HSV-2 - 4.51
Now for some history I should probably include. I was in a monogamous relationship for 5 years until the first of this year. My ex tested negative for both back in August, and we have been seeing each other again for the past 6 weeks. She went and had an type 1 and 2 IGG drawn today, and had a biokit test. The biokit test was negative, and we are waiting on the results of the IGG. I have had two possible risks since the start of this year. One person I was dating, and another was someone I saw casually and the condom broke. I have asked both of them to get tested and will see what the results are. My GP still seems to think the ELISA is giving a false positive since I have been asymptomatic my entire life, and my ex is negative after 6 weeks of unprotected sex.
MEDICAL PROFESSIONAL
I'm not going to speculate on "what if" questions. Just let me know the new ELISA result and we'll go from there.
I have ordered another ELISA. That should be in on Wednesday. My GP said he would consider the biokit reliable for a negative result though considering I have always been asymptotic. The doctor at the clinic said the he would go with the biokit result also. Any more thoughts? What if the Elisa comes back greater than 1.0?
MEDICAL PROFESSIONAL
I would have preferred a WB, but this result strongly suggests your earlier ELISA was the correct one and the more recent one unreliable, i.e. that you don't have HSV-2 (and probably not HSV-1, although that's a little less clear).
For an update...
Went to my university health center and took the hsv-2 rapid test. Results were negative. Hope this post helps someone else also. Thanks HHH
Went to my university health center and took the hsv-2 rapid test. Results were negative. Hope this post helps someone else also. Thanks HHH
The biokitusa hsv-2 rapid test might be easier to find and quicker. Isn't this just as good as a western blot?
MEDICAL PROFESSIONAL
See above. I agree with your primary care doc's uncertainty about these results.
MEDICAL PROFESSIONAL
Welcome to the STD forum.
Reacting first to the follow-up comment below: If you indeed had a completely negative HSV blood test only around 6 weeks ago, I agree it would be wise for you to be retested. Going from completely negative to positive results (for both HSV-1 and -2) in 6 weeks, without any symptoms, is atypical and raises a reasonable possibility your current results are false. (The IgM results don't factor in at all. That test is inherently unreliable and pretty much meaningless.)
If the results are similar on retesting, I would conclude you are certainly infected with HSV-1 (as is half the population, i.e. no big deal) and probably with HSV-2 as well. Your question suggests you understand that being HSV-1 positive increases the chance your HSV-2 result is false. (That's the result of only one research study, and not all experts agree about it.) But regardless of the HSV-1 result, an HSV-2 ELISA ratio over 3.0 strongly suggests (over 80% chance) you are infected with HSV-2.
What to do now? Repeat the test. You could also talk to your doctor about doing an HSV Western blot test, in addition to repeating the ELISA. (ELISA and EIA are the same thing, by the way.) Ask your doc to tell the lab to skip the IgM test. Feel free to return here with a follow-up comment to report the results of all this.
Good luck-- HHH, MD
Reacting first to the follow-up comment below: If you indeed had a completely negative HSV blood test only around 6 weeks ago, I agree it would be wise for you to be retested. Going from completely negative to positive results (for both HSV-1 and -2) in 6 weeks, without any symptoms, is atypical and raises a reasonable possibility your current results are false. (The IgM results don't factor in at all. That test is inherently unreliable and pretty much meaningless.)
If the results are similar on retesting, I would conclude you are certainly infected with HSV-1 (as is half the population, i.e. no big deal) and probably with HSV-2 as well. Your question suggests you understand that being HSV-1 positive increases the chance your HSV-2 result is false. (That's the result of only one research study, and not all experts agree about it.) But regardless of the HSV-1 result, an HSV-2 ELISA ratio over 3.0 strongly suggests (over 80% chance) you are infected with HSV-2.
What to do now? Repeat the test. You could also talk to your doctor about doing an HSV Western blot test, in addition to repeating the ELISA. (ELISA and EIA are the same thing, by the way.) Ask your doc to tell the lab to skip the IgM test. Feel free to return here with a follow-up comment to report the results of all this.
Good luck-- HHH, MD
I should follow up by saying that my primary care physician said he was suspect of these results as the one about a month and a half ago was negative, the IgM this time and last was negative, and I have never had any symptoms or an outbreak for HSV-2 in my life.
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