HSV2 IgG POS

[orientatedx3]

Greetings and thanks in advance for your time and expertise.  

I am a fem with ITP 2nd to SLE.  I have not been on steroids in 7 yrs, maintained on IVIG. Asymptomatic except for heart and platelet involvement.

With the exception of a pretested 6 month long monogamous stint in 2006, I have not had unprotected sex or unprotected genital to genital contact in 9 years.  I did on 7/11 and 7/13 have protected vaginal sex and unprotected oral sex (swallowed).  On July 17th I went to my gyno due to vaginal irritation and burning. She examined, cultured and sent me home. 7/19 I returned w/severe itching/burning and odor. I also had  a sore throat and ulcers on my gums. Vag. culture was + for  gardinella and some yeast so I was prescribed Flagyl.  I completed the 5 day course of Flagyl, and went to my internist on 7/29 due to my throat feeling worse, my gums hurting and several gum ulcers.  At that time I insisted I be tested for all STDS.  She did a very thorough genital and mouth exam and felt that I was coming down with a virus.

Returned to internist today, throat worse, and I seem to have thrush. She declared it viral. Vaginal symptoms remitted 1 wk ago.  Test results were given, all neg with the exception of HSV-I POS (Ab, IgG, Type Spec) at 4.38, (which I already knew) and the HSV 2 IgG Type Spec coming back pos also with a count of 2.05 (neg 1.09).

My questions to you (please) are these.... My internist feels that the infection would be older than several weeks due to the IgG +, and said that in early infections only IgM is spiked. Is this true, or are my symptoms aligned with a new infection? Would my autoimmune disorder possibly cause the IgG to test higher earlier? I am simply trying to figure out how long I've had this infection, and who needs to be told, given my proclivity for having only condom protected sex, having very sporadic sex (3-4 per yr) and with the exception of early July, not having completed oral sex.

[Edward W Hook, MD]

At this time I'm afraid you know more about HSV testing than your doctor.  This is a result of your intense study of the matter.  Many doctors assume lab tests are black or white and that issues such as false positves are not a problem.  Sadly that is not the case.  The Reference I use on this matter is by Morrow, R et al in BMC Infectious Diseases, Volume 4 starting on page 84 (2005).  It indicates that 50% of persons with HSV-2 IgG assays positve in the range of 2.0 to 2.5 are falsely positve, usually because of cross reactive HSV-1 antibodies which "confuse" the test.  EWH

[Edward W Hook, MD]

If the IVIG you receive contains HSV antibodies, the Biokit and Western blot will detect them as well as other type-specific tests.  I think your strategy of waiting to test until just before your next infusion is a good one but there could still be residual antibodies present (don't know for sure though, would discuss with your doctors).  A partial answer might be to get a test right after an infusion and just before the next one; if the strenght of the result is declining, I would think that that would be good evidence that the test results reflect antibodies in your therapeutic infusions, not infection.  

I think the likelyhood of infection on your part is sufficnetly low that I do not see a need for mentioning this to your prior partners.  EWH

[Edward W Hook, MD]

Your SLE and the therapy for it make your situation a bit unique and complex.  To cut straight to the chase, I doubt very much that you have HSV-2 and suspect that your recent illness is, as your doctor has suggested, due to a non-STD virus of some sort.

Indeed, many HSV-2 IgGs in the 2.05 range are false positive, particularly since you already have HSV-1 which can cross react in the test. I will bet that is the case.

There is one more complicating factor which I need to mention however.  Your SLE/ITP is treated with regular infusions of other people's antibodies  (IVIG is intravenous IgG).  This is manufactured from the collection of antibodies form others which are then pooled and used for therapy.  I would not be surprised if some of the donors from whom your IgG is collected have antibodies to HSV-2, giving you a 2nd reason to have a false positive type specific IgG when you were tested.  I am by no means a specialist in the contect of IVIG but I will be that sometime when you are dosed with it, you get some antibodies to HSV as part of the deal.  This would give you a false positive result too (and you cannot get HSV from commercially prepared IVIG.

Hope this comment is helpful to you.  It is most unlikely that you have HSV-2.  EWH

[orientatedx3]

Sorry to bother again. If you could clarify please, what is the rate of false positive on the Focus Select HSV-2 test with a + of 2.05 (and a + of over 4 on HSV-1)?

I just provided the internist who diagnosed me via the blood test with the information I gathered here, via Gammunex, and from the two studies I found ("Use of Biokit to improve the positive predictive value of Focus HerpesSelect HSV-2 Elisa," and "HSV type 2 Western Blot confirmatory testing among men testing positive for HSV-2 using Focus Enzyme assay in a sexually transmitted disease clinic,") and she basically continues to assert that I am positive for HSV2 and should inform my old and recent partners or risk having them spread it unknowingly in the meantime while I try to sort it out. She is willing to do serial Focus Select testing, or additional testing in order to confirm my diagnosis but maintains that she sees many women who have never had outbreaks and who report they've not engaged in risky sexual behavior who are positive for HSV via the Focus test as per her Labcorp ranges (>1.09) which...yeah... I kind of got the "I know it's difficult to deal with a new diagnosis, but you tested positive and need to warn everyone you've ever been with, now." speech.

Help? Stats please on the specifics of the false positive at that range? Or studies where I might find them.

[Edward W Hook, MD]

thanks for your question and follow-up.  I learned something too.  Take care.  EWH

[orientatedx3]

Spoke to both the pharmacist at the makers of Gammunex and my hematologist. Pharmacist response was that HSV is not one of the antibodies that they screen for in production and therefore may be present. Hematologist stated that the IVIG infusions can give low positives on ELISA type IgG testing in any number of diseases and that they only way to get a clean test would be to cease IVIG for an extended period, which of course is out of the question. He also said that I might wish to get retested next month and that if the titers were at that time significantly higher, that might be indicative of a recent infection.

You were correct though, Gammunex is probably the best/cleanest IVIG product out there and it is not screened for either type of HSV. The company took my test results as an "adverse reaction" report.

Thanks for your time!

[orientatedx3]

I am so relieved that there really are no words...so I'll just say thank you again.

To be sure, should I be retested using the biokit or Western Blot, or would those results also possibly be skewed?  If affirmative, should I wait or is 3-4 weeks from last exposure to anyone enough and perhaps time the test so that it's right before my IVIG infusion rather than right after as the last one was? Is there some way to parse this out to know for certain that I don't have it.

Also, I am not in an ongoing relationship or contact with the person I was last with ...but I do know that he is sexually active with several partners.  Do I have an ethical responsibility to at least warn him of the possibility, or would it simply be spreading hysteria?

Thank you again. You have no idea how much you have eased my mind.

[orientatedx3]

I'm now reading the forum...is a HSV2 IgG test result of 2.05 possibly a false positive, given that my HSV1 IgG is 4.38? Also, since my ex-husband was tested in early 2002 and was negative at the time - and I've only had protected sex with the exception of the guy in 2006 who was tested at the time...could this whole horrendous ordeal be NOTHING? I've never had any vaginal lesions, only ever cold sores on my mouth since a kid.  I had a one night stand (protected) in 2006 with an acquaintance that confessed the following day he was HSV2+, and ran to my gyno the next week and made her thoroughly exam me, she found nothing.

Do I wait and get retested with something more accurate? If so, when? And do I need to tell the person I was with this month that he may have exposed me or I him prior to getting that test done? Thanks again. I'll just sit over here quietly having a panic attack and await response. Sorry to pester. Really...I'm not one of those people who *wants* an STD...I would send give the SLE and ITP away if I could.